bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Predicting Survival for Cancer of the Ethmoid Sinus
Authors: Bhattacharyya Neil
Published: August 2018

Objective

The aim of this study was to determine survival and prognostic factors for ethmoid sinus cancer.

Methods

From the Surveillance, Epidemiology, and End Results database for the time period 1988–1998, all cases of ethmoid sinus malignancy were extracted. Demographic, staging, treatment, and survival data were computed. Survival analysis was conducted with the Kaplan-Meier method. Clinical factors influencing survival were determined with the Cox proportional hazards model.

Results

After excluding patients with metastatic disease on presentation (8.9%) and patients with missing data for T stage, a total of 180 cases were identified. Average age was 60.2 years. Squamous cell carcinoma was the most common tumor (27.8%), followed by adenocarcinoma (12.8%). Overall mean survival was 57 months (median, 38 months) with a 5-year survival of 40.3%. The percentage of patients presenting with T4 lesions was 45.6%, which had a notably lower mean survival of 38 months (median, 18 months). Only 2.3% of patients had positive nodal disease. Increasing age, T stage, and absence of radiation therapy predicted poorer survival in the multivariate model. Adenocarcinoma, adenoid cystic carcinoma, esthesioneuroblastoma, and melanoma showed more favorable survival than other tumor types.

Conclusions

T stage and tumor histology are the most important prognostic factors in ethmoid sinus carcinoma. Survival for T4 lesions is markedly worse than survival for T1-T3 lesions. Radiation therapy offers a survival benefit in ethmoid sinus malignancy.
Yamik Sinus Catheter in the Topical Treatment of Patients with Acute Rhinosinusitis after Previous Sinus Surgery
Authors: Gosepath Jan , Ecke Ulrich , Kozlov Vladimir S. , Mann Wolf J.
Published: August 2018

Background

The Yamik sinus catheter was designed as a new device for the topical treatment of rhinosinusitis. It creates intermittent positive and negative intranasal pressure after sealing the ipsilateral nostril and choana with two inflatable cuffs. Affecting the nasal cavity and all paranasal sinuses of one side at a time, it is used to evacuate mucous and secretions as well as and to introduce antiseptic, antibacterial, or antifungal solutions.

Methods

This study was designed to evaluate the effectiveness of the Yamik catheter in cases of acute purulent rhinosinusitis in patients who previously underwent endonasal sinus surgery for chronic rhinosinusitis. Twenty patients were treated at repeated visits to the outpatient clinic of our institution. At each visit, their clinical symptoms as well as findings on anterior rhinoscopy, nasal endoscopy, and A-mode ultrasound were evaluated.

Results

Acute disease resolved completely within 10 days of treatment in 17 of the 20 patients. Two patients discontinued treatment after repeated visits, showing only mild improvement. One patient felt uncomfortable during the application of the Yamik catheter and did not continue after the initial treatment.

Conclusion

Our results suggest that the Yamik catheter may be a helpful device in the topical treatment of acute rhinosinusitis and it appears possibly helpful in patients who suffer from episodes of acute purulent infection after previous sinus surgery.
Significance of Eosinophilia in Chronic Rhinosinusitis
Authors: Zadeh Mani H. , Banthia Vishal , Anand Vijay K. , Huang Clark
Published: August 2018

Background

The purpose of this study was to investigate the impact of serum eosinophilia in the prognosis of chronic rhinosinusitis (CRS). Eosinophils are now considered to play a major role in the pathogenesis of CRS. To date, no study has evaluated the clinical course of patients with CRS and serum eosinophilia.

Methods

A retrospective chart review of 620 patients who underwent endoscopic sinus surgery (ESS) for CRS was performed. Thirty-one patients (5%) had elevated serum eosinophil counts and served as the study group. Patient charts of the study group and 34 (5%) controls with normal serum eosinophil counts were reviewed for comorbid diseases including asthma, polyps, and allergic fungal sinusitis. The number of ESSs performed and the postoperative recurrence of multiple sinus infections and need for antibiotics, systemic steroids, and antifungal agents were compared.

Results

A higher proportion of patients with serum eosinophilia had a history of asthma, polyp disease, and allergic fungal sinusitis. Postoperatively, the study group had a statistically significant difference (p < 0.05) as compared with controls with respect to postoperative recurrent sinus infections (94% versus 32%) and polyp disease (35% versus 3%). Statistical difference between study and control groups was also found with respect to the postoperative need for antifungal agents (23% versus 3%), multiple courses of antibiotics (84% versus 32%), and revision ESS (84% versus 24%). Although not statistically significant, a higher proportion of the study group required systemic steroids.

Conclusions

CRS patients with serum eosinophilia have a worse prognosis when compared with controls. Patients with eosinophilia should be counseled appropriately, and the physician should be aware of the chronicity of disease.
Bacterial Colonization of Nasal Steroid Inhalers in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil , Kepnes Lynn
Published: August 2018

Background

The aim of this study was to determine if nasal steroid inhalers harbor bacteria.

Methods

Nasal steroid inhalers were randomly selected from an adult patient population with chronic rhinosinusitis. Swab cultures of the tip of the nasal inhaler were obtained and submitted for microbiological analysis. Contemporaneous control cultures were obtained from freshly opened nasal steroid inhalers. Comparisons were conducted between bacterial recovery rates and types of organisms recovered from the patient and control groups.

Results

Among 31 nasal inhalers in use, 14 inhalers (45%) were found to harbor bacteria. The most common organisms were coagulase negative Staphylococci (11 inhalers) followed by oral flora (2 inhalers) and bacillus species (1 inhaler). None of the 10 control cultures were found to harbor bacteria. Nasal steroid inhalers in use were more likely to have bacterial colonization than new inhalers (p = 0.008, chi-square).

Conclusions

Nasal steroid inhalers may harbor pathogenic bacteria. Therefore, they may serve as a vehicle for subsequent reinfection.
Allergic Rhinitis and Atopy in 18-Year-Old Students
Authors: Brattmo Marianne , Lindberg Sven , Wihl Jan-åke , Petersson Göran , Malm Lars
Published: August 2018

Background

The aim of this study was to investigate the prevalence of allergic rhinitis and atopy in adolescents and whether air pollution in their schools contributed to allergic sensitization.

Methods

Analyses were performed in 1992–1994 on 511 18-year-old students at four schools and on the indoor air and floor dust of their classrooms. The students underwent skin-prick tests (SPTs) and a nasal lavage and answered a computer-based questionnaire containing questions on allergy and nasal symptoms.

Results

Atopy, defined as at least one positive SPT response, was found among 37% of the students, with no difference between students of the four schools, regardless of whether the data were adjusted for gender, hereditary disposition to allergy, and smoking habits. The number of students who had positive SPT and reported nasal symptoms when exposed to possible allergens, which were found among 35%, did not differ between the schools. No correlation was found between the prevalence of atopic individuals and the levels of different indoor air pollutants in the schools.

Conclusion

The prevalence of allergic rhinitis among adolescents is very high and suggests that it is, at least at the time of our study and in comparison with other studies, still increasing. Our results indicate that the indoor air and floor dust at the schools of the students do not contribute to allergic sensitization.
Suppression of the Th2 Pathway by Suplatast Tosilate in Patients with Perennial Nasal Allergies
Authors: Furukido Kyosuke , Takeno Sachio , Ueda Tsutomu , Hirakawa Katsuhiro , Yajin Koji
Published: August 2018

Background

Suplatast tosilate (IPD-1151T), a selective Th2 cytokine inhibitor that suppresses the production of interleukin (IL)-4 and IL-5 in vitro or in animal models has been proved clinically effective for allergic rhinitis (AR). The aim of this study was to investigate changes in the Th2 pathway in human nasal mucosa after medication with IPD-1151T. Twelve patients were treated with IPD-1151T.

Methods

Twelve healthy volunteers served as normal controls. The following parameters were evaluated: (i) subjective nasal clinical symptoms, (ii) percentages of inflammatory cells (EG2, CD4, and CD8) by immunocytological staining, and (iii) levels of cytokines (IL-4, IL-5, IL-13, regulated on activation, normal T-cell expressed, and secreted [RANTES], and interferon [IFN] γ) by enzyme-linked immunosorbent assay.

Results

Nasal symptom scores significantly decreased after treatment. With respect to cell infiltration, a significant decrease was observed in the percentage of inflammatory cells (EG2 and CD4) and CD4/CD8 ratio. The levels of cytokines (IL-4, IL-5, IL-13, and IFN-γ) and the IL-5/IFN-γ ratio were significantly decreased, and the IL-4/IFN-γ ratio became not significantly different from that in normal subjects. In contrast, RANTES did not change significantly. The percentage of reduction in IL-5 correlated with that in eosinophil infiltration, whereas that in RANTES did not.

Conclusion

These results suggest that IPD-1151T can reduce the Th2 pathway.
Treatment of Allergic Fungal Sinusitis with High-Dose Itraconazole
Authors: Rains B. Manrin , Mineck Corey W.
Published: August 2018

Background

Since its original description in the early 1980s, our understanding of allergic fungal sinusitis (AFS) has continued to evolve. The goal of this research was to characterize the typical AFS patient and describe a treatment protocol using endoscopic sinus surgery, high-dose itraconazole, low-dose bursts of oral corticosteroids, and topical corticosteroids.

Methods

A 12-year retrospective chart review was conducted to extract demographic and management data on 139 patients meeting the AFS criteria of atopy, characteristic radiographic findings, eosinophilic mucin, nasal polyposis, and a positive fungal culture or stain.

Results

The typical AFS patient presented at 42.8 years of age, was female, and had 3.5 positive fungal cultures over an average of 31.4 months of follow-up. Although 69 patients (50.3%) experienced recurrence, reoperation was required in only 17 (20.5%) of 83 patients initially managed by our protocol. There were no serious adverse effects attributed to itraconazole over the 36,000 doses prescribed.

Conclusion

The use of itraconazole, short-burst low-dose oral corticosteroids, topical corticosteroids, and endoscopic surgery is a safe and clinically effective regimen in the management of AFS. Our clinical experience suggests medical management of recurrent AFS with itraconazole may avoid revision surgery.
The Effect of FloSeal on Mucosal Healing after Endoscopic Sinus Surgery: A Comparison with Thrombin-Soaked Gelatin Foam
Authors: Chandra Rakesh K. , Conley David B. , Kern Robert C.
Published: August 2018

Background

The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established. Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS.

Methods

Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6–8 weeks after surgery.

Results

No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation. Conclusion: Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.
Inferior Turbinectomy in Children
Authors: Segal Samuel , Eviatar Ephraim , Berenholz Leonard , Kessler Alex , Shlamkovitch Nathan , Kennedy David W.
Published: August 2018

Background

Inferior turbinectomy on patients of all ages is a controversial procedure. Its effect on children has been reported little in the literature and the few studies that are available involved relatively older children, i.e., >10 years old. Nasal obstruction caused by extensive hypertrophy of the inferior turbinates is not an uncommon observation in the pediatric population. The clinical manifestations might present as snoring, noisy breathing, mouth breathing, and, possibly, sleep apnea.

Methods

In this study, we followed 227 children >10 years of age who underwent inferior turbinectomy (27 children also underwent a revision of an earlier adenoidectomy), of whom 179 children had significant relief of nasal obstruction at the 1-year follow-up.

Results

Nocturnal breathing was reported to be more regular and otherwise improved in the 36 children with a suspected history of sleep apnea. Forty-two of 47 children who had thick nasal secretions and did not respond to antibiotic therapy before the operation had significant relief postoperatively. Postoperative complications were few and their number did not exceed that of adults.

Conclusions

A complete inferior turbinectomy should be considered in children >10 years of age who have hypertrophied inferior turbinates that cause major interference with nasal breathing.
Arterial Ligation for Pediatric Epistaxis: Developmental Anatomy
Authors: Isaacson Glenn , Monge Janet M.
Published: August 2018

Background

Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships.

Methods

We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns.

Results

There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half.

Conclusion

Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.
Spontaneous Nasal Cerebrospinal Fluid Leaks and Empty Sella Syndrome: A Clinical Association
Authors: Schlosser Rodney J. , Bolger William E.
Published: August 2018

Background

Spontaneous, idiopathic nasal meningoencephaloceles are herniations of arachnoid/dura and cerebrospinal fluid (CSF) through anatomically fragile sites within the skull base. Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF and giving the radiographic appearance of an absent pituitary gland. The objective of this study was to examine the association between spontaneous encephaloceles/CSF leaks and empty sella syndrome because of their similar clinical features and potential common pathophysiology.

Methods

Retrospective.

Results

Sixteen patients were treated for spontaneous encephaloceles between 1996 and 2001. All 16 patients had associated CSF leaks. Five patients had multiple simultaneous encephaloceles. Fifteen patients with imaging of the sella turcica had empty (10 patients) or partially empty (5 patients) sellas. One patient did not have complete imaging of the sella. Three patients had lumbar punctures with measurement of CSF pressure during computed tomography cisternograms because of multiple skull base defects. Mean CSF pressure was 28.3 cm of water (range, 19–34 cm; normal, 0–15 cm). Thirteen of 16 patients (81%) were obese women (mean body mass index, 35.9 kg/m2; normal, <25 kg/m2). Mean follow-up was 14.2 months with 100% success in closure of the defects after one procedure.

Conclusion

Spontaneous meningoencephaloceles and CSF leaks are strongly associated with radiographic findings of an empty sella and suggest a common pathophysiology. The underlying condition probably represents a form of intracranial hypertension that exerts hydrostatic pressure at anatomically weakened sites within the skull base. Otolaryngologists should be familiar with this disease entity and the implications intracranial hypertension has on patient management.
Management of the Orbital Floor in Silent Sinus Syndrome
Authors: Thomas Robert D. , Graham Scott M. , Carter Keith D. , Nerad Jeffrey A.
Published: August 2018

Background

Enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction.

Methods

A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. Patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case.

Results

There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1–2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 ± 0.06 cm3 and a postoperative volume of 19.56 ± 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications.

Conclusion

Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients’ enophthalmos may improve with endoscopic antrostomy alone.
An Association between Acquired Epiphora and the Signs and Symptoms of Chronic Rhinosinusitis: A Prospective Case–Control Study
Authors: Annamalai Sivakumar , Kumar N. Ajith , Madkour M. B. , Sivakumar Saraswati , Kubba Haytham
Published: August 2018

Background

It has been suggested that chronic rhinosinusitis may lead to epiphora because of inflammatory edema at the nasal end of the nasolacrimal duct and that treatment of the underlying nasal disease may obviate the need for dacryocys-torhinostomy. The aim of this study was to establish whether or not there is an association between the signs and symptoms of chronic rhinosinusitis and a complaint of epiphora in a blinded, prospective case-control study.

Methods

A consecutive series of 15 adult patients presenting to the ophthalmology department with acquired epiphora were compared with 29 patients presenting with chronic open-angle glaucoma over the same study period. Nasal symptoms and the findings on nasal endoscopy were recorded by a single otolaryngologist blinded to the diagnosis and using a standardized staging system.

Results

The age and sex distributions of the two groups were similar. Scores for headache and altered smell were significantly higher in the epiphora cases than in controls (p = 0.05 and 0.03, respectively). Trends for higher scores for congestion and discharge were not statistically significant (p = 0.06 and 0.07, respectively). Mucosal edema and discharge were significantly more common on endoscopy in the epiphora cases than in the control cases (p < 0.02).

Conclusion

We have shown an association between rhinosinusitis and acquired epiphora, and this would be consistent with chronic rhinosinusitis being the cause of the epiphora in some cases.
Image-Guided Resection of Fibro-Osseous Lesions of the Skull Base
Authors: Samaha Mark , Metson Ralph
Published: August 2018

Background

Endoscopic resection of sinonasal fibro-osseous lesions remains a technical challenge because of the loss of anatomic landmarks and the frequent need to resect bone along the skull base. The purpose of this study was to evaluate the usefulness of image-guidance systems for the resection of these lesions.

Methods

Endoscopic surgery was performed in 10 patients with fibro-osseous lesions of the sinuses and skull base (six fibrous dysplasias and four osteomas). Indications for surgical intervention were recurrent infection (7), facial pain (3), mucocele (1), and compressive optic neuropathy (1). All surgeries were performed with an image-guidance system, which included an integrated high-speed drill system.

Results

Anatomic localization was accurate to within 1 mm when monitoring the depth of bone removal along the skull base. Complete resection of the fibro-osseous lesion was possible in six patients (60%) and partial removal was possible in four patients (40%). In the latter group, a margin of dysplastic bone was preserved along the ethmoid roof to prevent dural exposure. There were no intraoperative complications. Surgery resulted in resolution of infection and facial pain in nine patients (90%). Additional surgery was required in one patient (10%) who developed recurrent optic neuropathy because of continued dysplastic bone growth. Mean follow-up was 34 months (range, 13–67 months).

Conclusion

Image-guidance technology appears to be ideally suited for the treatment of patients with fibro-osseous lesions of the sinonasal cavity. Real-time monitoring of the depth of bone removal relative to the skull base may enhance the safety and efficacy of such surgery.
Cost Analysis in the Diagnosis of Chronic Rhinosinusitis
Authors: Stankiewicz James A. , Chow James M.
Published: August 2018

Background

The present treatment regimen for a diagnosis of chronic rhinosinusitis involves a prolonged course of antibiotic therapy along with other adjunctive therapy. The decision to start treatment is made after diagnosis of chronic rhinosinusitis, which is based on subjective symptoms. The working hypothesis of this study is that the diagnosis based on subjective symptoms is inaccurate, leading to inappropriate antibiotic therapy and unnecessary health care expense.

Methods

One hundred patients were evaluated prospectively to determine which patients qualified for this study. Seventy-eight patients satisfied current criteria for a diagnosis of rhinosinusitis.

Results

Fifty-three percent (41 patients) of the 78 patients did not have a diagnosis of chronic sinusitis based on same-day computed tomography (CT) scanning. A charge analysis comparing treatment after diagnosis with medical therapy alone and CT scan for failures versus CT scanning with medical treatment for positive scans was performed. Although the most economical method of treatment was initiating medical therapy, it was also the least sensitive and specific in that 52% of patients didn't require the treatment. Endoscopy and/or CT screening with medical therapy were much better at appropriate diagnosis and targeted therapy but charge analysis indicated a much higher cost.

Conclusion

Presently, the current subjective diagnostic paradigm for chronic rhinosinusitis is most cost-effective but least accurate. Objective evaluations (endoscopy and CT scanning) to aid in diagnosis are more accurate but more costly. Where cost constraints are important, careful considerations of alternatives are important.
Bacteriology of Chronic Maxillary Sinusitis and Normal Maxillary Sinuses: Using Culture and Multiplex Polymerase Chain Reaction
Authors: Kalcioglu M. Tayyar , Durmaz Bengul , Aktas Elif , Ozturan Orhan , Durmaz Riza
Published: August 2018

Background

Although many investigations have been performed on bacteriology of chronic sinusitis and normal sinuses, there still is much discussion. Also a new bacterial agent, Alloiococcus otitidis determined in the nasopharynx and middle ear specimens can be thought as a causative agent of sinusitis.

Methods

The bacteriology of chronic maxillary sinusitis and maxillary sinuses with normal radiogram and endoscopic findings were studied by culture methods for aerobic and anaerobic bacteria. Multiplex polymerase chain reaction (PCR) was used to investigate four bacteria in study and control groups. There were 27 specimens in the study group and 28 specimens in the control group.

Results

In the study group, the bacteria commonly isolated were Staphylococcus aureus (11.1%), α-hemolytic streptococci (11.1%), Streptococcus pneumoniae (11.1%), Haemophilus influenzae (7.4%), coagulase-negative staphylococci (7.4%), and anaerobes (33.3%). Coagulase-negative staphylococci (14.3%), α-hemolytic streptococci (10.7%), and anaerobes (35.7%) were isolated also in the control group. PCR was used to investigate S. pneumoniae, H. influenzae, Moraxella catarrhalis, and A. otitidis in the study and control groups. None of these bacteria was determined in the control group whereas detection rates of these bacteria in the study group were 11.1, 11.1, 3.7, and 7.4%, respectively. It should be considered that PCR yielded faint amplification band for A. otitidis.

Conclusion

Using multiplex PCR can help to increase detection rates of bacterial etiology. Healthy sinuses are not sterile. A. otitidis may be one of the pathogens causing sinusitis.
In Vitro Study on the Influence of N-Chlorotaurine on the Ciliary Beat Frequency of Nasal Mucosa
Authors: Hofer Edmund , Neher Andreas , Gunkel Andreas R. , Nagl Markus
Published: August 2018

Background

The aim of this study was to investigate the in vitro effects of N-chlorotaurine (NCT), a new endogenous antimicrobial agent, on the nasal ciliary beat frequency (CBF) in nasal mucosa samples of 10 adult patients who underwent conchotomy.

Methods

CBF was measured by a photometric technique, combining a light microscope, a photometer, a photograph multiplier, and a computed analyzing unit.

Results

CBF decreased ∼10% after 20 minutes of incubation in aqueous 1% NCT solution compared with 3% in 0.9% saline, and 0.1 and 0.01% NCT had no effect. However, a solution of 7% cocaine, which is used routinely for shrinking the nasal mucosa before rhinoscopy lowered the CBF to 50% after the same incubation time.

Conclusion

These results confirm the very low toxic potential of NCT, and they are fundamental for clinical investigations regarding its topical application in the nasal and paranasal sinuses.
Cranial Bone Grafts in Cerebrospinal Fluid Leak and Encephalocele Repair: A Preliminary Report
Authors: Bolger William E. , Mclaughlin Kevin
Published: August 2018

Background

With the introduction and subsequent widespread acceptance of endoscopic surgery, otolaryngologists are increasingly being called on to care for patients with cerebrospinal fluid rhinorrhea and meningoencephaloceles. Patients with large encephaloceles and skull base defects present a special challenge. We present our experience with cranial bone grafts in treating this important entity.

Methods

Our clinical experience was reviewed from 1998 to 2001. Review parameters included defect size, cranial bone graft harvest site and size, and graft appearance on postoperative follow-up.

Results

Results revealed that 20 patients underwent defect repair with cranial bone graft. The average defect was ∼0.92 x 0.7 cm; nine defects were located in the ethmoid roof, eight defects were in the sphenoid, and three defects were in the posterior table of the frontal sinus. Donor sites included 2 parietal, 3 frontal, and 15 temporal (mastoid). Grafts healed well and all defects remained closed on endoscopic and computerized tomographic follow-up. All donor sites healed well.

Conclusion

Our experience indicates that cranial bone graft is an excellent material for endoscopic reconstruction of skull base defects. It confers special advantages in large defects, in defects with complex three-dimensional characteristics, and in patients with cerebrospinal fluid leaks associated with an elevated intracranial pressure.
Normal Range for Nasal Partitioning of Airflow Determined by Nasal Spirometry in 100 Healthy Subjects
Authors: Roblin D. Graham , Eccles Ronald
Published: August 2018

Background

Nasal spirometry has been used previously to monitor the nasal cycle. Asymmetry of nasal airflow is expressed as a nasal partitioning ratio (NPR) that ranges from -1 (left nasal cavity obstruction) to +1 (right nasal cavity obstruction) with 0 indicating symmetry of airflow. This study investigated the normal range of NPR in the decongested nose as a means of assessing the degree of nasal septal deviation.

Methods

NPR was measured in 100 healthy volunteers using a portable spirometer.

Results

Mean NPR before decongestion was -0.1 ± 0.32 SD (range, -0.84–0.75), and after decongestion mean NPR was -0.02 ± 0.16 SD (range, -0.46–0.51). Male NPR ranged from -0.46 to 0.51 (mean, -0.1 ± 0.22) whereas female NPR was from -0.21 to 0.37 (mean, -0.03 ± 0.1; p < 0.001). There was a significant correlation between the clinicians assessment of the degree of septal deviation and NPR, rs = 0.69 (p < 0.01). The 95% reference range for NPR in this normal population was found to be between +0.30 and -0.34.

Conclusion

A normal range of NPR may prove useful in assessing patients complaining of nasal obstruction. A case may be made that patients on the waiting list that fall within the normal range of NPR are unlikely to benefit from septal surgery because their nasal passages are not greatly asymmetrical.
Elevated Intracranial Pressures in Spontaneous Cerebrospinal Fluid Leaks
Authors: Schlosser Rodney J. , Wilensky Eileen Maloney , Grady M. Sean , Bolger William E.
Published: August 2018

Background

Spontaneous cerebrospinal fluid (CSF) leak is a condition that previously has been considered idiopathic and classified as having “normal” intracranial pressure (ICP). We present clinical and radiographic evidence that indicates elevated ICP in this group. In addition, we review the pathophysiology and unique management issues in caring for patients with spontaneous CSF leak.

Methods

We present a retrospective review of medical records, imaging studies, ICP measurements, and surgical treatment of patients with spontaneous CSF leaks.

Results

Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. Ten patients underwent postoperative lumbar puncture with CSF pressure measurement during clinically indicated computed tomography cisternograms. Intracranial pressures were elevated in all 10 patients, with a mean of 26.5 cm H2O and a range of 17.3–34 cm H2O, (normal, 0–15 cm H2O). Demographically, 13/16 patients were women, all were middle-aged with a mean age of 49.6 years, and 15/16 patients were obese with a mean body mass index of 35.9 kg/m2. Radiographically, 15 patients had imaging of the sella turcica, 10 patients had completely empty sellas, and 5 patients had partially empty sellas. Surgical repair was 100% successful in leak cessation with a mean follow-up of 14.1 months.

Conclusion

Although the precise cause and mechanism of spontaneous CSF leaks is not fully understood, this study sheds light on important factors to consider. Patients with this condition have similar physical and radiographic findings such as middle-aged, female gender, obesity, and empty sella. Additional investigation is needed to determine the exact cause of the condition, its relationship to elevated ICPs, and if further medical or surgical treatments to correct the intracranial hypertension are warranted.
Comparison of Conventional Instruments and Mechanical Debriders for Surgery of Patients with Chronic Sinusitis
Authors: Selivanova Oksana , Kuehnemund Matthias , Mann Wolf J. , Amedee Ronald G.
Published: August 2018

Background

This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery.

Methods

Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long-term (mean, 13 month) follow-up visits, which included nasal endoscopy, saccharin transport time, assessment of mucociliary transport times and clinical symptoms.

Results

In this prospective randomized study we were unable to find a statistical difference (p > 0.05) in surgical outcome for patients when using either conventional instruments or mechanical debriders.

Conclusion

In the literature, mechanical debriders are supposed to provide for mucosal preservation and faster healing. However, for surgical outcome, the use of microdebriders in our study was not better than the results at 3-, 6-, and at 13-month follow-up visits when compared with conventional instruments. Synechia formation, patency of middle meatal antrostomy, and ostial reocclusion were the same in both groups. The incidence of polyposis as a sign of recurrent or persistent infection was similar. Functional results using the saccharin transport time, as a marker of mucociliary function, or episodes of recurrent purulent secretions, again, were identical.
Surgical Techniques for the Removal of Frontal Recess Cells Obstructing the Frontal Ostium
Authors: Wormald Peter John , Xun Chan Steven Zion
Published: August 2018

Background

Cells pneumatizing through the frontal ostium may vary in the degree of frontal sinus penetration. This series describes the use of the axillary flap technique and the endoscopic modified Lothrop procedure (EMLP) for the removal of cells that pneumatize to a varying degree through the frontal ostium into the frontal sinus.

Methods

Out of a total of 204 patients undergoing endoscopic sinus surgery, 31 patients had a cell on one side and 7 patients had bilateral obstructive cells resulting in 38 sides undergoing an axillary flap approach for the removal of the obstructing cell. In 13 patients, the obstructing cell was deemed inaccessible by conventional technique and these patients underwent an EMLP for removal of the obstructing cell.

Results

All patients who underwent both the axillary flap approach and the EMLP had a patent frontal ostium confirmed endoscopically at the last follow-up visit. However, 8 of the 38 sides (21%) that underwent the axillary flap procedure had residual minor symptoms with four patients (30%) who underwent an EMLP having a recurrence of minor symptoms

Conclusion

The axillary flap and the EMLP can be used to remove successfully ethmoidal cells that have pneumatized through the frontal ostium.
Comparison of Feline Nasal Cavity Dimensions Measured by Acoustic Rhinometry and Nasal Casts
Authors: Straszek Sune P. , Mcleod Robbie L. , Hey John A. , Mosekilde Lis , Pedersen Ole F.
Published: August 2018

Background

The goal of this study was to evaluate the relationship between feline nasal cavity geometry determined in vivo by acoustic rhinometry (ARinvivo) and by nasal cavity casts. Cast cross-sectional areas were measured by acoustic rhinometry (ARcast), a fluid-displacement method (FDM), and slicing. A volume comparison between ARinvivo and ARcast was studied in cats with varying degrees of nasal obstruction after application of phenylpropanolamine, saline, or compound 48/80.

Method

After measurements of ARinvivo, impression material was injected into the nasal cavity to produce casts. Subsequently, the cross-sectional areas of the nasal impressions were measured by ARcast and FDM using ethanol. All casts were weighed to determine exact volume. Six casts also were sliced into segments of equal thickness for determination of cross-sectional area.

Results

Cast volume determined by ARcast was consistent with results obtained using FDM and weight. Volumes of the first 3 cm determined by ARinvivo ranged between 78 ± 9% of cast volumes determined by ARcast for decongested cavities and 16 ± 15% for congested cavities.

Conclusion

ARinvivo does not reflect cast geometry, probably because of (1) underestimation by AR because of methodological problems caused by the cavity geometry, (2) deformation of compliant structures within the nasal passageways resulting from the casting procedure, and/or (3) the casting material reaches parts of the nasal cavity not accessible to sound, e.g., sinuses or recesses. Nevertheless, this study does not preclude the use of AR as a sensitive method suited to evaluate relative changes in nasal volume caused by experimental challenges of the nasal mucosa. Compared with ARinvivo, casts still may be of use but it is less sensitive to measure relative changes after experimental challenge.
An Internet Otolaryngology Referral Center: A Preliminary Report
Authors: Baum Eric D. , Becker Daniel G. , Kennedy David W.
Published: August 2018

Background

The aim of this study was to review our early experience with the UPenn Otolaryngology Referral Center Website, ENTConsult.org.

Methods

ENTConsult.org is an interactive website that allows a referring physician to select a University of Pennsylvania Health System otolaryngologist and share clinical information, including uploaded pictures, radiographs, and other images via the Internet. Traditional methods of long-distance consultation involve mailing clinical information, which often is slow and unwieldy, thus discouraging consultation. ENTConsult.org seeks to take advantage of Internet functionality to facilitate efficient and timely consultation regardless of any of the participants’ locations.

Results

In this report we reviewed our initial experience with ENTConsult.org, including an overview of the website functionality and a detailed review of critical logistical considerations.

Conclusion

The UPenn Otolaryngology Referral Center Website ENTConsult.org offers considerable promise as an avenue for long-distance referral and consultation.
Comparative Karyometric Study of the Glandular Epithelium of Normal Nasal Mucosa and Rhinosinus Polyposis
Authors: Fernandes Atílio Maximino , Anselmo-Lima Wilma , Azoubel Reinaldo
Published: August 2018

Background

Rhinosinus polyposis, characterized by a degeneration of the nasal mucosa of the middle meatus, is poorly understood but probably is correlated with several clinical and etiopathogenic entities. Although not definitely characterized, infectious, atopic, inflammatory, genetic, and other factors are involved. The occurrence of malignant degeneration also has been suggested.

Methods

To contribute to the elucidation of the etiopathogenicity of rhinosinus polyps, we performed a karyometric analysis of their glandular mucosa compared with the normal mucosa.

Results

A significant increase in nuclear volume was observed, which was not accompanied by changes in shape.

Conclusion

The results suggest that nuclear alterations may contribute to the pathogenicity of this condition.
Facial Growth after Middle Turbinate Resection: An Experimental Study in the Rabbit
Authors: Egrilmez Murat , Mutlu Cemil , Unlu H. Halis , Celik Onur
Published: August 2018

Background

The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model.

Methods

Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8–10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test.

Results

Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones.

Conclusion

This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.
Outcome of Computer-Assisted Sinus Surgery: A 5-Year Study
Authors: Tabaee Abtin , Kacker Ashutosh , Kassenoff Tali L. , Anand Vijay
Published: August 2018

Background

The aim of this work was to study the outcome and rate of complications in a cohort of patients who underwent computer-assisted surgery (CAS). A retrospective study was performed of all patients undergoing CAS at a tertiary care teaching hospital over a 5-year period.

Methods

All patients who underwent computer-assisted sinus surgery with at least 1 year of follow-up were included in the study. Charts were reviewed for indication of CAS, incidence of major complications, and need for revision surgery after CAS.

Results

A total of 120 patients underwent CAS in the 5-year period. Ten patients were lost to follow-up and were not included in the analysis. Indications for the use of CAS were revision surgery in 85 patients, sphenoid sinus disease in 12 patients, isolated frontal sinus disease in 4 patients, combined sphenoid and frontal disease in 2 patients, and cerebrospinal fluid leak (CSF) leak in 7 patients. The mean postoperative follow-up was 2.6 years. There were no major complications. Fifteen (16.5%) patients required revision surgery: 10 patients required revision endoscopic sinus surgery (1–5 revisions using CAS), 3 patients required an external open procedure, and 3 patients required revision CSF leak closure (one patient required both revision sinus surgery and an external procedure). There were no cases of major intra- or postoperative bleeding, central nervous system damage, CSF leak, or orbital trauma in this study.

Conclusion

CAS helps in avoiding trauma to the orbit and anterior skull base and has a low incidence of major complications. The need for revision surgery may occur in patients with frontal sinus disease, nasal polyposis, or recurrent CSF leak.
The Bath-Plug Closure of Anterior Skull Base Cerebrospinal Fluid Leaks
Authors: Wormald P. J. , Mcdonogh Mike
Published: August 2018

Background

This study presents the technique and results of cerebrospinal fluid (CSF) leak closure by placement of a fat plug on the intracranial surface of the dura. A prospective cohort study of all consecutive patients undergoing endoscopic closure of an anterior skull base CSF leak using the bath-plug technique was performed at a tertiary care center.

Methods

Thirty-three patients presented with CSF leaks: 6 were traumatic, 7 were spontaneous, 9 were iatrogenic, and 10 were associated with a meningoencephalocele. The average age of the patients was 40 years and the male-to-female ratio was 1.2:1. All patients underwent the bath-plug technique for closure of CSF leaks. The surgical technique was presented.

Results

Thirty-one of the 33 patients had a successful primary closure of their CSF leak with 2 patients requiring a repeat procedure. After an average of 28 months follow-up, there were no recurrent leaks in any of the patients. This gives a primary closure success rate of 94% and a secondary closure rate of 100%.

Conclusion

The bath-plug technique for closure of anterior skull base CSF leaks was a reliable technique for a large variety of causes.
The Risk of Olfactory Disturbance from Conchal Plate Injury during Ethmoidectomy
Authors: Kim Kyung-Su , Choi Yoon-Seok , Kim Hyun Jun , Yoon Joo-Heon
Published: August 2018

Background

Even though the olfactory function usually is improved or unchanged after ethmoidectomy, some patients complain of olfactory disturbance, which may be caused by direct injury to the olfactory nerves. However, the detailed anatomic pathway of the olfactory nerves that leave the olfactory mucosa and after going through the cribriform plate insert into the olfactory bulb is uncertain. In the studies of lateral nasal wall, we referred to the thin bone that connects the middle, superior, and supreme turbinates to the skull base as the “conchal plate.” We undertook this study to determine the anatomic relation between the conchal plate and the olfactory nerve.

Methods

Ten midsagittal sections from adult cadaver head specimens were used for gross anatomy and the midportion of the conchal plate was taken and fixed in 10% formalin. The microscopic structures of the conchal plate were observed after hematoxylin and eosin staining.

Results

The olfactory nerves originated from the olfactory mucosa lining the middle and superior turbinates and ran upward within the bone of the conchal plate. These results suggest that the olfactory nerve may be injured inadvertently in the conchal plate during ethmoidectomy and that this injury is likely to be one of the possible causes of olfactory disturbance.

Conclusion

We propose a possibility that injury to the conchal plate can affect olfactory function. Therefore, care should be taken to avoid damage to the conchal plate during ethmoidectomy.