bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Medial Subperiosteal Orbital Abscess: Medical Management Where Possible
Authors: Brown Christopher L. , Graham Scott M. , Griffin Mark C. , Smith Richard J. H. , Carter Keith D. , Nerad Jeffrey A. , Bauman Nancy M.
Published: August 2018

Background

Controversy exists about the optimal management of subperiosteal orbital abscesses (SPOAs) in pediatric patients. Some otolaryngologists advocate immediate surgical drainage while others recommend medical management initially and reserve surgery for nonresponders. We hypothesized that patients who can be managed without surgery have identifiable features on presentation that may aid in predicting their response to medical therapy.

Methods

A retrospective chart review was performed on all patients ≤18 years of age who were admitted to the University of Iowa between 1984 and 2001 with findings consistent with an SPOA on computed tomography imaging. Patients were divided into two groups: group I received medical treatment only while group II underwent surgical drainage of the abscess. Presenting features were compared between the two groups.

Results

Forty-two patients were identified with 17 group I patients and 25 group II patients. All patients had resolution of their SPOA and favorable outcomes. The following variables attained significance: group I patients were younger than group II patients (5.1 years versus 11 years; p < 0.0001), had less restriction of ocular motility (—1.0 versus —2.3), and were hospitalized for fewer days (6.5 days versus 9.6 days; p = 0.011). The following clinical variables did not vary significantly between the groups: gender, side of abscess, temperature, total white blood cell count, neutrophil count, chemosis, visual acuity, and proptosis. Culture results predominantly showed growth of anaerobic organisms (7/23). With increasing age, there was an increase in the number of organisms cultured (p = 0.005).

Conclusion

A subset of patients with SPOAs can be managed medically. These patients tend to be younger and present with minimal restriction of ocular motility. (American Journal of Rhinology 18, 321–327, 2004)
Clinical Outcomes of Septoplasty and Inferior Turbinate Reduction in the Geriatric Veterans’ Population
Authors: Busaba Nicolas Y. , Hossain Monir
Published: August 2018

Background

Patients older than 65 years constitute an increasingly large percentage of the patient population that presents to an adult otolaryngology practice due to the increase in life expectancy. The objective of this study is to assess the clinical outcomes of septoplasty with or without inferior turbinate reduction in patients who are 65 years or older.

Methods

This is a prospective nonrandomized longitudinal study of 40 patients aged 65 years or more and who underwent septoplasty with or without inferior turbinate reduction. Patients received Nasal Health Survey (NHS) and General Health Status Short Form (SF-12) questionnaires before and 6 months after surgery. Statistical analysis was performed using the paired t-test.

Results

The preoperative NHS score was 52.3, while the postoperative score was 76.6 (p < 0.001). The reported benefit reflected improvement in symptoms (p < 0.001) and reduction in medication usage (p < 0.001). In addition, the SF-12 score improved after the surgery but the difference did not reach statistical significance (p = 0.055).

Conclusion and Significance

Septoplasty and inferior turbinate reduction is beneficial in the veterans’ population for patients 65 years or older who present with nasal obstruction and are noted on physical examination to have septal deviation and inferior turbinate hypertrophy.
Nasal Airflow, Mucociliary Clearance, and Sinus Functioning during Viral Colds: Effects of Allergic Rhinitis and Susceptibility to Recurrent Sinusitis
Authors: Alho Olli-Pekka
Published: August 2018

Background

The aim was to compare nasal airflow and mucociliary clearance (MCC) and their association with paranasal sinus functioning during acute natural colds and convalescence in allergic and sinusitis-susceptible patients and healthy controls.

Methods

Nine allergic subjects, 16 sinusitis-susceptible subjects, and 20 healthy controls were examined during days 2–4 of acute colds and 3 weeks later by taking viral specimens, recording symptoms, performing rhinomanometry and dyed saccharin tests, and evaluating sinus functioning with computed tomography (CT).

Results

Viral etiology of the cold was identified in 31 (69%) subjects. Nasal airflow was decreased and MCC time prolonged during the cold compared to convalescence. A higher proportion of the allergic subjects, but not of the sinusitis-susceptible subjects, compared to the control subjects tended to have abnormal nasal airflow and MCC values. Abnormal nasal airflow and MCC values associated significantly with higher ipsilateral paranasal sinus CT scores.

Conclusion

Abnormal nasal airflow and MCC rates seem to be associated with impaired functioning of paranasal sinuses during viral colds and tend to be more common in allergic subjects.
Management of the Lacrimal System during Maxillectomy
Authors: Habib Ramez , Har-El Gady
Published: August 2018

Background

Oncologic resection of the maxilla requires management of the nasolacrimal sac/duct system (NLS). A variety of techniques may be used: simple transection, transection with transcanalicular stenting, drilling of the entire nasolacrimal bony canal to the inferior meatus with mobilization of an intact NLS, marsupialization of the NLS with or without stenting, and simple transection with routine delayed dacryocystorhinostomy (DCR) for symptomatic epiphora. Rates of prolonged epiphora range from 13 to 63%.

Objectives

We present our approach to NLS management during maxillectomy, and our rates of epiphora.

Study Design

Review of 212 consecutive patients who underwent transection of the NLS during medial maxillectomy, complete maxillectomy with preservation of orbital contents, suprastructure maxillectomy, or maxillectomy as part of anterior craniofacial resection. Patients with primary NLS tumors were excluded. Prolonged epiphora is defined as persistent if it lasts more than 6 months.

Methods

After exposure of the anterior maxillary wall and inferior and medial orbital rim, a high-speed drill and Kerrison rongeurs are used to remove the anterior wall of the nasolacrimal canal. The NLS is transected 12–15 mm distal to the periorbita and removed from the canal. Two 4–6-mm opposing incisions are made at the distal duct. Two semicircular flaps are everted, folded, and sutured to the proximal sac or periorbita. A transcanalicular stent is not placed.

Results

Two-hundred twelve patients underwent the abovementioned procedure. Four patients (1.9%) developed prolonged epiphora, which required delayed DCR.

Conclusions

Marsupialization of the NLS without stenting provided us with an acceptably low rate of prolonged epiphora.
Thresholds in Nasal Histamine Challenge in Patients with Allergic Rhinitis, Patients with Hyperreflectory Rhinopathy, and Healthy Volunteers
Authors: Wuestenberg Eike G. , Hauswald Bettina , Huettenbrink Karl-Bernd
Published: August 2018

Background

Characteristic symptoms of hyperreflectory rhinopathy include recurrent sneezing, nasal obstruction, and nasal secretion without an allergic background. The diagnosis can only be made if all differential diagnoses have been excluded. So far no clinical test has been established to reliably diagnose hyperreactivity of the nasal mucosa. The present study aimed to investigate whether nasal provocation with histamine allows identification of patients with hyperreflectory rhinopathy.

Materials and Methods

One-sided nasal challenge with histamine was applied to 13 patients with allergic rhinitis, 13 patients with hyperreflectory rhinitis, and 12 healthy volunteers. Histamine concentrations used were 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, and 16.0 mg/mL. Test results were quantified using a symptom score (positive at values above 3) and active anterior rhinomanometry (positive at a reduction of airflow of 40% or more in comparison to challenge with solvent).

Results

While there was a significant difference between controls and patients with allergic rhinitis or hyperreflectory rhinopathy, respectively, no significant difference was observed between the two groups of patients. Results indicated that one-sided nasal provocation with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. In terms of the differentiation between subjects with hyperreactivity of the nasal mucosa and healthy controls, the sensitivity of one-sided nasal histamine provocation with 1 mg/mL was found to be 100%; its specificity was 83% if it was evaluated by rhinomanometry and symptom score.

Conclusion

The present results indicate that one-sided nasal challenge with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. However, the test does not differentiate between patients with allergic rhinitis and patients with hyperreflectory rhinitis.
Evidence of Bacterial Biofilms on Frontal Recess Stents in Patients with Chronic Rhinosinusitis
Authors: Perloff Joel R. , Palmer James N.
Published: August 2018

Background

Bacterial biofilms have been documented on middle ear mucosa, tonsils, and cholesteatoma. We hypothesize that bacterial biofilms are present in mucosa of patients with chronic sinusitis. We believe that frontal sinus stents may serve as a reservoir for biofilms.

Experiment

We studied silicone frontal sinus stents removed from six patients 1 to 4 weeks after FESS with scanning electron microscopy (SEM).

Results

We identified evidence of bacterial biofilms on the frontal recess stents in six of six patients under SEM. Five of these patients had sinus cultures positive for Staphylococcus aureus. Bacterial biofilms were identified by evidence of glycocalyx, water channels, and three-dimensional structure. These images were similar to other images of known biofilms.

Conclusions

This is evidence of the possible presence of bacterial biofilms on frontal sinus stents in patients with chronic sinusitis. Further study into the role of bacterial biofilms in perpetuating chronic sinusitis is warranted.
Overcorrected Septum as a Complication of Septoplasty
Authors: Lee Bong-Jae , Chung Yoo-Sam , Ju Jang Yong
Published: August 2018

Background

After septoplasty, the rhinologic surgeon often encounters an unexpected deviation of the septum toward the side contralateral to the initial deflection, a phenomenon which we would call an overcorrection.

Methods

To investigate the incidence of overcorrected septum, we assessed the incidence of overcorrection in different age groups by reviewing medical records.

Results

Of 1124 patients, 22 (2.0%) showed occurrence of overcorrection after septoplasty. The incidence of overcorrection was 7.3% (16/218) in subjects aged 10 to 19, 1.7% (5/294) in their twenties, 0.4% (1/250) in their thirties, and 0% in the older ages.

Conclusion

The results of this study indicate that the risk of overcorrection following septoplasty is particularly higher in the younger patient group.
Ethnic and Gender Differences in Bone Erosion in Allergic Fungal Sinusitis
Authors: Wise Sarah K. , Venkatraman Giridhar , Wise Justin C. , DelGaudio John M.
Published: August 2018

Background

Erosion of the bony sinus walls in allergic fungal sinusitis (AFS) is an established phenomenon. Reports of the incidence of bone erosion in AFS vary widely, and definitions of bone erosion lack uniformity. Differences in bone erosion among ethnic and gender groups have not been examined previously in the literature.

Methods

At our institution we reviewed 47 cases of AFS for ethnic and gender differences in presentation and presence of bone erosion.

Results

Caucasians presented at a mean 12 years later than African-Americans (p = 0.002); however, this difference was largely carried by Caucasian females. African-Americans presented with a greater incidence of bone erosion than Caucasians (p = 0.028). In addition, there are statistically significant differences in the individual paranasal sinuses affected by bone erosion in AFS.

Conclusions

We examine the potential implications of ethnic and gender differences in presentation and bone erosion in AFS.
Enlargement of the Bone Component in Different Parts of Compensatorily Hypertrophied Inferior Turbinate
Authors: Uzun Lokman , Savranlar Ahmet , Beder Levent Bekir , Ugur Mehmet Birol , Cinar Fikret , Ozdemir Huseyin , Gundogdu Sadi
Published: August 2018

Background

To evaluate the unilateral compensatorily hypertrophied inferior turbinate (CHIT) by computed tomography (CT) and determine the enlargement of the bone component in different parts of the CHIT.

Methods

Patients were studied in three groups: those with a straight or nearly straight septum (n = 143), with mild deviation (n = 42), and with moderate to severe deviation (n = 99). The cross sectional area (CSA) of the inferior turbinate (IT) bone and the whole turbinate were measured at anterior, middle, and posterior thirds of the IT in coronal sections. The ratio of CSA of the IT bone on two sides of the septum (interturbinate ratio) and the ratio of the CSA of the overall turbinate to the IT bone (intraturbinate ratio) were calculated.

Results

The interturbinate ratio of the bony turbinate CSA for the severe deviation group was significantly higher compared with other groups in anterior and middle segments (p < 0.0001). The intraturbinate ratio was highest in the posterior segment and lowest in the middle segments in compensatorily hypertrophied sides for all groups (p < 0.001).

Conclusion

Skeletal enlargement is prominent in anterior and middle thirds of CHIT in patients with pronounced septal deviation.
Evidence of Bacterial Biofilms in a Rabbit Model of Sinusitis
Authors: Perloff Joel R. , Palmer James N.
Published: August 2018

Background

Bacterial biofilms have been documented on middle ear mucosa, tonsils, and cholesteatoma. In addition, we have described previously bacterial biofilms on frontal recess stents placed during surgery for chronic sinusitis. We hypothesize that bacterial biofilms are present on the mucosa of animals with sinuses experimentally infected with Pseudomonas aeruginosa.

Methods

We instilled Pseudomonas aeruginosa at log phase growth into the right maxillary sinus in 22 New Zealand white rabbits and harvested specimens 1–20 days later. We then examined the tissues with scanning electron microscopy (SEM) and light microscopy. Mucosa from the middle turbinate on the contralateral side was used as a control.

Results

We identified evidence of bacterial biofilms on the mucosa of all 22 animals under SEM. Twenty-one of 22 animals had sinus cultures positive for Pseudomonas. Bacterial biofilms were identified by evidence of glycocalyx, water channels, and three-dimensional structure. These images were similar to other images of known biofilms.

Conclusion

This is evidence of the presence of bacterial biofilms in an animal model of sinusitis. This model may serve as a means to study the efficacy and safety of pharmacologic and surgical treatments on the disruption and elimination of bacterial biofilms. Additional study into the role of bacterial biofilms in perpetuating chronic sinusitis is warranted.
Expression, Localization, and Significance of Vascular Permeability/Vascular Endothelial Growth Factor in Nasal Polyps
Authors: Gosepath Jan , Brieger Juergen , Lehr Hans Anton , Mann Wolf J.
Published: August 2018

Background

The exact etiologic mechanisms leading to the formation of nasal polyps have remained largely obscure. A key phenomenon of this specific type of chronic inflammatory disease in nasal respiratory mucosa is remarkable edema. Vascular permeability/vascular endothelial growth factor (VPF/VEGF) plays an important role in inducing angiogenesis and modulating capillary permeability.

Objective

To study the expression and localization of VPF/VEGF as a putative key factor in nasal polyp development.

Methods

Specimens of nasal polyps (n = 12) were harvested during endonasal sinus surgery in patients with polypous chronic rhinosinusitis. Specimens of healthy nasal respiratory mucosa (n = 12) served as controls and were obtained from inferior turbinates of patients undergoing surgery for nasal obstruction without signs and symptoms of inflammatory disease. Frozen sections were immunohistochemically stained for VPF/VEGF and quantitatively analyzed, using computer-based image analysis.

Results

The expression of VPF/VEGF in specimens of nasal polyps was significantly stronger than in specimens of healthy nasal mucosa of controls. VPF/VEGF in polypous tissue was mainly localized in vascular endothelial cells, in basal membranes and perivascular spaces, and in epithelial cells.

Conclusion

The markedly increased expression in nasal polyps as opposed to healthy nasal mucosa suggests that VPF/VEGF may play a significant role in both the formation of nasal polyps and in the induction of heavy tissue edema. This finding is discussed with respect to the differential expression of cyclooxygenase (COX) isoenzymes-1 and -2 (COX-1 and COX-2) in nasal polyps.
An Assessment for the Presence of Bacterial Contamination of Venturi Principle Atomizers in a Clinical Setting
Authors: Rizzi Mark , Batra Pete S. , Hall Geraldine , Citardi Martin J. , Lanza Donald C.
Published: August 2018

Background

Venturi principle atomizers have been criticized for potential contamination and disease transmission when used for nasal application. A recent laboratory study reported a high rate of contamination of these atomizers after their tips were immersed and sprayed into a broth containing Staphylococcus aureus. The objective of this study was to determine whether the Venturi-type atomizers used regularly at a busy referral center for sinonasal disorders were contaminated with bacteria.

Methods

Fifteen Venturi-type atomizers containing 2% lidocaine (four bottles), 4% lidocaine (three bottles), or 0.05% oxymetazoline (eight bottles) were sprayed onto blood agar plates. All atomizer bottles had been in routine use in a tertiary rhinology clinic for 1 month. The contents within each bottle's reservoir also were cultured. Thus, the total sample size was 30 plates. Then, the plates were incubated at 35°C for 48 hours and then at room temperature for 72 hours.

Results

Three of our 30 plates grew one colony each of Gram-positive bacilli, Gram-positive cocci, and Staphylococcus species.

Conclusion

The rare growth of any bacteria seen in our samples could as likely represent contamination during processing and handling of the plates as contamination of the atomizers themselves. Thus, Venturi-type atomizers may not have a high potential contamination risk, which has been suggested by previous reports.
Presence of Fungus in Sinus Cultures of Cystic Fibrosis Patients
Authors: Wise Sarah K. , Kingdom Todd T. , McKean Lawrence , DelGaudio John M. , Venkatraman Giridhar
Published: August 2018

Background

Sinonasal pathology is nearly universal in the cystic fibrosis (CF) population. The bacteriology of sinus cultures from CF patients and the implications of sinus bacterial pathogens in this group have been studied; however, sinus fungal isolates from CF patients have not been examined in the literature.

Methods

We reviewed 30 consecutive CF patients undergoing endoscopic sinus surgery at our institution for the presence of fungal isolates obtained from the sinuses at the time of surgery.

Results

Thirty-three percent of fungal cultures were positive in this sample; in addition, two patients were newly diagnosed with allergic fungal sinusitis.

Conclusion

We examine the possible implications of positive fungal sinus cultures in the CF population.
Long-Term Rhinoflowmetry: A New Method for Functional Rhinologic Diagnostics
Authors: Grützenmacher Stefan , Lang Christian , Mlynski Robert , Mlynski Barbara , Mlynski Gunter
Published: August 2018

Background

With current functional diagnostic tools in rhinology (rhinomanometry, rhinoresistometry, and acoustic rhinometry) long-term assessment of nasal function is difficult to acquire. Usually, only the situation at the time of examination is evaluated. Therefore, temporary nasal complaints of the nasal cycle are difficult to assess. It was the aim of this work to create a diagnostic tool to measure nasal flow over a long time period under physiological and everyday life conditions. We term the method long-term rhinoflowmetry (LRFM).

Methods

A portable device recording nasal airflow over a time period up to 72 hours was developed. Kinetic pressure fluctuations during respiration as a measure for the flow were registered over time and relative airflow was calculated. A summary of diagnostic results is given in six exemplary patients.

Results

Classic nasal cycles could be recorded in detail with durations ranging from 90 minutes to 10 hours. The manifestation of nighttime nasal obstruction as well as a case of paradoxical nasal obstruction were objectified. LRFM enables the assessment of time, duration, and extent of temporary nasal obstruction.

Conclusion

LRFM enables an assessment of temporary nasal obstruction as well as physiological and pathological fluctuations in the nasal cycle. Especially in cases in which traditional rhinological diagnostic tools are unsatisfying, the enhanced diagnostic quality of LRFM appears to be a promising supplement to the currently available rhinological monitoring methods.
Morphology and Distribution of Nasal Telangiectasia in HHT-Patients with Epistaxis
Authors: Folz Benedikt J. , Wollstein Ana Cerra , Lippert Burkard M. , Werner Jochen A.
Published: August 2018

Background

Epistaxis in hereditary hemorrhagic telangiectasia (HHT; Rendu-Osler-Weber syndrome) is a frequent symptom that may be caused by a multitude of different genetic and epigenetic phenomena. This investigation analyzes the distribution of nasal telangiectasia in 21 patients with HHT.

Methods

The patients were examined for endonasal telangiectasia by videoendoscopy with rigid endoscopes; in addition, the anterior portion of the nose was examined under the operating microscope. The endonasal findings were recorded on videotape and then evaluated in the media laboratory.

Results

Morphology of the nasal telangiectasia showed wide variations: the vessels were shaped like spots, loops, or spiders or they clustered and resembled raspberries. Gender did not have an influence on the phenotype of telangiectasia, whereas advancing age correlated with a higher density of telangiectasia. Patients with an intact nasal septum exhibited the bulk of telangiectasia in the anterior nasal cavity but also on the middle turbinates, the floor of the nose, and within the valve area. Patients with septal perforations displayed the majority of telangiectasia around the edge of the perforations, on the floor of the nose, and on the turbinates. Scattered telangiectasia also could be found in the profound parts of the nasal cavity and in the nasopharynx, especially in patients with septal perforations.

Conclusion

The shapes of endonasal telangiectasia in HHT patients are very heterogeneous; predilection sites could first of all be found within the anterior portion of the nose. Morphology and distribution of endonasal telangiectasia change as a result of therapeutic interventions, development of septal perforations, and with advancing age. Therefore, repeat endoscopies are recommended to assess the actual stage of the disease before epistaxis therapy.
The SF-36 Health Status Questionnaire in Assessing Patients with Epistaxis Secondary to Hereditary Hemorrhagic Telangiectasia
Authors: Lennox Penelope A. , Hitchings Anne E. , Lund Valerie J. , Howard David J.
Published: August 2018

Background

This study assesses the ability of the short form 36 (SF-36), a validated health status survey, to measure the health of patients with epistaxis due to hereditary hemorrhagic telangiectasia (HHT).

Methods

Thirty-eight patients completed the SF-36 and symptom-specific questionnaires. They were asked to rate their epistaxis as severe, moderate, or mild. The SF-36 data are compared with a reference population and analyzed with respect to the subgroups.

Results

The scores for each dimension of health were significantly reduced (p < 0.05) when compared with the reference population for all dimensions except pain. When compared with the patients’ ratings of severity, a significant correlation was detected in five dimensions (p < 0.05).

Conclusion

The SF-36 reflects the reduced health status of patients with epistaxis due to HHT. Changes in the SF-36 score could be used as an outcome measure in assessing efficacy of treatment of this condition.
The Effect of Treatment for Epistaxis Secondary to Hereditary Hemorrhagic Telangiectasia
Authors: Hitchings Anne E. , Lennox Penelope A. , Lund Valerie J. , Howard David J.
Published: August 2018

Background

Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia. Different treatment options have been described but with little reference to their effect on quality of life or disease severity.

Methods

This study prospectively investigated the effect of nasal closure, argon laser, and a combination of septodermoplasty and argon laser treatments on quality-of-life scores and disease severity ratings in a group of 29 patients with moderate to severe epistaxis referred to a tertiary referral center.

Results

The only group of patients who showed a significant improvement (p < 0.05) in quality of life were those who underwent nasal closure. In addition, the nasal closure patients were the only group in which there was a complete cessation of bleeding.

Conclusion

Nasal closure should be offered to patients with moderate to severe epistaxis secondary to hereditary hemorrhagic telangiectasia that has proved unresponsive to other treatment.
Economic Analysis of the Treatment of Posterior Epistaxis
Authors: Miller Timothy R. , Stevens Edwin S. , Orlandi Richard R.
Published: August 2018

Background

The aim of this study was to compare the economic impact of controlling posterior epistaxis by transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular embolization.

Methods

We conducted a retrospective chart review of patients undergoing treatment of posterior epistaxis by either TESPAL or embolization. International Classification of Diseases 9 code 784.7 (epistaxis) was the initial screen followed by common procedural terminology codes for TESPAL and angiography with embolization. The total charges and direct costs for TESPAL and endovascular embolization were determined. An unpaired Student's t-test was used to evaluate statistical significance.

Results

Analysis revealed 25 patients that met inclusion criteria. The mean total charge was $14,088 for embolization and $7561 for TESPAL. The differences were statistically significant (p < 0.00006). Costs, defined as reimbursement by third-party payers and direct payments, varied widely and their difference did not reach statistical significance in this sample.

Conclusion

Our data established no economic advantage for angiography and, in fact, show a trend toward this treatment being more expensive than TESPAL. TESPAL is a procedure that can be performed quickly and on an outpatient basis without the need for angiography equipment or expertise. Additionally, the procedure provides the advantage of a comprehensive endoscopic nasal evaluation for ruling out tumors or other intranasal lesions. With equal efficacy, at least equal costs and equal risk, and additional diagnostic advantages, TESPAL is a more rational treatment for posterior epistaxis.
Endoscopic Biopsy of Human Olfactory Epithelium as a Source of Progenitor Cells
Authors: Winstead Welby , Marshall Charles T. , Lu Cheng L. , Klueber Kathleen M. , Roisen Fred J.
Published: August 2018

Background

The adult central nervous system contains progenitor cells; however, invasive surgery is required for their harvest. Olfactory neuroepithelium (ONe) has attracted attention because it is extracranial and contains progenitor cells that account for its regenerative capacity. Olfactory progenitor cells have been cultured from postmortem ONe. Our aim was to determine if olfactory progenitors could be obtained via biopsy from patients in a feasible, effective, and safe manner.

Methods

Endoscopic biopsy was performed on individuals undergoing sinus surgery (n = 42). Olfactory function was assessed pre- and postoperatively. Specimens were cultured under conditions for olfactory progenitor cell development.

Results

Progenitor cells emerged in cultures from 50% of our patients. The superior turbinate, biopsied with cutting punch forceps, gave the highest yield. No adverse impact on olfaction or complications with the biopsy were observed.

Conclusion

Endoscopic biopsy of ONe for obtaining olfactory progenitor cells from living donors is feasible, effective, and safe.
Glycoconjugate Expression in Normal Human Inferior Turbinate Mucosa: A Lectin Histochemical Study
Authors: Berger Gilead , Kogan Tatiana , Skutelsky Ehud , Ophi Dov
Published: August 2018

Background

Further study on the composition and concentration of normal nasal mucosal glycoconjugates is needed.

Methods

A battery often lectins was used to stain six carbohydrates residing in the inferior turbinate mucosa of 21 healthy individuals.

Results

The concentrations of glycoconjugates of the glycocalyx exceeded that of epithelial goblet, ciliated, and basal cells, and also of mucous, serous, and mixed submucosal glands. Epithelial goblet cells and submucosal mucous glands contained relatively high concentrations of glycoconjugates, whereas in epithelial ciliated and basal cells, similar to serous and mixed submucosal glands, concentrations were scanty. The concentrations of N-acetylgalactosamine and galactose were higher in goblet cells than in mucous glands (p = 0.006, and p = 0.056, respectively). Differences in the concentrations of N-acetylglucosamine, fucose, mannose, and sialic acid were insignificant.

Conclusions

The findings provide a baseline for comparison of the composition and concentration of carbohydrates of the normal and pathologic inferior turbinate mucosa.
Microbiology of Sinus Puncture versus Middle Meatal Aspiration in Acute Bacterial Maxillary Sinusitis
Authors: Joniau Sander , Vlaminck Stephan , Van Landuyt Herman , Kuhweide Rudi , Dick Catherine
Published: August 2018

Background

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is an invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated.

Methods

We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS.

Results

Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%.

Conclusions

In our study, endoscopic sampling compared favorably with sinus puncture and aspiration.
Increased Role of the Otolaryngologist in Endoscopic Pituitary Surgery: Endoscopic Hydroscopy of the Sella
Authors: Senior Brent A. , Dubin Marc G. , Sonnenburg Robert E. , Melroy Christopher T. , Ewend Matthew G.
Published: August 2018

Background

The aim of this study was to discuss the use of nasal irrigation and suction systems in endoscopic pituitary surgery to examine the sella and facilitate tumor removal. We describe a new technique of sellar exploration.

Methods

Following the endoscopic approach to the pituitary by the otolaryngology team, pituitary masses are resected. Then, the ClearESS nasal irrigation and suction system is used by the otolaryngology team to visualize the sella (“hydroscopy”). The combination of this ClearESS technology and angled endoscopes is used to scrutinize previously inaccessible areas of the tumor bed.

Results

Over 50 patients have undergone minimally invasive pituitary surgery via the endoscopic approach with postresection hydroscopy of the sella. The use of angled endoscopes in combination with the ClearESS technology greatly increased visualization of the sella, thereby facilitating complete tumor removal. There have been no complications associated with the use of hydroscopy.

Conclusion

The use of angled endoscopes in conjunction with hydroscopy increases visualization of the sella. The otolaryngologist plays a critical role in this examination with manipulation of the angled endoscopes. Therefore, the role of the otolaryngologist is extended beyond the approach to the pituitary.
Isolated Sphenoid Sinusitis after Transsphenoidal Hypophysectomy
Authors: Batra Pete S. , Citardi Martin J. , Lanza Donald C.
Published: August 2018

Background

Literature addressing the incidence and management of sinusitis after transsphenoidal hypophysectomy is sparse.

Methods

Retrospective chart analysis was conducted on 200 consecutive patients who had undergone transsphenoidal procedures between January 1998 and December 2001. The postoperative incidence of sinusitis was determined. Clinical characteristics, management strategy, and outcome were reviewed.

Results

Fifteen of the 200 patients (7.5%) developed rhinosinusitis after transsphenoidal surgery. Seven of the patients were referred to otorhinolaryngology for further management. Three additional patients, who had undergone transsphenoidal hypophysectomy at outside institutions, also were evaluated during this time. Nine of 10 patients (90%) had isolated sphenoid sinusitis by computed tomography and/or endoscopic criteria. The most common symptoms included headaches and nasal discharge present for an average of 2.9 years. Medical management resulted in resolution of symptoms in 5 of 10 cases (50%). The remaining five patients required endoscopic sphenoidotomy for recalcitrant disease. Intraoperatively, fungal balls were identified in three cases. Mucocele formation was encountered in one case, and an infected fat graft was evident in one case. Sphenoid sinusitis was resolved successfully in all 10 cases.

Conclusion

A high index of suspicion must be maintained to avoid an inordinate delay in diagnosis of isolated sphenoid sinusitis in this setting, in light of the nonspecific presentation of this clinical entity. Aggressive medical and/or surgical treatment is required for resolution of refractory symptoms in this patient population.
Surgical Decisions in the Management of Frontal Sinus Osteomas
Authors: Chiu Alexander G. , Schipor Ioana , Cohen Noam A. , Kennedy David W. , Palmer James N.
Published: August 2018

Background

The development of chronic rhinosinusitis, a mucocele, or persistent headaches is a common indication for the removal of a frontal sinus osteoma. The best surgical approach to ensure complete and safe removal of the lesion is less clearcut. The advent of specialized frontal sinus instruments, angled endoscopes, and surgical navigational systems has made removal of frontal sinus osteomas possible through an endoscopic approach. The aim of this study is to review our recent experience with the surgical management of frontal sinus osteomas, and the anatomic features that make specific lesions more or less amenable to endoscopic resection.

Methods

A retrospective review of all frontal sinus osteomas surgically resected from the years 1999 to 2003 was used. This period was selected to reflect the invention and popularization of surgical navigation systems and specialty instruments designed specifically for the frontal sinus. CT scans, operative reports and postoperative course were reviewed.

Results

Nine patients were identified. A grading system was devised to reflect the three variables involved in the limitations for endoscopic removal. These are the location of the base of attachment, relative size to the frontal recess, and location in relation to a virtual sagittal plane through the lamina papyracea. Three osteomas were removed through an endoscopic approach. Four were removed by a combined osteoplastic flap and endoscopic dissection of the frontal recess. Two were removed through an osteoplastic flap with obliteration of the sinus.

Conclusion

The ability to remove a frontal sinus osteoma endoscopically can be determined preoperatively, taking into account the location and size of the lesion. There is still a role for external procedures in the surgical management of these lesions, and such procedures may be combined with endoscopic techniques for optimal results.
The Effect of Endoscopic Sinus Surgery on Symptoms of Eustachian Tube Dysfunction
Authors: Stoikes Nathaniel F.N. , Dutton Jay M.
Published: August 2018

Background

The symptom of eustachian tube dysfunction has been categorized as a “minor” symptom in chronic rhinosinusitis. The aim of this pilot study was to determine the frequency of otologic symptoms in patients with confirmed rhinosinusitis and the likelihood of its resolution in those patients undergoing endoscopic sinus surgery (ESS).

Methods

Questionnaires were obtained from 168 patients who had undergone prior ESS over a 5-year period. Patients were asked to evaluate if they suffered from several different potential symptoms of eustachian tube dysfunction before ESS and whether that symptom changed postoperatively.

Results

Using the binomial test, 95% confidence intervals were determined for the following otologic symptoms of tubal dysfunction: “ear fullness and congestion,” “ear cracking and popping,” “dizziness,” and “ear pain.” ESS was found to have a significant treatment effect for the indicated otologic symptoms of tubal dysfunction.

Conclusion

Tubal dysfunction, as manifested by otologic symptoms, is common in patients with chronic rhinosinusitis undergoing ESS. The classification of this as a “minor” symptom of rhinosinusitis needs to be reevaluated. These symptoms improve or resolve in the majority of patients undergoing ESS.
Opening the Nasal Valve with External Dilators Reduces Congestive Symptoms in Normal Subjects
Authors: Latte Jenny , Taverner David
Published: August 2018

Background

We examined whether the use of two different external nasal dilator devices influenced the size of the nasal valve area and symptoms of nasal congestion.

Methods

This was a randomized blind-allocation, open three-way crossover study of Breathe Right, Side Strip Nasal Dilators, and placebo. We studied 12 healthy subjects (10 female, 2 male; age range 26–56 years). Measures of total volume and total minimum cross-sectional area were collected. Subjective symptoms were collected using a visual analog scale and an ordinal scale.

Results

With both products, there was significant increase in the size of the minimum cross-sectional area compared to placebo, p = 0.004. This is supported by the decrease in the subjective reports of congestion; on the visual analog scale, compared to placebo p = 0.012 and the ordinal scale, compared to placebo, p = 0.004.

Conclusion

Both devices significantly increase the size of the nasal valve area and reduce congestion in normal subjects.
The Effects of an External Nasal Dilator on Labor
Authors: Sadan Oscar , Shushan Sagit , Eldar Ido , Evron Shmuel , Lurie Samuel , Boaz Mona , Glazerman Marek , Roth Yehudah
Published: August 2018

Background

The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus.

Methods

One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed.

Results

No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001).

Conclusion

Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.
Long-Term Effects of FloSeal™ Packing After Endoscopic Sinus Surgery
Authors: Chandra Rakesh K. , Conley David B. , Haines G. Kenneth , Kern Robert C.
Published: August 2018

Background

A previous study by our group showed increased adhesions and granulation tissue in ethmoid cavities packed with FloSeal (FS) compared with those packed with thrombin-soaked gelatin foam after endoscopic sinus surgery (ESS). That study included 20 patients whose cavities were graded 6–8 weeks postoperatively. The goal of this study was to report long-term follow-up on this cohort.

Methods

At least 1 year follow-up was available in 18/20 patients. The number of office procedures required to lyse adhesions during the follow-up period was tabulated also. Pathology was available from one patient who underwent lysis of adhesions on an FS side. The histopathological findings are presented.

Results

The mean follow-up period was 21.4 (±2.3) months, and none of the 18 patients required revision ESS during this interval. The overall incidence of adhesions (p = 0.013) and the number requiring lysis of adhesions (p = 0.046) were both greater in the FS group. During the interval between previous study evaluation (6–8 weeks postop) and last follow-up, five FS sides required a total of seven procedures to lyse adhesions. Silent adhesions were observed in an additional five FS sides. Although asymptomatic adhesions were observed in two thrombin-soaked gelatin sides at last examination, none underwent lysis. Biopsy of an adhesion from a patient packed with FS 25 months earlier revealed incorporated foreign material.

Conclusion

FS appears to be associated with scar tissue formation and may be incorporated into recovering mucosa. Use of FS may increase the degree of postoperative care required after ESS.
The Effect of Topical Corticosteroid on Basic Fibroblast Growth Factor in Nasal Polyp Tissue
Authors: Yariktas Murat , Doner Fehmi , Sutcu Recep , Demirci Mustafa , Dogru Harun , Yasan Hasan
Published: August 2018

Background

The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid.

Methods

Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 μg/day. The bFGF levels were measured by competitive enzyme immunoassay method.

Results

The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 ± 826 ng/mg protein (range, 416–3434 ng/mg) and 1340 ± 749 ng/mg protein (range, 330–3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011).

Conclusion

Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.
The Effect of Insulin-Like Growth Factor 1 Incorporated into a Hyaluronic Acid-Based Nasal Pack on Nasal Mucosal Healing in a Healthy Sheep Model and a Sheep Model of Chronic Sinusitis
Authors: Rajapaksa Suresh , McIntosh David , Cowin Allison , Adams Damian , Wormald Peter-John
Published: August 2018

Background

Endoscopic sinus surgery (ESS) is the accepted surgical treatment for chronic refractory rhinosinusitis. Prolonged healing and adhesion formation remain common problems. This study investigates the use of a hyaluronic acid-based pack impregnated with insulin-like growth factor (IGF) 1 to facilitate more rapid and effective healing after ESS in a healthy sheep model and a sheep model of chronic sinusitis.

Methods

This study used 12 healthy sheep and 9 sheep with chronic sinusitis. In each sheep one side (computer randomized) was used as a control. Under endoscopic guidance, mucosal injuries and adhesions were created on both sides and were either packed with a hyaluronic acid pack impregnated with IGF-1 or left unpacked as a control. Serial biopsies were performed for 4 months.

Results

In the healthy sheep there was a statistically significant (p < 0.05) improvement in reepithelialization in IGF-1 packed wounds at day 28 (89% for IGF-1 versus 44% for controls). In both healthy sheep and sheep with sinusitis there was no significant difference in mucosal reepithelialization at any of the other measured time points. In the sinusitis group, there was a significant decrease in ciliary regeneration at day 56 in the Merogel/IGF-1 group compared with the control group: 59.20% versus 77.68% (p < 0.01) and at day 112, 69.70% versus 87.26% (p < 0.01).

Conclusion

Hyaluronic acid impregnated with IGF-1 improved reepithelialization in the healthy sheep but not in the sheep with chronic rhinosinusitis. These packs had a detrimental effect on mucosal ciliary regeneration in the sheep with chronic rhinosinusitis.
Effects of Anatomical Variations of the Nasal Cavity on Acoustic Rhinometry Measurements: A Model Study
Authors: Cakmak Ozcan , Çelik Huseyin , Cankurtaran Mehmet , Ozluoglu Levent Naci
Published: August 2018

Background

The goal of this study was to assess how anatomic variations of the nasal cavity affect the accuracy of acoustic rhinometry (AR) measurements.

Methods

A cast model of a human nasal cavity was used to investigate the effects of the nasal valve and paranasal sinuses on AR measurements. A luminal impression of a cadaver nasal cavity was made, and a cast model was created from this impression. To simulate the nasal valve, inserts of varying inner diameter were placed in the model nasal passage. To simulate the paranasal sinuses, side branches with varying neck diameters and cavity volumes were attached to the model.

Results

The AR measurements of the anterior nasal passage were reasonably precise when the passage area of the insert was within the normal range. When the passage area of the insert was reduced, AR measurements significantly underestimated the cross-sectional areas beyond the insert. The volume of the paranasal sinus had limited effect on AR measurements when the sinus ostium was small. However, when the ostium size was large, increasing the volume of the sinus led to significant overestimation of AR-derived areas beyond the ostium.

Conclusion

The pathologies that narrow the anterior nasal passage result in the most significant AR error by causing area underestimation beyond the constriction. It also appears that increased paranasal sinus volume causes overestimation of areas posterior to the sinus ostium when the ostium size is large. If these physical effects are not considered, the results obtained during clinical examination with AR may be misinterpreted.