American journal of rhinology最新文献

Background: Tension pneumocephalus is an uncommon, but life-threatening, postoperative complication associated with craniofacial resection. This study was performed to evaluate our institution's experience using nasal trumpets for airway diversion.

Methods: A retrospective chart review was performed of patients who underwent anterior craniofacial resection (ACR) from 2000 to 2006. After Institutional Review Board approval, charts were reviewed with specific attention to short- and long-term complications.

Results: Twenty-two patients have undergone ACR since 2000 and had nasopharyngeal airways postoperatively. Nineteen patients (86.4%) were extubated on the day of surgery. Fourteen patients (63.6%) spent 1 day in an intensive care unit for observation. Nasal trumpets remained in place for an average of 7.3 days and patients had an average hospital stay of 7.4 days. Complications occurred in 14 patients (63.6%), with infection as the most common cause. No cases of tension pneumocephalus, meningitis, epidural abscess, or bone flap loss occurred in this group of patients.

Conclusion: We present the use of nasopharyngeal airways in postoperative ACR patients as a successful method of airway diversion, which can significantly reduce the incidence of postoperative pneumocephalus and related morbidity.

Objective: To assess role of hydroxyl radials in the ozone-induced upper airway hyper-responsiveness to tachykinins.

Methods: A prospective, controlled, animal model (n = 96) was performed. Half of them exposed to air (A-group, placebo) and the other half exposed to 3 ppm ozone (O-group) for 2 h. Two hours post air/ozone exposure, animals were anesthetized and equally randomized to be pretreated with one of the three treatments, including saline vehicle, dimethylthiourea (DMTU; 500 mg/kg m, a hydroxyl radical scavenger), or phosphoramidon (Phos; 2 mg/kg, an inhibitor for neutral endopeptidase). Ten minutes after pretreatment, half of the animals in each group were i.v. injected with capsaicin (2 microg/kg), and the other half were i.v. injected with substance P (10 microg/kg) to produce Evans blue dye extravasation.

Results: Nasal exudative response to capsaicin or substance P in O-group was found to be significantly greater than that in A-group. This ozone-induced nasal airway hyperresponsiveness was largely prevented by DMTU. Phosphoramidon produced a similar nasal airway hyperresponsiveness in the A-group, but failed to alter ozone-induced nasal airway hyperresponsiveness in O-group. In sharp contrast, only substance P, but not capsaicin, produced a laryngeal exudative response in the A-group, which was similar to that in the O-group. The laryngeal exudative response to substance P was not significantly affected by DMTU or Phos.

Conclusion: In the guinea-pig model, hydroxyl radicals play a vital role in the development of ozone-induced nasal airway hyperresponsiveness to tachykinins. It is possibly mediated through the suppressive action of ozone on the tachykinin degradation.

Background: The transsphenoidal approach (TSA) is the procedure of choice for the vast majority of pituitary neoplasms. Sinusitis is considered a contraindication to TSA because of possible transcranial spread of infection. This study was performed to determine if TSA for pituitary tumors could be extended to patients with pituitary adenoma and chronic rhinosinusitis (CRS).

Methods: Medical records, including rhinologic outcomes, were retrospectively assessed in 11 consecutive patients who underwent concurrent TSA and endoscopic sinus surgery (ESS) because of pituitary adenoma and CRS between May 2004 and October 2007.

Results: The 11 patients consisted of 5 men and 6 women, with a mean age of 55 years (range, 31-69 years) and average follow-up of 24.4 months (range, 6-44 months). Preoperatively, all patients had symptoms of CRS, but none had acute exacerbation of rhinosinusitis. All patients had CRS and two had nasal polyps. TSA was via the transcolumellar transseptal approach in seven patients and the transnasal approach in four patients. No postoperative complications due to ESS were observed. Two patients, including one with sphenoid aspergillosis, had preoperative unilateral sphenoid sinusitis, which was managed by ESS on the involved side, with TSA performed concurrently through the contralateral healthy sphenoid sinus. There was one case of postoperative sphenoid sinusitis and one case of septal perforation due to TSA. There were no postoperative intracranial complications, including meningitis and brain abscess.

Conclusion: Concurrent TSA and ESS can be performed in selected patients with CRS and pituitary adenoma. Future studies should involve more patients and longer follow-ups.

Background: This study was performed to show occlusion of the nasofrontal duct and mucocele formation in a goat model. A pilot study was performed to investigate whether a goat is a suitable model for creating nasofrontal duct obstruction and mucocele formation.

Methods: Three adult goats underwent frontal sinus anterior table osteoplastic flap creation with identification and occlusion of the nasofrontal outflow tract with frontalis muscle plugging. Three months later, the goats were killed and gross examination of the frontal sinus, along with histopathological confirmation of mucocele formation, were performed.

Results: All animals showed mucocele formation on gross examination and histological sectioning. There was no gross or histological evidence of bony erosion. The nasofrontal outflow tracts remained occluded.

Conclusion: This study provides a suitable animal model for the investigation of nasofrontal outflow tract obstruction and mucocele formation in the frontal sinus. The goat frontal sinus and nasofrontal outflow tract provide an excellent model for frontal sinus studies because they are comparable in size with humans. The results provide evidence of mucocele formation with occluded nasofrontal outflow tracts.

Background: Retrobulbar hematoma (RH) is a complication that can result from both otolaryngic and ophthalmologic procedures. RH can occur during endoscopic sinus surgery and improper treatment can result in several morbidities, including visual loss. Despite serious consequences, management for RH is not well evaluated. However, lateral canthotomy with cantholysis is generally recommended. The objective of this study is to review the management for RH.

Methods: A retrospective study was performed at our tertiary hospital from 1979 to 2006 for patients with the ICD-9 code for orbital hematoma. The demographic information, comorbidities, presentation, management, follow-up period, and outcomes were evaluated. Data were analyzed.

Results: Twenty-two patients were identified with 13 male patients and an average age of 43 years (range, 11-80 years). The RH was broken into three categories: iatrogenic, six cases; trauma, eight cases; and spontaneous, eight cases. The most common symptom was diplopia followed by orbital pain. The average pretreatment and posttreatment tonometric pressures were 25.3 mm Hg (range, 11-60 mm Hg) and 14.5 mm Hg (range, 10-22 mm Hg), respectively. The average proptosis was 4.3 (range: 0-8) mm. Treatments were observation (13 cases), medical treatment alone (4 cases), and surgical treatment with and without medical treatment (5 cases). Sixty-eight percent of the patient's visual acuity improved with these treatments. Twenty-seven percent had no visual changes from the RH. The average follow-up was 5 years.

Conclusion: Traditionally, lateral canthotomy with cantholysis is recommended for the treatment for RH. However, in certain patients and settings, there may be an acceptable alternative option for the management of RH.

Background: Nasal irrigation is widely used in treating sinonasal diseases. Not only does it remove static secretions and promote mucociliary clearance, but, in chronic rhinosinusitis, nasal flush is also a potential route for topical drug administration into paranasal sinuses. A clinical study was conducted to investigate how well nasal irrigation could reach paranasal sinuses with the ostiomeatal units blocked in chronic rhinosinusitis. This study was performed to (1) assess the ability of a nasal douche and spray to deliver a solution into the paranasal sinuses in chronic rhinosinusitis and (2) compare the performance of the two techniques.

Methods: Fourteen patients, with bilateral chronic rhinosinusitis, underwent nasal irrigation with 140 mg/mL of iodinated contrast solution by 40 mL of douching using an irrigation syringe in one side, and 10 mL of spraying in the other side. A computed tomography scan was undertaken for each patient to determine the volume and the distribution of staining in the nose and paranasal sinuses.

Results: Only two patients had any staining, with a small amount present in a total of three maxillary sinuses (0.10 mL, 0.04 mL, and 0.13 mL). The mean volumes of paranasal sinus staining by nasal douche and nasal spray were 0.0093 and 0.01 mL, respectively. We found that the two techniques had a similar performance. Both of them delivered only a small amount of the solution, if any, into the sinuses (with a mean difference of -0.0007 mL; 95% CI, -0.02-0.02 mL; p = 0.94).

Conclusion: Nasal douche and spray is not effective in delivering a nasal irrigation solution into paranasal sinuses in chronic rhinosinusitis.

Background: Nasal airflow, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). The decongestion test evaluates whether the application of an intranasal vasoconstrictor drug increases nasal airflow. That allergy is characterized by inflammation and that the response to the decongestion test correlates with the grade of inflammatory reaction has previously been shown. The aim of this study was to verify the suitability of the use of the visual analog scales (VASs) as a surrogate for rhinomanometry in the decongestion test assessment in patients with persistent allergic rhinitis.

Methods: One hundred three patients (mean age, 23 years [2.24 SD]) were studied. Nasal symptoms, VAS, rhinomanometry, and nasal decongestion test were assessed in all patients.

Results: A significant association was observed between VAS and nasal airflow after the decongestion test (Spearman R = -33.3%; p < 0.001). Moreover, a significant inverse association between changes in decongestion measures was detected, with a Spearman R = -64.7% (p < 0.001). The associated sensitivity was of 92.5%, and the specificity for this test was 60.0%. The corresponding area under the receiver operating characteristic curve was 0.81.

Conclusion: The use of VAS for assessing the decongestion test appears clinically relevant in that it allows, with a fair degree of reliability, such a test to be performed in the absence of rhinomanometry.

Background: Intraoperative surgical navigation has become widely accepted as an important tool for improvement of surgical outcomes and reduction of complication in endoscopic sinus surgery (ESS). The purpose of this study was to assess the clinical utility of intraoperative volume computed tomography (CT) scanning in endoscopic sinonasal and skull base procedures.

Methods: Retrospective review of patients who underwent intraoperative volume CT imaging (xCAT; XoranTechnologies, Ann Arbor, MI) during endoscopic sinonasal and skull base surgery during a 3-month period was performed. Intraoperative, computer-enabled triplanar review of reformatted 0.4-mm images was performed in all cases.

Results: Intraoperative volume CT scanning was completed in 25 patients. Surgical procedures included revision/primary ESS for chronic rhinosinusitis (CRS) with or without polyposis (12 cases) and mucoceles (6 cases) as well as endoscopic neoplasm resection (5 cases), endoscopic fibro-osseous lesion resection (1 case), and endoscopic meningoencephalocele repair (1 case). The indications for intraoperative CT scanning included assessment of surgical dissection (23 cases), extent of tumor resection (6 cases), and frontal stent placement (6 cases). Based on the intraoperative volume CT information, additional interventions, including additional tumor resection (2 cases), dissection of ethmoid partitions (2 cases), frontal bone drilling during Draf IIB (1 case), and repositioning of a frontal stent (1 case) were performed in 6 (24%) cases.

Conclusion: Intraoperative volume CT scanning was successfully performed in 25 patients undergoing ESS. Because additional surgical intervention was performed in 24% of cases, this technology may have an important role in endoscopic sinonasal and skull base procedures.

Background: The anterior nasal segment is the most effective part of the nasal airways when it comes to warming and humidification of the inhaled air. Any changes in nasal geometry in this segment modifying the airflow could therefore affect nasal air conditioning. The goal of this study was to examine if external nasal strips have an influence on intranasal geometry and air-conditioning.

Methods: Twenty healthy volunteers (mean age, 36 years) were enrolled in the study. All volunteers received active anterior rhinomanometry and acoustic rhinometry before and while wearing commercially available external nasal strips. In addition, in vivo air temperature and humidity were measured with and without nasal strips at the defined intranasal sites.

Results: No statistically significant changes in temperature, humidity, and rhinomanometric values were detected during the use of nasal strips (p > 0.05). The statistical analysis of the acoustic rhinometric results showed a significant increase (p < 0.05) in the minimal cross-sectional areas (MCA) 1 (0-2 cm) and MCA2 (2-5 cm) and the nasal volume (Vol) 1 (0-2 cm). On the other hand, the nasal strips did not significantly alter the nasal Vol2 (2-5 cm; p > 0.05).

Conclusion: Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips did not relevantly alter intranasal air-conditioning. The application of nasal strips entails an increase in MCAs but not in nasal airflow Vol.

Background: Local tissue production of antigen-specific immunoglobulin E (IgE) has been shown in patients with allergic rhinitis and in patients with chronic rhinosinusitis (CRS) with nasal polyps. In allergic fungal rhinosinusitis (AFRS), specific IgE has been established in nasal lavage fluid and eosinophilic mucin. In this study, local production of antigen-specific IgE within sinus mucosa of AFRS patients was evaluated.

Methods: Sinus mucosa homogenates from 11 AFRS patients, 8 patients with CRS without nasal polyps (CRSsNP), and 9 nonrhinosinusitis control patients were assessed for IgE localization by immunohistochemistry. AFRS and control tissue homogenates were also evaluated for antigen-specific IgE to 14 common antigens by ImmunoCAP testing (Phadia AB, Portage, MI).

Results: There was a significant increase in IgE staining in AFRS sinus epithelium and subepithelium compared with controls and with patients with CRSsNP (p

Conclusion: AFRS patients showed significantly more IgE in sinus mucosa tissue specimens, with increased IgE in subepithelial sites when compared with epithelium. The increased expression of antigen-specific IgE is not limited to fungal antigens. These findings support the role of type I hypersensitivity and local manifestations of allergy in AFRS patients.