bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Gender on General Health-Related Quality of Life in Patients with Chronic Sinusitis
Authors: Baumann Ingo , Blumenstock Gunnar
Published: August 2018

Background

The aim of this study was to evaluate the impact of gender on health-related quality of life (HRQOL) in patients with chronic sinusitis

Methods

A prospectively administered survey was performed. For measuring HRQOL, we used the German versions of the Short Form 36 (SF-36; eight subscales) and the European Quality of Life—5 Dimensions (EQ-5D) (two subscales). For all SF-36 subscales we used norm-based scoring of the general German population.

Results

One hundred twenty-three patients (45 women and 78 men) underwent HRQOL evaluation at baseline (preoperatively) and 3 months after endonasal sinus surgery. Compared with male patients, female patients scored a significantly worse baseline in all SF-36 and one EQ-5D subscales and 3 months later in only one SF-36 subscale. Compared with the norm-based scores, both women's and men's SF-36 scores reached normal levels in seven subscales after 3 months.

Conclusion

Compared with men, women assessed preoperative HRQOL as being worse. Most women's and men's SF-36 subscales reached normal levels at the 3-month follow-up.
An Evaluation of Effect of Pterygopalatine Fossa Injection with Local Anesthetic and Adrenalin in the Control of Nasal Bleeding during Endoscopic Sinus Surgery
Authors: Wormald Peter-John , Athanasiadis Theodore , Rees Guy , Robinson Simon
Published: August 2018

Background

The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery.

Methods

A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation.

Results

At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade.

Conclusion

Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.
Anatomic Measurements for the Endoscopic Modified Lothrop Procedure
Authors: Farhat Firas T. , Figueroa Ramon E. , Kountakis Stilianos E.
Published: August 2018

Background

The aim of this study was to introduce preoperative radiographic frontal recess and sinus anatomic measurements to assist in the selection of patients considered for the modified Lothrop procedure.

Methods

Data were collected from sagittally reconstructed computed tomography (CT) scans of seven cadaver heads. Four anatomic parameters for measurement were defined as follows: (1) thickness of the nasal beak (desirable <10 mm); (2) midsagittal distance from nasal beak to skull base (adding 1 and 2 provides the anterior–posterior (AP) space at the cephalad margin of the frontal recess; desirable, ≥15 mm); (3) accessible dimension (in a parasagittal plane through the frontal ostium; the distance between two lines drawn parallel to the plane of the anterior skull base and perpendicular to the line of the insertion of the nasal endoscope during surgery; the posterior line is drawn at the skull base and the anterior line is drawn at the posterior margin of the nasal beak; the distance between the lines indicates the space available for instrumentation; desirable, >5 mm); (4) AP dimension of each frontal sinus.

Results

The average and the range of each parameter measured were as follows: (1) nasal beak thickness = 8.0 mm (5.0–10.4 mm); (2) nasal beak–skull base = 7.9 mm (2.5–14.1 mm); (3) accessible dimension, 6.1 mm (0.9–9.6 mm); (4) AP diameter of the frontal sinus, 9.7 mm (5.2–14.1 mm). Four specimens were considered candidates for modified Lothrop and three were not.

Conclusion

Preoperative radiographic frontal recess and sinus anatomic measurements may assist in the selection of patients considered for the endoscopic modified Lothrop procedure.
Orbital Volumetric Analysis of Allergic Fungal Sinusitis Patients with Proptosis before and after Endoscopic Sinus Surgery
Authors: Stonebraker Angela Chu , Schlosser Rodney J.
Published: August 2018

Background

The aim of this study was to examine the changes of orbital volumes in allergic fungal sinusitis (AFS) patients with proptosis who undergo endoscopic sinus surgery.

Methods

A retrospective study of operative patients with proptosis due to AFS was performed. Normative data were obtained using patients with chronic sinusitis without orbital involvement. Orbital volume measurements were obtained using digitized images and computer software to calculate volumes (cm3) of outlined regions on 1.3-mm axial computed tomography images. Orbital volumes were measured as total volumes and volumes within the bony orbit. Bony orbits were defined using two techniques: (1) the region posterior to a line from ipsilateral zygoma to contralateral zygoma and (2) the region posterior to a line from zygoma to ipsilateral lacrimal bone. Four affected orbits in three AFS patients with proptosis were evaluated. Twenty-eight unaffected orbits in 14 patients were used as normal comparisons.

Results

Orbital involvement by AFS resulting in proptosis decreased orbital volumes within the bony orbit to a mean of 70% of normal. After successful endoscopic sinus surgery, bony orbital volumes normalize or approach normal ranges to a mean 90% of normal with resolution of clinically apparent proptosis. Total volumes remained stable before and after surgery.

Conclusion

Massive AFS may affect the orbit resulting in proptosis. Spontaneous orbital remodeling with clinical resolution of proptosis and normalization of bony orbital volumes can be seen in AFS patients several months after sinus surgery and aggressive medical treatment. Surgical orbital reconstruction typically is not needed once the sinus disease is adequately addressed.
Endoscopic Management of Sinonasal Tumors: A Preliminary Report
Authors: Poetker David M. , Toohill Robert J. , Loehrl Todd A. , Smith Timothy L.
Published: August 2018

Background

The increased experience with the endoscopic approach to sinonasal inflammatory disease has resulted in the increased use of endoscopes to manage many different sinonasal pathologies.

Methods

A chart review of patients with sinonasal tumors treated with primary endoscopic management, from January, 1993 to November, 2003 was performed.

Results

Forty patients were identified (26 men and 14 women). The mean age was 53.2 years, and the mean follow-up was 31.1 months. For benign tumors, 24 patients were identified with a mean age of 50.7 years, a mean follow-up of 17.5 months, and a recurrence rate of 4.2%. For malignant tumors, 16 patients were identified, with a mean age of 57.3 years, a mean follow-up of 51.5 months, and a recurrence rate of 31.3%. The overall survival rate was 87.5%.

Conclusion

Endoscopic surgical excision of selective sinonasal tumors may be an effective therapeutic modality. In some cases, adjuvant external procedures may be required based on tumor location.
Assessment of Sensory Perceptions and Patient Preference for Intranasal Corticosteroid Sprays in Allergic Rhinitis
Authors: Khanna Puneet , Shah Ashok
Published: August 2018

Background

Long-term intranasal corticosteroid sprays (INCSs), the mainstay of therapy in allergic rhinitis, differ little in efficacy and safety. Compliance to therapy is strongly influenced by patients’ perceptions and preferences. We evaluated the acceptability, based on sensory perceptions, of beclomethasone, budesonide, fluticasone propionate (FP), and mometasone furoate (MF) nasal sprays.

Methods

A single-blind (patient), crossover study was performed; 114 patients with allergic rhinitis, categorized as “sneezers and runners” (group 1) and “blockers” (group 2) were assessed for their sensory perceptions (nasal spray evaluation questionnaire, 14 sensory attributes, and 100-point scale).

Results

Significantly more patients preferred MF because of its less irritation, liking of odor, more moistness, and less aftertaste. FP rated significantly higher odor strength and amount of irritation. Seventy-two (63%) patients were in group 1 and 42 (37%) patients were in group 2. MF was the most preferred drug in both group 1 (40 patients, 56%; p < 0.05) and group 2 (21 patients, 50%). Liking the odor was the strongest attribute that affected choice in group 1 (52 patients, 58%), and strength of aftertaste in group 2 (13 patients, 31%). Significantly more patients in group 1 (55 patients, 76%) could appreciate differences in attributes than in group 2 (27 patients, 64%). Ninety-one (80%) patients predicted a better compliance with their preferred drug.

Conclusion

MF was the most preferred INCS in our patients. This was ascribed to less irritation, odor, and aftertaste along with superior moistness. “Sneezers and runners” appreciated significant differences in INCS. In patients with allergic rhinitis, assessment of sensory perceptions could play a crucial role in promoting compliance with therapy.
Revision Dacryocystorhinostomy: A Comparison of Endoscopic and External Techniques
Authors: Tsirbas Angelo , Davis Garry , Wormald Peter J.
Published: August 2018

Background

Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the ability of the surgeon to achieve good nasal and lacrimal mucosa apposition. This study evaluates the comparative success rates of the external and endoscopic techniques for revision DCR.

Methods

Seventeen consecutive revision endoscopic DCRs (average age, 60.9 years) and 13 revision external DCRs (average age, 65.1years) performed from January 1999 to December 2000 performed by separate surgeons were entered into the study. Patients with functional nasolacrimal and canalicular obstruction were excluded. The average follow-up was 11.1 months for the endoscopic DCR group and 10 months for the external DCR group.

Results

A successful DCR required complete relief of symptoms and an endoscopically determined anatomic patency of the nasolacrimal system. Revision endoscopic DCR surgery was successful in 76.5% of cases (13 of 17 cases) and external DCR surgery was successful in 84.6% (11 of 13 cases). This difference was not statistically significant. (p = 0.64, Fisher exact test with a two-tailed probability).

Conclusion

Revision endoscopic DCR has a success rate of 76.5%, which compares favorably with that of the revision external DCR (84.6%).
Staphylococcal Exotoxins and Nasal Polyposis: Analysis of Systemic and Local Responses
Authors: Tripathi Anju , Kern Robert , Conley David B. , Seiberling Kristin , Klemens Julie C. , Harris Kathleen E. , Suh Lydia , Huang Jie , Grammer Leslie C.
Published: August 2018

Background

Staphylococcal exotoxins have been implicated in the pathogenesis of several chronic inflammatory diseases including atopic dermatitis (AD), asthma, and, most recently, chronic rhinosinusitis with nasal polyposis (CRS/NP). In severe AD, these toxins act both as superantigens (SAg), triggering massive T-cell activation, and as conventional allergens, triggering toxin-specific immunoglobulin E (IgE) in the serum. In CRS/NP, evidence for both processes has been reported but it is unclear whether these processes are linked. The aim of this study was to correlate SAg activity as inferred by staphylococcal-specific T-cell receptor (TCR) V-β expansion in the polyp and blood of CRS/NP patients with staphylococcal-specific anti-IgE antibodies in the serum.

Methods

IgE antibodies to staphylococcal exotoxin A (SEA), staphylococcal exotoxin B (SEB), and toxic shock syndrome toxin (TSST) 1 were measured in the serum of 12 individuals with CRS/NP before functional endoscopic sinus surgery. Flow cytometry was used to analyze the SEA, SEB, and TSST-1–specific TCR V-β domains on the T cells from the polyp and blood of these patients.

Results

Serum SEA-, SEB-, and TSST-1-specific IgE antibodies were detected in 0/12 (0%), 6/12 (50.0%), and 9/12 (75%) of CRS/NP patients, respectively. Evidence of SAg effect in the polyp lymphocytes (TCR V-β expansion in both CD4+ and CD8+ subsets) was noted in 7/12 (58.3%) patients. Five of 6 CRS/NP patients had overlapping evidence of a systemic IgE response and TCR V-β expansion, suggestive of exposure to the same exotoxin. No patients had evidence a SAg effect in blood lymphocytes. Nine of 12 subjects also had coexistent asthma.

Conclusion

These results provide evidence for a local SAg effect in 7/12 (58.3%) polyp patients and establish a positive correlation of V-β expansion with the presence of corresponding toxin-specific IgE in the serum.
Pharyngeal pH Probe Findings in Patients with Postnasal Drainage
Authors: Loehrl Todd A. , Smith Timothy L. , Merati Albert , Torrico-Brusky Laura , Hoffman Raymond G. , Toohill Robert J.
Published: August 2018

Background

Patients commonly present with complaints of postnasal drainage (PND). This study reports the pharyngeal pH probe findings in patients without rhinitis/rhinosinusitis who present with complaints of PND.

Methods

This is a prospective study of patients presenting with PND but no historical or endoscopic evidence of rhinitis/rhinosinusitis. Twenty-four-hour pharyngeal pH probe studies were done on 32 consecutive patients and compared with historical controls.

Results

There were a total of 32 patients with PND (mean age, 54 years) and 51 controls (mean age, 49 years). The proportion of patients with positive pH probe studies was higher in PND (28.1%) versus controls (17.6%) but did not reach statistical significance (p = 0.27). However, when comparing the mean number of pharyngeal acid exposure events, patients with PND had significantly more events (1.6) than controls (0.3; p < 0.002). In addition, the mean acid exposure time was significantly higher in PND (0.18%) versus controls (0.01%; p < 0.004).

Conclusion

The proportion of patients with PND displaying positive pharyngeal 24 pH probe studies is not significantly greater than controls. However, patients with PND do exhibit a statistically greater degree of pharyngeal acid exposure as compared with controls. Additional research is required to delineate the role of pharyngeal reflux in patients with PND.
Sagittal and Coronal Dimensions of the Ethmoid Roof: A Radioanatomic Study
Authors: Zacharek Mark A. , Han Joseph K. , Allen Robert , Weissman Jane L. , Hwang Peter H.
Published: August 2018

Background

Understanding the anatomy of the ethmoid roof is critical to safe surgical outcomes. Normative data regarding the height and slope of this region have been somewhat limited, derived primarily from cadaveric coronal computed tomography (CT) studies. With triplanar imaging programs, precise multidimensional measurements of the ethmoid roof are now possible. We present a radioanatomic study to characterize normative sagittal and coronal dimensions of the ethmoid roof.

Methods

Bilateral measurements were taken in 100 consecutive sinus CT scans using ThinClient 3D software. In the sagittal plane, the height of the ethmoid roof was measured in quadrants at five equidistant points between the frontal beak and sphenoid face, referencing the nasal floor. In the coronal plane, the ethmoid roof was measured at three points at the level of the anterior ethmoid artery and at two points at the junction of the posterior ethmoid and sphenoid sinuses.

Results

When examined sagittally, the right side showed significantly lower skull base heights in the anterior ethmoid compared with the left side (59.0 mm versus 59.8 mm, p = 0.017; 53.7 mm versus 54.5 mm, p = 0.0004). Coronal measurements of the anterior ethmoid roof showed similar significant differences. The anterior ethmoid roof had greater asymmetries of height compared with the posterior ethmoid roof, which was fairly constant.

Conclusion

This study provides numerical correlates to accepted concepts regarding the shape and slope of the ethmoid roof. Differences in height of the skull base between right and left sides, especially in the anterior ethmoid sinus, may be an important surgical consideration. The posterior ethmoid roof appears to be relatively constant and should serve as a reliable surgical landmark.
Inverted Papilloma: New Classification and Guidelines for Endoscopic Surgery
Authors: Kamel Reda , Khaled Ashraf , Kandil Tarek
Published: August 2018

Background

Surgery is the gold standard in the management of inverted papilloma (IP); however, the approach and extent of the surgical procedure are still controversial. Moreover, there is still no universal staging system of IP to plan surgery and/or evaluate results. We performed a retrospective study.

Methods

A new classification depending on the origin of the lesion was used to plan surgery in 70 cases of IP. Conservative transnasal endoscopic excision was performed in lesions arising from the nasal septum and lateral nasal wall (type I IP, 42 cases) and radical transnasal endoscopic medial maxillectomy was performed in lesions arising from the maxillary sinus (type II IP, 28 cases).

Results

Excluding cases with a follow-up of <2 years, follow-up for periods ranging between 2 and 13.3 years with a median of 78 months showed recurrence in a single case of type I (3.2%) and 2 cases of type II (9.5%).

Conclusion

The new classification system, based on the origin of IP, is a simple tool for grading IP. It can be used to define cases suitable for conservative excision or radical medial maxillectomy. Both could be performed transnasally and endoscopically.
Inspiratory and Fixed Nasal Valve Collapse: Clinical and Rhinometric Assessment
Authors: Vidyasagar Ramakrishnan , Friedman Michael , Ibrahim Hani , Bliznikas Darius , Joseph Ninos J.
Published: August 2018

Background

Acoustic rhinometry (AR) has been used to assess nasal valve obstruction. Standard AR measurement of the cross-sectional area (CSA) of the nasal valve is done in the apneic phase, whereas collapse often occurs on inspiration. We used the ratio of the CSA obtained during active inspiration and during apnea to compute a more meaningful method of diagnosing nasal valve collapse.

Methods

AR was performed in 40 patients without nasal valve obstruction and 47 patients diagnosed with nasal valve obstruction. Patients with septal deflection or anterior inferior turbinate hypertrophy were excluded. The internal and external nasal valve area was observed during apnea and on active inspiration. AR measurement of the CSA of both nasal valves was performed during the apneic phase and during active inspiration and the CSA (inspiratory)/CSA (apneic) ratio was calculated.

Results

The CSA (inspiratory)/CSA (apneic) ratio was ≥1 in normal patients and in patients with fixed nasal valve collapse. The ratio was <1 in patients with inspiratory collapse. Data from history, physical examination, and dual-mode AR testing successfully differentiated patients into (1) normal valves, (2) fixed valve collapse, and (3) inspiratory valve collapse. A large number of patients with collapse had both internal and external valve obstruction and a large number also had a combination of inspiratory and fixed collapse.

Conclusion

Dual-mode AR testing is an effective tool in more precisely identifying nasal valve obstruction and is the first objective test shown to be highly diagnostic of inspiratory nasal valve collapse.
Low-Grade Primary Mucosa-Associated Lymphoid Tissue Lymphoma of the Nasopharynx: Clinicopathological Study
Authors: El-Banhawy Omar A. , El-Desoky Ibraheim
Published: August 2018

Background

Malignant tumors of the nasopharynx are always a challenging problem, both from the diagnostic and from the therapeutic standpoint. Most extranodal lymphomas arise in the gastrointestinal tract, but the other mucosal organs also may be involved, especially the upper aerodigestive tract. Nasopharyngeal lymphomas are rare among lymphoma of the upper aerodigestive tract.

Methods

Twenty-two patients with primary lymphoma arising in mucosa-associated lymphoid tissue of the nasopharynx have been studied with reference to age, sex, clinical symptoms, laboratory finding, radiological finding, histological subtype, and immunohistochemistry.

Results

All patients were diagnosed histologically as low-grade lymphoma of mucosa-associated lymphoid tissue type with its characteristic lymphoepithelial lesions and follicular colonization. The tumor cells typically exhibit the following immunophenotypes: positive for CD20, CD45RA, and proliferating markers bcl-2. It was negative for T-cell markers CD45RO (UCHLI).

Conclusion

Ear, nose, and throat surgeons and pathologists should be aware of this type of lymphoma to avoid misinterpretation and to set up a protocol for its management.
Superior Orbital Fissure Syndrome due to Sinusitis: Report of Two Cases
Authors: de Rezende Pinna Fabio , Dutra Daniel L. , Neves Maura C. , Romano Fabrizio Ricci , Voegels Richard L. , Botugan Ossamu
Published: August 2018

Background

The potential morbidity and mortality of sphenoid sinus infectious processes are related to their proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome, a rare entity affecting structures that cross this anatomic region. Early recognition of this syndrome is mandatory. Delays in adequate treatment may compromise the patient's prognosis.

Methods

We present two cases of incomplete superior orbital fissure syndrome due to infectious processes of the posterior ethmoid and sphenoid sinuses.

Conclusions

In our experience, endoscopic decompression of the lamina papyracea shows complete recovery of extrinsic ocular motility in these patients and should be combined with intravenous antibiotic therapy.
Image-Guided Osteoplastic Frontal Sinusotomy
Authors: Innis William , Byrne Patrick , Tufano Ralph P.
Published: August 2018

Background

A 6-ft Caldwell radiograph template and transillumination, typically, are used to elucidate the frontal sinus outline for osteoplastic frontal sinusotomy (OFS). These techniques can be fraught with imprecision. The consequences of imprecise OFS may result in significant complications. Computer-aided surgery may offer a safe and accurate alternative to these techniques in selected cases. Several disadvantages were noted with early computer-aided assistance. Current infrared and electromagnetic systems have eliminated many of these disadvantages. We describe our technique and experience with an infrared image-guidance system (The LandmarX Evolution; Medtronic Xomed, Jacksonville, FL) to create a precise OFS that maximizes exposure while minimizing morbidity.

Methods

We describe the use of an infrared image guidance system, the LandmarX Evolution for OFS in three cases.

Results

The LandmarX Evolution allowed for accurate placement of the OFS in each of the three cases and successful treatment of two symptomatic frontal sinus osteomas and a recurrent inverted papilloma. No complications were encountered.

Conclusion

Image-guided OFS results in a confident and accurate entry into the frontal sinus. Image-guided OFS creation should be considered for select cases (i.e., complete opacification and altered anatomy) where performing an OFS by standard techniques may increase the complication rate. More experience with the technique and increased accessibility to image-guided equipment must be made possible before establishing this technique as a standard.
Combined Endoscopic Trephination and Endoscopic Frontal Sinusotomy for Management of Complex Frontal Sinus Pathology
Authors: Batra Pete S. , Citardi Martin J. , Lanza Donald C.
Published: August 2018

Background

The advances in endoscopic sinus surgery have revolutionized the management of frontal sinus disease. Despite the successes, the purely endoscopic approach has its limitations, especially in patients with alterations in anatomy caused by previous surgical intervention or complex frontal sinus pneumatization patterns. The purpose of this study was to evaluate the efficacy of combined endoscopic trephination and endoscopic frontal sinusotomy (the above and below approach) in the management of these difficult cases.

Methods

Chart review was performed on patients undergoing the combined approach from October 1999 to June 2004. Demographic data, symptomatology, comorbidity, previous surgery, and primary pathology were determined. Outcome was assessed based on subjective symptom relief and objective endoscopic patency.

Results

Twenty-two patients with a mean age of 49.2 years underwent the combined approach. The primary pathology included mucoceles (15 patients), frontal sinusitis (2 patients), inverted papilloma (2 patients), osteoma (1 patient), fibrous dysplasia (1 patient), and pneumocephalus (1 patient). A total of 25 above and below procedures (22 primary and 3 revision procedures) were performed to manage the pathology. Postoperatively, headaches resolved in 47%, improved in 35%, and remained unchanged in 18% of the patients. Orbital symptoms resolved in 63%, improved in 25%, and remained unchanged in 12% of the patients. Endoscopic patency of the frontal sinusotomy was confirmed in 19 of 22 cases (86%) at a mean follow-up of 16.2 months.

Conclusion

Management of complex frontal sinus pathology may require adjunct approaches in conjunction to the standard endoscopic techniques. In this series, the above and below approach was used successfully in 22 patients. The combined approach may serve as an important adjunct for management of complex frontal sinus disease.
Surgical Revision of the Post-Caldwell–Luc Maxillary Sinus
Authors: Han Joseph K. , Smith Timothy L. , Loehrl Todd A. , Fong Karen J. , Hwang Peter H.
Published: August 2018

Background

Endoscopic sinus surgeons are commonly faced with the management of patients with persistent maxillary sinusitis despite previous Caldwell–Luc surgery. Given the potential for altered mucociliary clearance in the post-Caldwell–Luc maxillary sinus, the optimal approach for surgical revision has not been well characterized. The objective of this study was to review our experience in endoscopic versus repeat Caldwell–Luc approaches in patients who have failed Caldwell–Luc surgery for chronic maxillary sinusitis.

Methods

Retrospective chart review was performed on patients who had a history of a Caldwell–Luc procedure and who then underwent a surgical revision for persistent maxillary sinusitis at the Oregon Health and Science University and Medical College of Wisconsin between 1983 and 2002.

Results

Sixty-eight patients were identified, with a total of 156 revision procedures performed on 103 maxillary sinuses. Fifty-three percent of the sinuses underwent endoscopic maxillary antrostomy as the first surgical revision, while 47% underwent a revision Caldwell–Luc procedure. Sixty-seven percent of the sinuses in the revision endoscopic group had clinical resolution with a single surgical revision, and 60% of the sinuses in the revision Caldwell–Luc group had clinical improvement with one surgical revision (p = 0.46). The endoscopic group averaged 1.3 ± 0.5 revision procedures per sinus to achieve clinical resolution, and the revision Caldwell–Luc group averaged 1.7 ± 1.0 revision procedures per sinus (p = 0.3). Mean follow-up was 25 months.

Conclusion

Endoscopic revision of the maxillary sinus yields comparable outcomes to repeat Caldwell–Luc procedure in patients with a history of previous failed Caldwell–Luc surgery. Endoscopic revision surgery is a viable alternative for surgical rehabilitation of the post-Caldwell–Luc maxillary sinus.
Bipolar Radiofrequency Plasma-Mediated Ablation of Porcine Nasal Septal Cartilage: A Pilot Investigation
Authors: Chao Michael C. , Kim Hong K. , Crumley Roger L. , Wong Brian J.F.
Published: August 2018

Background

The objectives of this pilot study were to (1) determine whether bipolar radiofrequency plasma-mediated ablation (PMA) can efficiently remove nasal septal cartilage and (2) calculate the ablation rate as a function of device power, probe force, and translation velocity using ex vivo porcine tissue.

Methods

Specimens were secured to a linear translation stage and were subjected to varying translation velocities (4, 7, and 12 cm/s), probe forces (140, 200, and 225 g), and bipolar radiofrequency generator (Coblator ENTec power settings, 38–58, 77–115, and 129–193 Watts root mean squared. Specimen mass loss and depth of ablation were measured using an analytic balance and dissection microscope, respectively.

Results

Visual and microscopic inspection revealed little char. Mass loss increased with decreasing translation velocity and increasing generator setting. Increasing probe force also influenced mass loss and increased crater depth. Depth of ablation did not correlate with translation velocity or generator setting.

Conclusion

PMA effectively ablates nasal septal cartilage and may be able to reduce or contour cartilaginous deformities and framework structures in the head and neck.
Pharmacological Characterization of Postjunctional α-Adrenoceptors in Human Nasal Mucosa
Authors: Corboz Michel R. , Rivelli Maria A. , Varty Lori , Mutter Jennifer , Cartwright Mark , Rizzo Charles A. , Eckel Stephen P. , Anthes John C. , Hey John A.
Published: August 2018

Background

Functional α1- and α2-adrenoreceptor subtype pharmacology was characterized in an in vitro human nasal mucosa contractile bioassay.

Methods

Nasal mucosa was obtained from 49 donor patients and mucosal strips were placed in chambers filled with Krebs–Ringer solution and attached to isometric force transducers.

Results

Nonselective α-adrenoreceptor agonists epinephrine, norepinephrine, and oxymetazoline produced concentration-dependent contractions of isolated human nasal mucosa (pD2= 5.2, 4.9, and 6.5, respectively). The α2-adrenoreceptor agonist BHT-920 (10 μM)–induced contractions were blocked by yohimbine (0.01–1 μM) and prazosin (0.01–1 μM) inhibited the contractile response to the α1-adrenoreceptor agonist phenylephrine (10 μM). Histological analysis showed that phenylephrine and BHT-920 differentially contracted the arteries and veins of human nasal mucosa, respectively.

Conclusion

Our results indicate that functional α1- and α2-adrenoceptors are present and functional in human nasal mucosa. The a 2-adrenoceptors display a predominant role in contracting the veins and the α1-adrenoceptors appear to preferentially constrict the human nasal arteries.
Clinical Strategy in Hereditary Hemorrhagic Telangiectasia
Authors: Kühnel Thomas S. , Wagner Birgit H. , Schurr Christian P. , Strutz Jürgen
Published: August 2018

Background

Hereditary hemorrhagic telangiectasia (HHT) is a recurrent bleeding tendency caused by vascular malformations and preferentially involving the mucous membrane of the nose. The rhinological management of epistaxis is a challenge in which the frequency of bleeding has to be reduced without damage to the nasal mucosa, despite the fact that therapy necessarily has to be repeated.

Methods

The clinical course in 30 patients with HHT was monitored prospectively. Nasal mucosal efflorescences underwent Nd:YAG laser therapy at individually defined intervals, and the effect on the frequency and duration of bleeding was documented, as were adverse effects.

Results

No serious adverse effects (e.g., septal defects or synechiae) were observed as a consequence of therapy. During the course of laser therapy and ongoing compliance with nasal mucosal care instructions, the frequency of bleeding fell from “several times daily” to “every 2 weeks.”

Conclusion

In conjunction with Nd:YAG laser therapy, ongoing and consistent care of the nasal mucosa is a proven and effective treatment regimen in HHT. As an integral element in an interdisciplinary strategy for diagnosis and therapy, this regimen yields satisfactory quality of life while avoiding local complications.
Resection of Anterior Skull Base Tumors: Comparison of Combined Traditional and Endoscopic Techniques
Authors: Batra Pete S. , Citardi Martin J. , Worley Sarah , Lee Joung , Lanza Donald C.
Published: August 2018

Background

Traditional craniofacial resection (tCFR) has been used successfully for resection of anterior skull base (ASB) tumors. Minimally invasive endoscopic resection (MIER) also has been used recently; this strategy facilitates superior visualization, avoids facial incisions, and preserves local structures. The goal of this study was to compare the outcome for these two approaches.

Methods

Retrospective chart analysis was conducted to identify patients undergoing resection of ASB tumors between January 1995 and January 2003. Demographic data, tumor characteristics, and the surgical approach used were determined. The mean operative time, estimated blood loss, hospital stay, and complications were analyzed. Recurrence and mortality rates were calculated.

Results

Nine patients were managed with the MIER approach, and 16 patients were treated with the traditional open approach. No significant difference was observed between groups on operative time, estimated blood loss, or hospital stay. Major complications were encountered in 2/9 (22%) and 7/16 (44%) patients in the MIER and tCFR groups, respectively. Recurrence was observed in 3/9 (33%) and 5/14 (36%) of the patients in the MIER and tCFR groups, respectively. Mortality rates in the MIER and tCFR groups were 0/9 (0%) and 4/15 (27%), respectively.

Conclusion

In this preliminary study, MIER of ASB neoplasia did not differ significantly from tCFR in operative time, estimated blood loss, hospital stay, or complication rate. Survival and recurrence rates were similar also. This early experience suggests that MIER is a viable alternative for the surgical management of ASB lesions in appropriately selected patients.
Expression of Cell Cycle Regulatory Proteins and Analysis of Apoptosis in Normal Nasal Mucosa and in Nasal Polyps
Authors: Garavello Werner , Viganò Paola , Romagnoli Marco , Sordo Lorenza , Berti Emilio , Tredici Giovanni , Gaini Renato Maria
Published: August 2018

Background

The etiopathogenesis of nasal polyps still is to be clarified. Although hyperplasia is a typical feature of these pathological processes, little attention has been paid to specific aspects of cellular growth in polyps. We have evaluated the expression and localization of some of the regulatory proteins that direct the cell through the specific sequence of events culminating in mitosis or apoptosis in nasal polyps.

Methods

Twenty samples of nasal polyps and 20 samples of normal nasal mucosa have been analyzed for apoptotic index by detecting the DNA 3’ OH ends deriving from DNA fragmentation. Moreover, they have been evaluated by immunohistochemical staining for expression of Ki-67, cyclins A and B1, p53, p21, p27, murine double minute clone 2, and Bcl-2.

Results

We have identified a greater proportion of proliferating cells in the lining epithelial cells of the polyps when compared with the normal mucosa as stained with anti–Ki-67 antibodies. An overexpression of p53, MDM2, and Bcl-2 and an increased apoptosis were observed in nasal polyps compared with the normal mucosa, whereas no variation of p27 expression was observed. The p21 and cyclins A and B1 were rarely expressed in both pathological and normal tissue.

Conclusion

The p53-based control system of cell cycle progression appears to be altered in nasal polyps, potentially leading to an abrogation of the DNA damage checkpoint. Evaluation of the expression of the regulatory proteins that direct the cells throughout their cycle in nasal polyps may allow a better understanding of the biological behavior and clinical outcome of these benign pathological entities.
Role of Macrophage Migration Inhibitory Factor in Paranasal Sinus Mucocele
Authors: Kariya Shin , Okano Mitsuhiro , Aoji Katsuya , Nakashima Tomoko , Kasai Norio , Onoda Tomoo , Nishizaki Kazunori , Schachern Patricia A. , Cureoglu Sebahattin , Paparella Michael M.
Published: August 2018

Background

Little is known about the immunologic aspects and the pathogenesis of the paranasal sinus mucocele.

Methods

The fluids of paranasal sinus mucoceles were obtained from 12 subjects. The concentration of macrophage migration inhibitory factor (MIF), interleukin 1β, tumor necrosis factor a, and regulated on activation normal T cell expressed and secreted (RANTES) were determined by enzyme-linked immunosorbent assay, and the levels of endotoxin were detected with kinetic Turbidimetric Assay.

Results

MIF and endotoxin were detected in the fluid of all samples, whereas interleukin-1β and RANTES were detected in 1 and 3 subjects out of 12 samples. Tumor necrosis factor a was not detected in any of the samples. A significant positive correlation between the levels of MIF and the period with symptoms such as pain, swelling of face, and visual disturbance was observed.

Conclusion

These findings suggest that MIF and endotoxin may play an important role in the pathogenesis of paranasal sinus mucocele. MIF may be an important factor causing the development and exacerbation of the disease.
Long-Term Outcomes of Endoscopic Repair of Cerebrospinal Fluid Leaks and Meningoencephaloceles
Authors: Zuckerman Jodi , Stankiewicz James A. , Chow James M.
Published: August 2018

Background

The management and surgical approach to cerebrospinal fluid (CSF) leaks and meningoencephaloceles have undergone transformation throughout the last 10 years. It is our interest to examine the long-term surgical outcome and reoccurrence rates of CSF leaks or meningoencephaloceles in patients having endoscopic surgical repair.

Methods

We performed a retrospective evaluation of 50 patients that underwent endoscopic surgical repair of a CSF leak, meningoencephalocele, or both, between September 1985 and October 2003.

Results

Cumulatively, reoccurrence rates were 15% (7/47) among the CSF leak patients with an average time frame for reoccurrence ranging from 1 to 25 months (average, 7 months). Patients with meningoencephaloceles had an overall reoccurrence rate of 8% (1/13). In addition, a Medline search on CSF leaks and meningoencephaloceles provided the names of 32 authors that have studied outcomes of endoscopic surgical repair. Of the 151 patients still followed in the 5- to 10-year postoperative group, there were 37 recurrences of CSF leaks and 5 reoccurrences of the meningoencephaloceles with a total recurrence rate of 27% (37 + 5/151). Of the 19 patients still followed in the >10-year postoperative group, there were three reoccurrences of CSF leaks and no reoccurrences of meningoencephaloceles, giving a reoccurrence rate of 16% (3 + 0/19).

Conclusion

Based on our cumulative results, a reoccurrence of a CSF leak or meningoencephalocele after endoscopic repair will occur within the first 2 years postoperatively. Once patients pass these postoperative time frames they are relatively free of reoccurrence from this very effective surgical management. Endoscopic repair results are better than craniotomy with much less morbidity.
Nasal Congestion and Hyperventilation Syndrome
Authors: Bartley Jim
Published: August 2018

Background

This article evaluates the prevalence of hyperventilation syndrome (HVS) in patients who continue to complain of ongoing nasal congestion, despite an apparently adequate surgical result and appropriate medical management.

Methods

Prospective case series of 14 patients from June 2002 to October 2003 was performed. Patients, who presented complaining of nasal congestion after previous nasal surgery and who appeared to have an adequate nasal airway with no evidence of nasal valve collapse, were evaluated for HVS. When appropriate, nasal steroids and oral antihistamines also had been tested without success. Three patients had end-tidal PCO2 levels measured and five patients underwent breathing reeducation.

Results

All patients had an elevated respiratory rate (>18 breaths/minute) with an upper thoracic breathing pattern. Twelve of the 14 patients complaining of nasal obstruction had an elevated Nijmegen score indicative of HVS. An average number of 2.5 procedures had been performed on each patient. End-tidal PCO2 levels were ≤35 mmHg in the three patients who had expired PCO2 levels measured. Breathing retraining was successful in correcting the nasal congestion in two of five patients.

Conclusion

HVS should be included in the differential diagnosis of patients presenting with nasal congestion, particularly after failed nasal surgery. One possible explanation is increased nasal resistance secondary to low arterial PCO2 levels. Another possible explanation is reduced alae nasae muscle activity secondary to the reduced activity of serotonin-containing raphe neurons. Additional surgery may not necessarily be the answer in HVS patients complaining of nasal congestion.
Comparison of Laser versus Surface-Touch Registration for Image-Guided Sinus Surgery
Authors: Woodworth Bradford A. , Davis Gavin W. , Schlosser Rodney J.
Published: August 2018

Background

Use of image-guidance systems has become more popular in endoscopic sinus surgery. The laser registration technique has been used previously; however, a less expensive surface-touch registration technique recently has been developed. We compared the accuracy and speed of laser and surface-touch registration techniques.

Methods

Localization accuracy after laser and surface-touch registration was examined after 15 endoscopic sinonasal procedures between July and September 2004. Compared anatomic locations included the nasofrontal angle, nasolabial angle, posterior maxillary wall, skull base, and posterior vomer. For each localization point, the degree of error (in millimeters) was measured in superior–inferior (SI), anterior–posterior (AP), and right-left (RL) dimensions. The length of time for each registration procedure was recorded for both techniques.

Results

Laser registration was significantly faster (mean, 20 seconds) than surface-touch registration (mean, 20 seconds versus 63 seconds, respectively; p < 0.05). Laser registration was accurate within 0.3 mm in the SI direction, 0.4 mm in the AP direction, and 0.4 mm in the RL direction. Surface-touch registration was accurate within 0.3 mm in the SI direction, 0.4 mm in the AP direction, and 0.3 mm in the RL direction. There was no significant difference between techniques for any anatomic point. In 97.7% of all points, accuracy was within 2 mm or less for both the laser and surface-touch registration.

Conclusion

Surface-touch registration is significantly slower than laser registration but has virtually no difference in accuracy. Both techniques compare very favorably to the accuracy of other systems reported in the literature.
Isolated Inflammatory Sphenoid Sinus Disease: A Revisitation of Computed Tomography Indications based on Presenting Findings
Authors: An Young H. , Venkatraman Giridhar , DelGaudio John M.
Published: August 2018

Background

Isolated inflammatory sphenoid sinus disease (IISSD) can be difficult to diagnose. Frequently, history and physical are inadequate in establishing a diagnosis. Computed tomography (CT) is an excellent screening tool; however, it often is obtained late in the disease process because of vague symptoms at presentation. Identifying the most common presenting symptoms of IISSD may allow earlier detection and avoidance of more severe sequelae by determining earlier indications for CT. Presently, headache is not an indication for sinus CT.

Methods

A retrospective chart review of IISSD presentation was performed at our institution. A literature review was performed also to quantitatively document trends in presentation of IISSD, including characterization of headache symptoms by location. Cumulative findings were then compared with current CT indications to determine if presentation patterns warrant a change in indications for CT.

Results

A total of 361 cases were evaluated by our inclusion criteria. Headache was the most common finding (81.7%), particularly peri/retro-orbital, vertex, and frontal headache. Ocular changes (17.5%) and cranial nerve involvement (16.1%) were common also, but headache frequently was a solitary finding (42.6%). Twenty-six IISSD cases were reviewed at our institution over 7 years, with similar results. Under current guidelines, the only IISSD findings that are indications for CT scan are the ophthalmologic and neurological complications.

Conclusion

Not every headache necessitates a CT scan. However, the deep-seated vertex, frontal, and, particularly, peri/ retro-orbital headaches, especially when aggravated by head movement and refractory to analgesics, as is often seen in IISSD, should be an indication for CT evaluation. (American Journal of Rhinology 19, 627–632, 2005)
Evidence-Based Recommendations for Antimicrobial Nasal Washes in Chronic Rhinosinusitis
Authors: Elliott Kimberly A. , Stringer Scott P.
Published: August 2018

Background

Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS.

Methods

An extensive review of basic science and clinical literature on the treatment of CRS with topical antimicrobial washes was completed. Pharmacokinetics of and organism susceptibility to appropriate topically applied antimicrobial agents were reviewed.

Results

The most common organisms associated with CRS were identified. The relevant pharmacokinetics of drugs targeted at these organisms are presented. Susceptibility breakpoints set by the National Committee for Clinical Laboratory Standards are identified to help establish the most effective concentration of the identified drugs. Recommendations for agent selection, agent concentration, length of treatment, dosing schedule, and methods of irrigation are presented.

Conclusion

Antimicrobial nasal washes provide a potentially effective treatment for the growing population of patients who remain symptomatic after appropriate medical and surgical intervention. This study establishes the basic principles supporting this treatment option and offers rational, evidence-based treatment guidelines. The study has identified additional areas that need to be investigated before prospective clinical trials can be effectively undertaken.