bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethmoidal Adenocarcinoma Presenting as Sensorineural Hearing Loss
Authors: Nuñez Faustino , Alvarez Ignacio , Suarez Carlos , Mateos Valentin , Campos Dulce M. , Astudillo Aurora
Published: September 2007

We present a case of ethmoidal adenocarcinoma which in early stages of the disease produced a meningeal carcinomatosis. Its first clinical manifestation, bilateral deafness, is exceptional. The patient's history and endoscopic and histopathological findings are presented and the relevant literature is reviewed.
Hypoplasia of the Maxillary Antrum: Anatomic Abnormalities, Diagnostic Difficulties and Surgical Implications
Authors: Hanna Ehab , Levine Howard L. , Timen Sanford , Kotton Bernard
Published: September 2007

Using conventional radiography, maxillary sinus hypoplasia (MSH) may be misdiagnosed as chronic infective sinusitis in patients with chronic nasal symptoms. Commonly associated anatomical abnormalities of the lateral nasal wall and orbit may also be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients. With the use of high resolution computed tomography scans and rigid nasal endoscopy, MSH and associated subtle anatomic abnormalities of related structures are diagnosed with higher precision and surgical complications minimized. The incidence, pathogenesis, and classification of MSH is reviewed. The clinical and surgical implications of associated anomalies of the lateral nasal wall are discussed. Two illustrative cases are presented.
Estradiol, Dihydrotestosterone, and Testosterone in Juvenile Nasopharyngeal Angiofibroma Tissue
Authors: Kumagami Hidetaka
Published: September 2007

Seven cases of juvenile nasopharyngeal angiofibroma were studied in terms of the presence of estradiol, dihydrotestosterone, and testosterone in the juvenile nasopharyngeal angiofibroma tissue using the peroxidase-antiperoxidase method. Estradiol was positive in all cases, however, two cases showed reduced stainability. Dihydrotestosterone and testosterone were positive in two and five cases of the seven patients, respectively. Hormone receptors in the juvenile nasopharyngeal angiofibroma tissue seem to change by the activity of nasopharyngeal angiofibroma and by the patient's age.
Rhinomanometric and Clinical Evaluation of Triamcinolone Acetonide and Beclomethasone Dipropionate in Rhinitis
Authors: Lebowitz Richard A. , Jacobs Joseph B.
Published: September 2007

A prospective randomized study comparing the effectiveness of triamcinolone acetonide and beclomethasone dipropionate nasal sprays in the treatment of allergic or vasomotor rhinitis was conducted at New York University Medical Center. Both medications were used at their recommended dosages. Fifty patients were evaluated during a 2-month treatment period. Nasal air flow and resistance were quantified by anterior active rhinomanometry using the Rhinotest microprocessor rhinomanometer. The patients’ subjective complaints were graded on a standard questionnaire. Both steroid inhalants were highly effective in relieving local symptomatology and the subjective improvement in nasal obstruction correlated with rhinomanometric assessment of the nasal airway. Triamcinolone acetonide used once daily represents an alternative to the twice daily beclomethasone dipropionate nasal steroid spray currently available for the treatment of rhinitis.
The Dose and Duration of Effect of Levocabastine, A New Topical H1 Antagonist, on Nasal Provocation Reaction to Allergen
Authors: Tomiyama S. , Ohnishi M. , Okuda M.
Published: September 2007

This study investigated the dose and duration of effect of topical levocabastine (LC) in patients with perennial allergic rhinitis as evaluated by the effect on nasal provocation test with house dust antigen. Three different doses (0.05, 0.1, and 0.2 mg) of LC were independently administered to evaluate the dose response and duration of effect. Reaction to nasal provocation was evaluated by a scoring system based on a combination of symptoms, such as number of sneezes, degree of nasal discharge, and nasal obstruction. The mean scores at 30 minutes postadministration of each of the three different doses of LC showed a significant decrease as compared with those of preadministration. The effect persisted for 4 hours with a dose of 0.05 mg and 0.1 mg of LC and for 12 hours with 0.2 mg of LC. In a comparison of the three doses potency of effect of LC, the highest dose (0.2 mg) demonstrated the strongest effect in the interval from 4 hours to 10 hours postadministration. These results indicate that LC has an immediate effect and its effect is dose dependent. The present study suggests that nasal symptoms in perennial allergic rhinitis could be relieved by topical application of 0.2 mg of LC, twice a day.
Do Rhinomanometric Findings Predict Subjective Postoperative Satisfaction? Long-term follow-up after Septoplasty
Authors: Suonpää Jouko T. , Sipilä Jukka I. , Laippala Pekka J.
Published: September 2007

Eighty-eight septoplasty patients were controlled with rhinomanometry 6 months after surgery and their subjective satisfaction was re-evaluated with a questionnaire 3–5 years after surgery. A slight but not statistically significant tendency for a decreasing level of subjective satisfaction was evident. The results show that patients whose nasal airways resistance was high preoperatively and patients who were normalized surgically were the most satisfied. The number of symptom-free patients was lower among those who were operated on with normal resistance, and in these cases it is suggested that the positive response is mainly a result of the spontaneous course of the chronic disease of nasal mucosa (e.g., allergic rhinitis), not a result of the operation. Preoperative rhinomanometry helps to select patients who benefit most from the surgery and thus, saves operative resources.
Orbital Penetration and Endoscopic Sinus Surgery
Authors: Schaitkin Barry , Mester Sara J. , May Mark
Published: September 2007

We reviewed medical records of 910 patients on whom we performed 1600 endoscopic sinus procedures between June 1987 and December 1991 to determine the incidence of orbital penetration during endoscopic sinus surgery. We examined this incidence in relation to the area of the orbit penetrated, sequelae, and responsible surgical maneuver during the procedure.

Orbital entry was documented in 33 procedures in 32 patients. All procedures were videotaped and these tapes were reviewed. The area of the orbit most often violated was anterior to the anterior ethmoid artery and the front face of the ethmoid bulla. No sequelae occurred in 12 patients, preseptal periorbital ecchymosis occurred in 17 cases, subcutaneous emphysema occurred in 3 cases, and the only serious sequelae, retrobulbar hematoma, occurred with violation of the lamina papyracea in the region of the anterior ethmoid artery in 1 case.

We found that complications occurred most often with removal of the uncinate process in patients with a deviated septum and a lateralized middle turbinate. In such patients, for uncinectomy, we deflect the uncinate process medially with a curved ball probe placed through the semilunar hiatus and directed into the infundibulum. With this revision of our technique for removal of the uncinate process, the incidence of orbital penetration dropped to zero.
Olfaction after Endoscopic Endonasal Ethmoidectomy
Authors: Hosemann W. , Goertzen W. , Wohlleben R. , Wolf S. , Wigand M.E.
Published: September 2007

A detailed preoperative and postoperative examination of the olfactory function of 111 patients with chronic polypoid ethmoiditis was carried out. Eighty-seven patients required a complete endoscopic endonasal sphenoethmoidectomy. In 24 patients an endoscopic partial resection of the ethmoidal cell system was performed. Before surgery a normosmia was ascertained in 39 patients (35%). Thirty-four patients (31%) were hyposmic, and 38 patients (34%) suffered from anosmia. In the postoperative olfactory function test 89 patients (80%) had a normal sense of smell; 13 patients (12%) showed hyposmia, and nine patients (8%) experienced anosmia. Seventy-eight percent of the patients with impaired olfactory function had marked improvement after the operation. Patients who had previously undergone a polypectomy had a less favorable prognosis. None of the preoperatively normosmic patients became hyposmic or even anosmic after endoscopic sinus surgery. The sense of smell of only two of the 34 patients with preexisting hyposmia worsened after surgery. The postoperative size of the middle nasal turbinate did not correlate with the ability to smell. More important was the accessibility of the olfactory cleft.
Endoscopic and Caldwell-Luc Approach in Chronic Maxillary Sinusitis: Intraoperative and Early Postoperative Results
Authors: Penttilä Matti A. , Rautiainen Markus E.P. , Laranne Jussi E. , Pukander Juhani S. , Karma Pekka H.
Published: September 2007

Endoscopic and Caldwell-Luc surgical approaches in 150 consecutive patients (aged 14–88 years) suffering from chronic maxillary sinusitis were compared. The patients were randomly subjected either to functional endoscopic sinus surgery (FES) with middle meatal antrostomy (n = 75) or to the Caldwell-Luc (C-L) operation (n = 75). In the FES group intraoperative bleeding was significantly lower than in the C-L group. There were no major complications during or after surgery in either group. Moderate or marked postoperative facial swelling and fever were more common in the C-L patients and also the need of analgetics was more frequent among them. One month postoperatively the antral irrigation findings did not differ between the groups, but C-L operated patients expressed more frequently distinct complaints than FES patients (P < .001).
AIDS Related Non-Hodgkin's Lymphoma of the Paranasal Sinuses
Authors: Goldberg Jeffrey E. , Moscatello Augustine L. , Babapour Reza , Finn Douglas G. , Pincus Robert L.
Published: September 2007

Non-Hodgkin's Lymphoma (NHL) is an established early manifestation of Autoimmune Deficiency Syndrome (AIDS). It is estimated that up to 10% of HIV+ patients will eventually acquire NHL. These lymphomas differ from those occurring in the general population with regard to natural history, histopathology, location, and therapeutic response. A review of the literature demonstrates only two previously reported cases of NHL originating in the paranasal sinuses in AIDS patients. We present four cases of AIDS-related NHL of the paranasal sinuses diagnosed at our institutions. Clinical and histopathological manifestations and modes of treatment are discussed. NHL must be considered in the differential diagnosis of HIV+ patients presenting with paranasal sinus pathology.
Granulocytic Sarcoma of the Nasal Septum
Authors: Singh Bhuvanesh , Magnuson Todd , Schneller Janet , Har-EI Gady
Published: September 2007

Granulocytic sarcoma (GS) is a solid form of leukemia. It may occur before, simultaneous with, or after the onset of systemic leukemia. More than 400 cases of GS are reported in the literature. However, only six cases involve the nasal cavity, none of which take origin from the nasal septum. In this paper, we report the first case of granulocytic sarcoma to occur on the nasal septum in a patient with chronic myelomonocytic leukemia. In addition, we review the currently accepted modalities for the diagnosis and treatment of these tumors.
Nasal Cavity Dimensions in Guinea Pigs Measured by Acoustic Reflections
Authors: Pedersen Ole F. , Yamagiwa Mikikazu , Miyahara Yukinori , Sakakura Yasuo
Published: September 2007

Acoustic reflections have been used in adult humans to determine nasal cavity dimensions in terms of cross-sectional areas as a function of the distance from the nostril (J. Appl. Physiol., 66:295–303, 1989). In order to measure nasal cavity dimensions in guinea pigs, we modified equipment for use in humans by decreasing sound tube dimensions, increasing sampling frequency, and applying a special nosepiece. We measured 5 guinea pigs (Duncan Hartley strain, 500 g) on two days, before and after instillation of epinephrine and histamine in one nostril. In the control measurements, the minimum cross-sectional area of a nasal cavity was 1.1 mm2 (SD = 0.3 mm2), and the volume from the nostril to 20 mm into the nasal cavity was 60 mm3 (SD = 19 mm3). There was a tendency (P < 0.10) for epinephrine to increase minimum cross-sectional area on the treated side and volumes on both sides. Histamine decreased volume on both sides (P < 0.05), but not uniformly between animals. Measurements in a tube with 2 mm internal diameter (area 3.1 mm2) underestimated true area by approximately 30%. The method, therefore, at its present state of development, measures changes in dimensions rather than absolute values. It is concluded that the acoustic reflections technique may be a useful alternative to other, more invasive methods to assess nasal cavity dimensions in guinea pigs, but further studies are necessary to improve and validate the method.
A Comparison of Sinus Computed Tomography (CT) Staging Systems for Outcomes Research
Authors: Gliklich Richard E. , Metson Ralph
Published: September 2007

The success of outcomes research for sinus disease will depend in part on the utilization of a computed tomography (CT) staging system that meets rigorous statistical criteria. Such a staging system must demonstrate an even distribution of population by scale, a high inter-rater and intra-rater agreement, and a low percentage of unclassifiable scans. Four proposed sinus CT classification systems were evaluated for these parameters. Each system was used by four masked raters to rate 42 consecutive preoperative CT scans on two separate occasions. One of these systems is based on the site of disease rather than the degree of sinus opacification and gives a clear definition of sinus disease (2 mm or greater of mucosal thickening). This system had the highest inter-rater agreement (κ = 0.61, range = 0.38 to 0.61) and the lowest percentage of unclassifiable scans (0.6%, range = 0.6 to 14.2%). The statistical attributes of this particular sinus CT staging system support its use for outcomes research in sinus disease.
Gram Negative Sinusitis: An Emerging Clinical Entity?
Authors: Bolger William E.
Published: September 2007

Traditionally sinusitis has been classified as acute or chronic based on the duration of patient symptoms, and treatment has been based on empiric principles, as the bacteriologic spectrum is felt to be understood, and culturing of nasal secretions has been frowned upon in the past. In this investigation, endoscopically guided cultures were obtained and analyzed from patients, with chronic sinusitis referred to a rhinologic surgeon for evaluation. Often sinusitis was “recalcitrant” to Standard medical and/or surgical therapy. Ninety-eight cultures were obtained from 47 patients with chronic sinusitis who had pathologic sinus secretions noted during the study period. Gram negative enteric bacteria were noted in 47/134 (34.1%) total isolates, a particularly high frequency. Organisms isolated included Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, and Enterobacter aerogenes. The results are significant as gram negative bacteria have been previously reported only infrequently as a cause of sinusitis. Data from this study suggest that endoscopically guided cultures may be helpful in directing medical therapy, especially in longstanding cases of chronic sinusitis that has been “recalcitrant” to traditional medical and surgical therapy. In these patients a shift in the bacterial spectrum to include gram negative organisms, not typically associated with sinusitis, may occur. Empiric selection of standard antimicrobial therapy for chronic sinusitis may not address these bacteria. Classifying sinus disease solely on symptom duration is an oversimplification, and the bacterial spectrum of sinusitis may not be as limited as previous studies suggest. Possible pathophysiologic mechanisms for the shift in the bacterial spectrum and poor response to treatment are discussed.
The “Hummer”: New Instrumentation for Functional Endoscopic Sinus Surgery
Authors: Setliff Reuben C. , Parsons David S.
Published: September 2007

The “Hummer” microdebrider is a powered rotary shaving device with continuous suction. Its use in functional endoscopic sinus (FES) surgery allows precise and delicate removal of diseased tissue. Traditional FES instruments frequently cause trauma to non-diseased mucosa or inadvertently strip mucous membranes, both of which are counter to the functional concepts. The “Hummer” facilitates preservation of mucosa and vital structures, such as the middle turbinate, by resecting diseased, obstructive tissue with very limited blood loss. Simultaneous continuous suction at the operative site is a marked benefit of this instrument, which helps overcome the well-recognized problem of blood pooling that increases the potential for operative morbidity. Polypectomies are performed in a more precise manner with very little blood loss so that visibility is usually unimpaired, even in patients with cystic fibrosis. The instrument is applicable to most FES cases and is the authors’ preferred technique, even for small pediatric patients. Accelerated healing and reduced synechiae were observed in these patients.
The Frontal Cell as a Cause of Frontal Sinus Obstruction
Authors: Bent John P. , Cuilty-Siller Carlos , Kuhn Frederick A.
Published: September 2007

The frontal cell is a rare anatomic anomaly that can become the etiology of chronic frontal sinusitis. It is an anterior ethmoid cell that can be differentiated from other ethmoid cells by serial analysis of sinus CT scans. Located cephalad to the middle meatus, it may obstruct natural mucociliary clearance by impinging on the frontal recess or the frontal sinus cavity. A classification of 4 types frontal cell (Type I-IV) is described. This anatomy is demonstrated in radiographic images of cadaver and patient sinuses. Four consecutive clinical cases of frontal cell obstruction of the frontal sinus are reviewed. In three instances, we performed a combined external and endoscopic intranasal frontal sinusotomy to effectively relieve the obstruction. We describe this technique in detail and provide a mean follow-up of 6 months for these four patients. With recognition of frontal cell obstruction of the frontal sinus, and proper treatment, the results appear to be very rewarding.
Nasal Irritation from Eye Drops
Authors: Yaniv Eitan , Hadar Tuvia
Published: September 2007

Although nasal irritation from nose drops is a common phenomenon well known to any otolaryngologist, nasal irritation from eye drops is little recognized. We describe eight patients who suffered from nasal irritation, rhinitis, and blocked nose resulting from the use of eye drops. Six had a clinical diagnosis of allergic rhinitis for which they were subsequently treated with antihistamines and beclomethasone nasal spray. In seven patients, we were able to stop treatment with eye drops, and the symptoms disappeared. We suspect the preservative benzalkonium chloride to be the main cause of the nasal irritation. We recommend that any physician dealing with nose problems consider eye drops as a possible etiologic factor.
An Assessment of Postganglionic Cryoneurolysis for Managing Vasomotor Rhinitis
Authors: Girdhar-Gopal Harsha , Okurowski Lee , Strome Marshall
Published: September 2007

Vasomotor rhinitis has been treated with multiple regimens with varied success. We have used intranasal cryosurgery to freeze the postganglionic parasympathetics as a definitive therapeutic procedure. A total of 154 cryoneurolysis procedures were performed in a 7-year period. Complete data was evaluable for 144 patients. Concomitant outfracture and cautery of their inferior turbinates was performed for visual access. Initially, 93% of patients treated had significant improvement in their nasal obstruction. Surveys were sent to all patients, with 70% responding. Of the responders, 86% would recommend the procedure to others. On a scale of 1–10, nasal breathing scores improved from a mean of 2.9 preoperatively to 8.0 at present. Data from this patient cohort revealed cryoneurolysis to be an effective alternative to vidian neurectomy and turbinectomy, with a high rate of patient satisfaction and a low recurrence rate.
The Use of Acoustic Rhinometry to Quantitatively Assess Changes after Intranasal Allergen Challenge
Authors: Lai Vincent W.S. , Corey Jacquelynne P.
Published: September 2007

Acoustic rhinometry (AR) is a technique of measuring the cross-sectional area (CSA) of the nasal cavity by analyzing reflected sound waves. It allows a quantitative measurement of the changes of the nasal airway diameter after intranasal allergen challenge. In this study, AR is used to quantitate the degree of narrowing of the nasal cavity produced by various amounts of allergen challenge. Intranasal challenges were performed on seven subjects using radioallergosorbent test (RAST) discs of dust mite or ragweed allergens. At the same time, the (modified) mRAST class of the subjects was obtained by performing mRAST in vitro testing. Five subjects had positive mRAST scores to either dust mite or ragweed, and two subjects had negative mRAST scores. AR was performed prior to intranasal challenge to obtain a baseline. Then AR was performed 15, 30, and 45 minutes after the application of one RAST disc to the head of the inferior turbinate on both sides of the nose. The same measurements were taken after the serial application of two, three, and four RAST discs. For each AR measurement, the CSA at 10 locations in the nasal cavity was averaged for both sides. The endpoint is defined as the number of RAST discs required to produce a 50% reduction in the average CSA of the nasal cavity. We found that the endpoint correlates inversely with the mRAST class of the subject (r = –0.89). In the subjects with negative mRAST scores, no end point was found, even after challenge with four discs.
Malignant Tumors of the Nasal Cavity
Authors: Christensen Eric C. , Hoover Larry A.
Published: September 2007

Malignant tumors of the nasal cavity are rare but interesting lesions because of the heterogeneity of histologic types. From 1951 to 1992, 102 patients with malignant tumors of the nasal cavity have been treated at the University of Kansas Medical Center. Squamous cell carcinoma was the most common histologic type (41 %), followed by malignant melanoma (15%), and adenoid cystic carcinoma (8%). A number of other rare tumors, including hemangiopericytoma, osteosarcoma, acinic cell carcinoma, and teratoid carcinosarcoma were found in single instances. Despite the high proportion of advanced stage disease in patients undergoing planned combined therapy for all histologic types, a 54% overall determinate 5-year survival rate was achieved. The 5-year cure rate for all forms of treatment was 49%. The purpose of this paper is to present our experience and compare the outcome of the various treatment options; the impact of combined surgery and radiation on survival; and the importance of proper patient selection now made possible by CT and MR imaging and endoscopic examination. The evolution of treatment modalities dating to the beginning of this study period and ending with our current techniques for anterior skull base resections is discussed.
Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles
Authors: Kennedy Thomas L.
Published: September 2007

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.
Epiphora Secondary to Blockage of the Lacrimal System: The Role of Endonasal Dacryocystorhinostomy
Authors: Mann Wolf J. , Amedee Ronald G. , Grehn Franz , Lieb Wolfgang
Published: September 2007

Stenosis of the lacrimal system may occur secondary to tumor, infection, trauma, and congenital etiologies. Attempts to remedy this problem often include irrigation and probing. However, if these fail, external or internal dacryocystorhinostomy (DCR) with or without stenting may be performed. The purpose of this article is to detail our experience with a microscopic endonasal approach to DCR utilized in 23 patients. This is a modification of an older accepted procedure which utilizes the modern techniques of endonasal sinus surgery. This approach has allowed for immediate restoration of drainage in 22 of 23 cases. In one case, the procedure was repeated because of restenosis at the level of the lacrimal sac, but ultimately successful drainage was obtained.
Orbital Decompression for Endocrine Ophthalmopathy: The Endonasal Approach
Authors: Mann Wolf J. , Kahaly G. , Lieb W. , Amedee Ronald G.
Published: September 2007

A surgical endonasal procedure is described to perform orbital decompression in patients suffering from ophthalmopathy in Grave's disease. The decompression technique employs removal of the lamina papyracea as an exclusive modality or in conjunction with a transmaxillary or lateral decompression approach. This present series contain 23 patients who underwent decompression over a 3-year period and were followed for at least 6 months postoperative. The results of decompression were assessed by measuring reduction in proptosis and visual acuity. All patients demonstrated improved visual acuity. Measuring retroplacement of the globe, the endonasal approach proved to equal the results obtained after a combined transantral-endonasal approach. Orbital fat was removed depending on the degree of proptosis. The complication rate was low, and establishment of an ocular muscle training program proved helpful.
The Endoscopic Management of Sinus Mucoceles following Orbital Decompression
Authors: Hoffer Michael E. , Kennedy David W.
Published: September 2007

Sinusitis is a reported complication after orbital decompression for endocrine ophthalmopathy. Herniation of orbital fat may lead to ostiomeatal obstruction and secondary involvement of the dependent maxillary, frontal, and ethmoid sinuses. However, the occurrence of mucoceles appears to be rare, and we were unable to identify a prior report of this condition. We present three cases of maxillary and ethmoid sinus mucoceles after transantral decompressions for orbital proptosis. All three cases subsequently underwent endoscopic sinus surgery for marsupialization of the mucoceles. The diagnosis and management of these lesions is a challenging problem. The coexistence of exophthalmos and the fact that sinus disease may present many years after orbital decompression increases the difficulty of making an appropriate diagnosis. In addition, the surgical approach to this problem is difficult because the surgeon must avoid damage to the low-lying orbit and simultaneously decompress the infection and reestablish adequate sinus drainage. Physician awareness of this problem is important for timely diagnosis. We review the anatomy of this condition and describe a practical approach to diagnosis and management of this problem.
Invasive Fungal Sinusitis following Liver or Bone Marrow Transplantation
Authors: Johnson Perry J. , Lydiatt William M. , Huerter James V. , Ogren Frederic P. , Vose Julie M. , Stratta Robert J. , Yonkers Anthony J.
Published: September 2007

Invasive fungal infection of the nose and paranasal sinuses occurs almost exclusively in immunocompromised patients and is increasingly recognized as a complication of organ transplantation. We performed a retrospective chart review of 955 bone marrow and 749 liver transplant patients to identify risk factors, presenting signs and symptoms, methods of diagnosis, and successful management strategies. We report on five cases following bone marrow transplantation and one case following liver transplantation. Neutropenia is the single most important risk factor in the development of and recovery from invasive fungal sinusitis. Early diagnosis, combined with antifungal agents, hematopoietic growth factors, and aggressive surgical debridement is the most effective means of management.
Endoscopic Findings after Functional and Radical Sinus Surgery: A Prospective Randomized Study
Authors: Penttilä Matti A.
Published: September 2007

Functional endoscopic (FES) and radical Caldwell-Luc (C-L) surgical approaches were compared in a prospective randomized trial of 150 consecutive patients (aged 14–88 years) suffering from chronic maxillary sinusitis over 3 months’ duration refractory to medical and repeated antral irrigation therapy. A total of 143 patients with 109 operated antra in the C-L group and 127 antra in the FES group were available for the follow-up nasal and antral endoscopic examination median 12 months postoperatively. Both modalities proved effective in relieving subjective symptoms. Postoperatively, FES antra contained markedly fewer secretions, although the endoscopically enlarged natural antral ostium was closed in 18.6% of the sinuses. The inferior meatal antrostomies of the C-L operation were markedly stenosed or closed in 31.4% of the sinuses. Antral mucosal thickness and antral polyps diminished significantly after both operations, but large polyps were found more often after FES.
Effect of Pretreatment with Ketotifen on Pollinosis: Correlation with Eosinophil Cationic Protein
Authors: Fujieda Shigeharu , Noda Ichiro , Sugimoto Chizuru , Mori Shigehito , Saito Hitoshi
Published: September 2007

In this study, we examined the effect of pretreatment with ketotifen on pollinosis, and correlations with the concentration of ECP in nasal discharge and the existence of eosinophils in nasal smear. Ketotifen was prophylactically administered to 74 patients with pollen allergy, and the treatment continued to the end of pollen season. An additional 25 patients with the same allergy commenced ketotifen treatment during the pollen season. The results showed that pretreatment with ketotifen reduced symptom scores during the pollen season, but did not suppress the increase in ECP concentration and eosinophil influx into the nasal sample. We suggest that pretreatment with ketotifen is useful for the treatment of pollinosis, and its effects may not be the result of suppression of eosinophil activation.
Histopathological Analysis of the Middle Turbinate after Ethmoidectomy
Authors: Milbrath Mary M. , Madiedo Gonzalo , Toohill Robert J.
Published: September 2007

A goal in ethmoid sinus surgery is to ventilate the sinuses by complete removal of all diseased tissue in the ostiomeatal complex. Many surgeons routinely preserve the middle turbinate because they feel it is not part of the disease process and its structure is very important for proper nasal physiology. Other surgeons frequently remove such to facilitate exposure to the ostiomeatal complex and, more importantly, they postulate that it is chronically diseased. This study involved 22 adult patients with CAT scan Stage I:2, II:2, III:5, and IV:13 sinus disease who underwent intranasal ethmoidectomy with resection of the middle turbinate. Three additional turbinate resections performed for other reasons in patients with negative radiological findings served as controls. Histologic findings demonstrated the middle turbinate was chronically diseased to a similar degree as the ethmoids in all 22 patients. Respiratory mucosa without significant pathologic change was found in the controls. This suggests resection of the middle turbinate may be essential, especially in CA T scan Stage III and IV disease. Persistent disease in the middle turbinate may enhance the tendency for synechia formation with the lateral nasal wall and may also account for failure to relieve symptoms in some patients. The question of reversibility of disease in the middle turbinate following ostiomeatal complex surgery remains unanswered.
Clinical Course of Acute Maxillary Sinusitis Documented by Sequential MRI Scanning
Authors: Leopold Donald A. , Stafford Chester T. , Sod Earl W. , Szeverenyi Nikolaus M. , Allison Jerry D. , Phipps Roger J. , Juhlin Kenton D. , Welch Mary Beth , Saunders Carol
Published: September 2007

A prospective study was designed to assess clinical and mucosal changes that occur during resolution of acute maxillary sinusitis. Thirteen previously healthy subjects with symptoms of acute sinusitis and radiographic opacification of at least one maxillary sinus were entered into the study and treated with amoxicillin/clavulinate potassium. Assessment of clinical symptoms, clinical examination, and magnetic resonance imaging (MRI) of the maxillary sinuses were performed at baseline and at days 3, 7, 10, 14, 21, 28 and 56 after initiation of therapy. The T2 values from the MRI scans were analyzed to approximate the more viscous and more fluid-like components of the maxillary sinus contents. After three days of antibiotic therapy, there was marked improvement in facial tenderness, thickness of nasal discharge, volume of nasal discharge, headache, and nasal congestion. Ten to 14 days of treatment were required, however, for improvement in nasal patency. MRI analysis of the volume percentage of air in the involved sinuses showed that by 10 days, only half of the opacification (fluid and thickened mucosa) had resolved. By 56 days, the sinuses were only about 80% aerated. This improvement was attributed mainly to resolution of the more fluid-like component. This study shows that: (1) tissue/fluid changes in sinusitis can be followed with MRI, and (2) although treatment of acute maxillary sinusitis generally results in clinical resolution of symptoms within one week, mucosal changes can persist for 8 weeks or more.
Applied Anatomy of the Posterior Sinuses in Relation to the Optic Nerve, Trigeminal Nerve, and Carotid Artery
Authors: Edelstein David R. , Liberatore Lisa , Bushkin Sheila , Han Jin C.
Published: September 2007

Retrobulbar hemorrhage and visual loss are among the most serious complications of endoscopic sinus surgery. To minimize the occurrence of these risks, the surgeon's knowledge of the specific locations of the neurovascular structures is of paramount importance. In this study, the location of the internal carotid artery (ICA), optic nerve, trigeminal nerve, and anterior and posterior ethmoidal arteries were evaluated by cadaver dissection and anatomic and radiographic measurements. Fifty cadavers were studied using endoscopic techniques, calibrated instruments, and photographic documentation. The average distances from the columella to the optic nerve and ICA were 8.31 cm and 8.57 cm respectively. Mean distances to the anterior ethmoidal artery, posterior ethmoidal artery, ostium of the sphenoid, and posterior wall of the sphenoid sinus were also determined. Measurements derived from 50 normal cranial MRI studies yielded similar results. The ICA was clearly identified in 95%, and the optic nerve in 72% of sagittal MRI studies. The interrelationship of the maxillary division of the trigeminal nerve with the lateral sphenoid wall, optic nerve, and carotid artery was also studied. Sagittal section MRI scans were very useful in determining the critical relationships between the optic nerve, carotid artery, and sphenoid sinus. Comparisons and contrasts are made between the usage of CT scans and MRI in the delineation of these structures.
Evaluation of Mucociliary Function in Patients with Allergic Rhinitis Treated with Trichloroacetic Acid: Mucociliary Transit Time (Saccharin Time) Measurements
Authors: Yao Kazuo , Shitara Tetsuya , Takahashi Hiro-omi , Nishiyama Kouichiro , Iguchi Yoshiaki , Yamamoto Kazuhiro
Published: September 2007

By means of the saccharin time measurement, the mucociliary function of the nasal mucosa of the inferior turbinate was evaluated in clinical cases with allergic rhinitis after the therapeutic application of trichloroacetic acid solution. It was found that the saccharin time (ST) tended to be prolonged within 1 year after the treatment, whereas it gradually became shortened to reach the level of normal control after 3 years. The result would indicate that the mucociliary function recovered correspondingly with regeneration of the ciliary epithelium.
Transfrontal Endoscopic Management of Frontal Recess Disease
Authors: Thawley Stanley E. , Deddens Alan E.
Published: September 2007

The frontal sinus outflow tract can be a difficult area from which to adequately and safely remove bony and/or disease obstructions. A combined endoscopic transfrontal trephination and intranasal endoscopic approach allows a safe and more confident identification and removal of obstructions from the frontal sinus outflow tract. A catheter is placed from the frontal sinus into the nose and left in place for 4–6 weeks before being removed intranasally. Complications have been few and easily treated, and the results in nine patients have been good, with patients being asymptomatic and requiring no antibiotics. This technique allows the safe and accurate identification of structures in a potentially anatomically difficult area and facilitates removal of bone and disease obstructions.
Paranasal Sinus Mucoceles: Modern Management
Authors: Beasley Nigel J.P. , Jones Nicholas S.
Published: September 2007

As a result of the introduction of endoscopic sinus surgery, together with improvements in diagnostic radiology, it is now possible to marsupialize the majority of paranasal sinus mucoceles. We present a review of our management of 34 consecutive mucoceles, of which 22 were approached endoscopically. We discuss the presenting features and radiological findings in these patients, and the surgical techniques employed. At review, two patients have had a recurrence; both had previously had drainage of their mucocele by an external approach. One was then managed by further external surgery and the other endoscopically. There were no significant complications following endoscopic surgery with a follow-up of 6 months to 3 years. We suggest what should be the contraindications to an endoscopic approach.
Computed Tomography Study of Sinus Involvement in Ozena
Authors: Talmi Yoav P. , Bar-Ziv Jacob , Cohen David , Finkelstein Yehuda , Kronenberg Jona
Published: September 2007

Atrophic rhinitis or ozena is a chronic nasal disease characterized by formation of foul smelling nasal crusts with subsequent turbinate mucosal atrophy and resorption of the underlying bone. This symptom complex involves nasal and sinus mucosa with resultant mucosal atrophy, as well as reduced or absent mucocilliary function. The question of the presence of sinusitis in ozena is yet unanswered. Mucosal atrophy may lead to widely patent sinus ostia, but it may well be that the nasal mucosal disease also involves the sinus mucosa with reduced ciliary motility and ensuing sinusitis. We have undertaken a prospective CT study of 11 ozena patients in order to define the occurrence of sinusitis in this entity. These studies, corroborated in part by nasal endoscopies, demonstrate a 70% ethmoid sinus involvement. The sphenoid, frontal, and maxillary sinuses are not usually involved. Other CT criteria of ozena are described.
Hot, Humid Air Partially Decreases the Response to Nasal Challenge with Antigen
Authors: Jankowski Roger , Kagey-Sobotka Anne , Proud David , Liechtenstein Lawrence M. , Baroody Fuad M. , Naclerio Robert M.
Published: September 2007

Allergic rhinitis affects individuals in multiple environmental settings. We hypothesized that the environmental conditions of temperature and humidity had no effect on the early response to nasal challenge with antigen. To test this hypothesis, we selected 16 subjects with allergic rhinitis and challenged them intranasally with either ragweed or grass antigen after they were acclimatized for 1 hour in an environmental chamber to the following conditions: 4°C and 30% relative humidity (RH) (cold and dry environment), 22°C and 50% RH (normal indoor environment), and 37°C and 90% RH (hot and humid environment). The subjects remained in the chamber and were challenged with three increasing doses of antigen. Their response was measured by counting the number of sneezes and measuring the levels of histamine, N-alpha-tosyl-L-arginine methyl ester (TAME)-esterase activity, albumin, and lacto ferrin in recovered nasal lavage fluids. The levels of TAME-esterase activity and albumin were significantly less during exposure to hot, humid conditions compared to normal or cold, dry environments. The other parameters were also less, although they did not reach statistical significance. We conclude that the temperature and humidity of inspired air affect the immediate allergic response. The mechanism for this reduction needs to be elucidated.
Computed Tomography (CT) Scan Findings of the Paranasal Sinuses in Cystic Fibrosis
Authors: April Max M. , Tunkel David E. , DeCelie-Germana Joan , Zeitlin Pamela L. , Zinreich S. James
Published: September 2007

Nearly all patients with cystic fibrosis (CF) have abnormal findings on plain paranasal sinus radiographs. To establish this relationship more accurately, 58 CF patients with nasal symptoms were evaluated with paranasal sinus computed tomography (CT). Bilateral medial displacement of the lateral nasal wall in the middle meatus and uncinate process demineralization were seen in 43 patients (74%). Three patients (5%) had unilateral displacement and uncinate demineralization. Ten patients had maxillary sinus opacification, two patients (3.5%) had unremarkable paranasal sinuses on CT, and another patient (2%) had normal findings on one side. Although the vast majority of CF patients do have paranasal sinus abnormalities, we found on CT scan a progression of abnormalities that range from normal sinuses to pansinus disease, and in 74%, bilateral medial displacement of the lateral nasal wall and uncinate process demineralization.
The Myospherulotic Potential of Water-Soluble Ointments
Authors: Moore David F. , Grogan James B. , Lindsey William H. , Anand Vinod K. , Gross Charles W.
Published: September 2007

Myospherulosis is a submucosal inflammatory condition that has been linked to the use of petrolatum-based ointment in the sinus cavities of patients after paranasal sinus surgery. To avoid this problem, several investigators have suggested using water-soluble ointments. Polyethylene glycol, a vehicle commonly used for water miscible ointments, has not been examined previously with regard to its potential to cause a myospherulotic lesion. Using an in vitro model, we confirmed the potential of petrolatum ointment to produce the myospherulotic lesion and examined the myospherulotic potential of polyethylene glycol ointment.
The Effects of Nasal Flow Stimulation on Central Respiratory Pattern
Authors: Nonaka Satoshi , Katada Akihiro , Nakajima Kizuku , Ohsaki Takashi , Unno Tokuji
Published: September 2007

The purpose of this study was to analyze the functional role of nasal afferents on central respiratory mechanisms. The electromyographic activity of the diaphragm and the neuronal activities of respiratory neurons within the brainstem were recorded during nasal flow stimulation, using decerebrate cats. Flow stimulation delivered to the nose prolonged the respiratory cycle time and decreased the amplitude of diaphragmatic activity. The respiratory cycle time was prolonged due to prolongation of expiratory phase. Cool air flow stimulation was more effective for changing the respiratory pattern than was warm air. All recorded inspiratory neurons of the dorsal respiratory group decreased their firing rate during stimulation, but more than half of expiratory neurons of the ventral respiratory group did not change. These results suggest that nasal afferents which respond to temperature can modulate the central respiratory pattern and have a stronger suppressive effect on the activity of inspiratory neurons than that of expiratory neurons.
Schizophyllum commune Sinusitis: A Case Report and Radiologic Findings
Authors: Emery Brian E. , Oberle Arnold D. , Abreo Fleurette , Day Terry A. , Stucker Fred J.
Published: September 2007

Chronic sinusitis is now considered the most common chronic disease seen in this country.1 The infections are commonly polymicrobial and include aerobes and anaerobes.2 Fungal sinusitis accounts for up to 10% of cases of chronic sinusitis, and the disease ranges from allergic fungal sinusitis through fungus balls to invasive fungal sinus disease.3,4 We report the case of a 19-year-old black female with nasal obstruction, clear rhinorrhea, and nasal polyps. She underwent endoscopic sinus surgery after medical management failed to eradicate her symptoms. Cultures from her paranasal sinuses grew S. commune, a mushroom, a member of the Basidiomycetes. There have been four prior reports of S. commune sinusitis described in the literature. Presented is a review of the literature, a description of the histologic, mycologic, and radiologic findings and suggested treatment. The magnetic resonance imaging (MRI) findings are presented here for the first time.
Acute Sinusitis and Fever in the HIV Positive Patient
Authors: Dolan Robert W. , Cohen Alan F.
Published: September 2007

The aim of the study was to investigate the significance of fever in the hospitalized HIV positive patient with acute sinusitis. Only patients with acute sinusitis and fever were included in our review, which necessarily limits our conclusions concerning the general clinical course of acute sinusitis in the HIV positive patient. However, a strong association was found between prolonged fever and systemic opportunistic disease. Prolonged fever in the setting of acute sinusitis that has been appropriately managed most likely indicates the presence of an acute systemic opportunistic disease, and not an insidious complication of sinusitis.
Late Phase Inflammation during Nasal Grass and Ragweed Challenge in a Double-Blind Placebo Controlled Trial with Astemizole
Authors: Frieri Marianne , Madden James , Zitt Myron , Kumar Nanjundaiah S. , Knapik Maria
Published: September 2007

Allergic rhinitis is an IgE-mediated inflammatory reaction characterized by an early “classic” immediate hypersensitivity response and/or a subsequent late phase response. Nasal provocation to antigen challenge is a useful method of evaluating this dual response. Several H1 antagonists may exhibit antiinflammatory properties by diminishing histamine release or inhibiting eosinophil chemotaxis. To determine whether astemizole has any anti-inflammatory characteristics, we studied 20 patients with allergic rhinitis in a double-blind placebo-controlled fashion after a 4-week course of treatment with this H1 antagonist. Nasal provocation over 30 minutes was performed out of season using increasing concentrations of grass or ragweed extract from 10–1000 PNU. Patients were evaluated for their clinical response, and nasal lavage secretions were analyzed over 6 hours by ELISA for alpha interleukin-1, interleukin-8, albumin, and histamine levels. Total sneezing and other symptom scores for rhinorrhea, nasal congestion, and pruritus were decreased in astemizole-treated compared to placebo-treated patients both at 30 minutes (early phase), and at 3 and 6 hours (late phase) after nasal provocation. However, these results did not reach statistical significance. Nasal α IL-1 levels diminished from diluent control lavage to a significantly greater degree in astemizole than in placebo-treated patients (P < 0.05). This diminution in late phase α IL-1 suggests that astemizole may possess anti-inflammatory properties.