Showing papers in "American Journal of Rhinology in 1998"
TL;DR: Findings from this study further the understanding of chronic sinusitis and may help guide practitioners in the treatment of this disease.
Abstract: In chronic sinusitis, culture-directed antibiotics are often recommended as a cornerstone of treatment. The significance of Gram-negative rods (GNRs), coagulase-negative Staphylococci (SCN), and St...
185 citations
TL;DR: It appears that specific cytokine patterns are found in different forms of sinusitis, and that IL-5 may represent the most important cytokine responsible for tissue eosinophilia in nasal polyposis.
Abstract: Cytokines are potent biologic factors involved in the regulation of inflammation, immune defense, and wound healing. Recently, growing interest has developed in the role of cytokines in chronic sin...
109 citations
TL;DR: The endoscopic Lothrop procedure is a viable option before frontal sinus obliteration in patients with recurring frontal Sinusitis who have failed conventional endoscopic techniques.
Abstract: Over a 2-year period, 21 patients with clinical and radiologic evidence of persistent or recurrent frontal sinusitis who had a prior ethmoidectomy and/or frontal sinusotomy underwent an endoscopic Lothrop procedure The patients' chief complaints were headaches (13), nasal obstruction and/or purulent rhinorrhea (4), orbital abscess/cellulitis (2), anosmia (1), and cough (1) Preoperative frontal headaches were present in 19 patients The common frontal ostium remained patent (> 50% of intraoperative size) by flexible fiberoptic examination and transillumination 2-24 months postoperatively in 12 of 21 patients (57%) Eighteen of 21 patients (86%) had improved or resolved chief complaints All but 4 of 19 patients (21%) with preoperative frontal headaches had improved or resolved symptoms Two patients required additional surgery during the follow-up period The endoscopic Lothrop procedure is a viable option before frontal sinus obliteration in patients with recurring frontal sinusitis who have failed conventional endoscopic techniques The surgical technique and results will be presented
104 citations
TL;DR: Sinus symptom scores was significantly more reduced in the Aqua compared to the Turbuhaler treated group, and both reduced symptom scores were significantly better compared to placebo, but there was no statistical difference between the two actively treated groups.
Abstract: Nasal polyps are commonly treated surgically. Intranasal administration of topical corticosteroids has gained increased acceptance as a treatment alternative. The aim of our study was to compare th...
102 citations
TL;DR: This study suggests that the 30 and 40-item UPSITs correlate well with measures derived from the T&T olfactometer, and that all three tests are sensitive to the smell loss of Japanese sinusitis/polyposis patients.
Abstract: The University of Pennsylvania Smell Identification Test (UPSIT) and a smell ability questionnaire were administered to 167 Japanese volunteers ranging in age from 20 to 59 years. Of these subjects, 80 also received the TT UPSIT40 r = 0.58; TT T&T recognition r = 0.69, p < 0.001), indicating that subjects are relatively accurate in assessing their olfactory ability. This study suggests that the 30 and 40-item UPSITs correlate well with measures derived from the T&T olfactometer, and that all three tests are sensitive to the smell loss of Japanese sinusitis/polyposis patients.
95 citations
TL;DR: Endoscopic dissection indicates that the sphenoethmoid (Onodi) cell is a more frequent anatomic variant than previously appreciated, and awareness of anterior sphenoid wall orientation may assist surgeons in identifying the Onodi cell, thereby reducing the risk of optic nerve trauma.
Abstract: Optic nerve injury is a devastating potential complication of endoscopic sinus surgery. Anatomic variations of the posterior ethmoid sinus are certainly contributing factors. In the most well described posterior ethmoid anatomical variant, the sphenoethmoid or Onodi cell, the optic nerve is placed at risk during sinus surgery. Improving preoperative and intraoperative identification of the sphenoethmoid (Onodi) cell could decrease the risk of optic nerve injury. The purpose of this investigation was to assess the reliability of computerized tomography (CT) in detecting the sphenoethmoid (Onodi) cell, and further our understanding of this clinically relevant anatomic variant. A total of 41 sinonasal complexes from 21 human adult cadaveric heads were studied with a standard coronal and axial plane CT, and subsequent endoscopic dissection. The prevalence of the sphenoethmoid (Onodi) cell was determined by CT and endoscopic dissection, as were other anatomic characteristics of the posterior ethmoid anatomy. In our study, CT identified a sphenoethmoid (Onodi) cell in 3/41 (7%) of the sphenoethmoid complexes. However, anatomic dissection identified a sphenoethmoid (Onodi) cell in 16/41 (39%) complexes. Coronal orientation of the anterior sphenoid wall was never associated with a sphenoethmoid (Onodi) cell. Conversely, oblique or horizontal orientations were present in all cases of sphenoethmoid (Onodi) cells. Current CT scanning protocols for the paranasal sinuses did not reliably detect the Onodi cell. Endoscopic dissection indicates that the sphenoethmoid (Onodi) cell is a more frequent anatomic variant than previously appreciated. Awareness of anterior sphenoid wall orientation may assist surgeons in identifying the Onodi cell, thereby reducing the risk of optic nerve trauma.
92 citations
TL;DR: Nine of 10 patients survived with an average hospital stay of 27.8 days (median of 17 days) and one child had recurrent meningitis, believed to be due to skull base dehiscence after endoscopic sinus surgery (ESS).
Abstract: Intracranial complications of sinusitis (ICS) (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and contemporary topic. The progressive...
91 citations
TL;DR: Preliminary data suggest that both an increased incidence of antimicrobial resistance and of enteric gram negative bacilli may exist in these outpatient, tertiary care center patients with chronic bacterial sinusitis.
Abstract: Recent reports describe the emergence of antimicrobial resistant bacteria in acute sinusitis and an increased incidence of enteric gram negative bacilli in chronic sinusitis. The objective of this ...
88 citations
TL;DR: It was found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip, and nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.
Abstract: The diagnosis of chronic sinusitis can be difficult due to the variety and lack of specificity of presenting symptoms. Sinus CT scanning is presently considered the most sensitive and specific diagnostic method, but is expensive. In order to determine whether a combination of patient symptoms and nasal endoscopy could be used to predict which patients would have CT evidence of chronic sinusitis, we conducted a prospective study in which 92 consecutive patients referred for chronic sinusitis were required to fill out a questionnaire detailing their symptoms. Their responses were then correlated with subsequent findings on nasal endoscopy and CT scanning. Briefly, we found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip. Also, nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.
72 citations
TL;DR: The aim of the present study was to assess the clinical utility of acoustic rhinometry (AR) compared with active anterior rhinomanometry (AAR) in the evaluation of nasal patency in subjects with nasal septal deviation.
Abstract: The aim of the present study was to assess the clinical utility of acoustic rhinometry (AR) compared with active anterior rhinomanometry (AAR) in the evaluation of nasal patency in subjects with nasal septal deviation. Fifty patients were divided into three groups based upon the part of the nasal cavity where the septal deviation was situated (anterior: up to 2.5 cm; middle: between 2.5 and 4.5 cm; posterior: between 4.5 and 8 cm measured from the columella). The control group consisted of 15 subjects with no nasal complaints and no history of nasal disease. Inspiratory and expiratory nasal airway resistance (NAR) at 75 Pa and at 150 Pa before and after decongestion were measured by AAR. Minimal Cross-sectional Area (MCA), distance of MCA, and nasal volume (Vol) were measured before and after decongestion by AR (Rhino 2000). Subjective nasal patency was assessed by Visual Analogue Score (VAS). In the statistical analysis the deviated unilateral nasal cavities were compared with the randomly chosen unilateral nasal cavities of normal subjects. Both techniques AR and AAR were sufficiently sensitive to reveal severe deviations in the anterior nasal cavity (MCA, Volant, NAR75, NAR150, p 0.05). The nondecongested inspiratory and expiratory NAR at 150 Pa were the only parameter that differed from normal in cases of posterior deviations. The VAS correlated better with NAR than with MCA. MCA correlated more frequently with expiratory than with inspiratory NAR.
71 citations
TL;DR: Clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas are reviewed, and the indications for surgical intervention are discussed.
Abstract: Craniofacial osteomas are benign tumors of the skull base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement, followed by the ethmoid, maxillary, and sphenoid sinuses, respectively. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection. The tumors are hard and lobulated with an ivory-like appearance, often mixed with a coarse granular component. The bone is compact or cancellous, with vascular or connective tissue components. The complications of osteoma growth are obstruction of sinus ostia, extension into adjacent bones and the intracranial cavity, and displacement of anatomic structures. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. When surgery is performed, these tumors can be successfully managed via endoscopic, open, or combined techniques. This article reviews the clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas. The indications for surgical intervention are discussed.
TL;DR: The data suggest that acoustic rhinometry is valuable for inter-individual comparisons and there was a significant correlation between the minimal cross-sectional area (MCA) and nasal volume.
Abstract: Reference values for acoustic rhinometry are presented from 334 individuals without nasal symptoms between 4 years and 61 years old. There was a significant correlation between the minimal cross-se...
TL;DR: Treatment of rhinovirus colds may require an antiviral agent (e.g., interferon a) in combination with antiinflammatory medication, which will depend on the causative virus.
Abstract: Upper respiratory viruses cause self-limited illness characterized by acute rhinitis. In rhinovirus colds the symptoms are thought to be caused by the host response rather than viral damage of the ...
TL;DR: The following approach to allergic fungal sinusitis is found to be most effective: adequate preoperative evaluation and medical preparation, closely supervised immunotherapy with relevant fungal and non-fungal antigens, and close clinical follow-up with endoscopically guided debridement when necessary.
Abstract: In little more than a decade, allergic fungal sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with pansinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained within the sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and fungal stains show the presence of noninvasive hyphae. Fungal cultures may or may not be positive. We have found the following approach to allergic fungal sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant fungal and non-fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by the patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.
TL;DR: Data show that tissue engineering with isolated multiplied human chondrocytes from a tiny biopsy seeded on bioresorbable polymer is a promising system to generate autologous cartilage transplants for replacements in reconstructive surgery.
Abstract: In reconstructive surgery there is increasing demand for cartilage transplants to fill defects, especially nose and/or outer ear defects. Tissue engineering is one of the most modern pathways to ge...
TL;DR: Paraffin-embedded tissues of 42 sinonasal inverted papillomas were subjected to polymerase chain reaction using type-specific primers pairs of HPV 6, 11, 16, 18, and 33 to suggest that HPV may be involved in the pathogenesis of inverted papilomas, may cause malignant transformation of inverted Papillomas, and that there may be an apparent relationship between HPV infection and the recurrence of sinon asal inverted Papilomas.
Abstract: Paraffin-embedded tissues of 42 sinonasal inverted papillomas were subjected to polymerase chain reaction using type-specific primers pairs of HPV 6, 11, 16, 18, and 33. Two cases of HPV 11 and one of HPV 6 were amplified in 36 samples of benign inverted papilloma, and two cases of HPV 16 were amplified in five samples of inverted papilloma with co-existing squamous cell carcinoma. Inverted papillomas recurred in 1 (16%) of 6 cases exhibiting dysplasia, and in 3 (10%) of 30 cases not exhibiting dysplasia. Inverted papillomas also recurred in 2 (66%) of 3 cases positive for HPV, and in 2 (6%) of 33 cases negative for HPV. These results suggest that HPV may be involved in the pathogenesis of inverted papillomas, may cause malignant transformation of inverted papillomas, and that there may be an apparent relationship between HPV infection and the recurrence of sinonasal inverted papillomas.
TL;DR: Three potential functional abnormalities are discussed in this article: those associated with the aging process of the nasal mucosa, those resulting in various forms of nasal hyperreactivity, and those reflecting imbalanced neuronal control of end organs of the nose.
Abstract: Most patients who suffer from chronic noninfectious, nonallergic rhinitis (NINAR) cannot be assigned to a syndrome of known etiology. The symptomatology may well resemble that of allergic rhinitis; however, NINAR has lower prevalence of sneezing, conjunctival symptoms, and pruritus and higher prevalence of symptoms compatible with sinus disease. The triggers for the symptoms of NINAR are mainly irritants and changes in atmospheric conditions. Among individuals who develop chronic rhinitis symptoms, the percentage of nonallergic etiology increases steadily with age and is more than 60% beyond the fifth decade of life. Our strategy regarding the pathophysiology of NINAR should be to identify functional abnormalities of nasal mucosa that can potentially result in the alleged nasal symptoms. In this respect, comparison of patients with NINAR to patients with allergic rhinitis and to healthy individuals could shed light into the cause(s) of NINAR. Three potential functional abnormalities are discussed in this article: those associated with the aging process of the nasal mucosa, those resulting in various forms of nasal hyperreactivity, and those reflecting imbalanced neuronal control of end organs of the nose. The most interesting development in the therapy of NINAR is the use of capsaicin. Although placebo-controlled studies are scarce and participants have not been adequately characterized, it is possible that abnormal nociceptor nerve endings play a role in the generation of the symptoms of NINAR. Alternatively, NINAR may represent a condition of increased perceptual acuity to irritants and to environmental changes. This problem may also benefit from defunctionalization of nociceptors.
TL;DR: In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed, and the costalcartilage graft and rib bone/costal cartilage combination graft are excellent alternatives.
Abstract: In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed. The costal cartilage graft and rib bone/c...
TL;DR: The middle turbinate is an excellent source of donor material for repair of almost any endoscopically repairable CSF leak.
Abstract: Endoscopic management of CSF leaks has been reported as highly successful by several authors. Various techniques are used for site preparation, graft selection, and graft stabilization. In this report the middle turbinate as a donor site for repair is described. Guidelines for harvest, preparation, and application are presented. The middle turbinate graft can be used as a free mucosal graft for linear cracks or small defects, as a composite bone/mucosal graft for moderate sized defects, or as a donor site for separate bone and mucosal grafts for large defects or encephaloceles when intracranial bone placement is desirable. Experience with 18 patients is presented with 100% initial graft take, and 17/18 (94%) with long term success. The middle turbinate is an excellent source of donor material for repair of almost any endoscopically repairable CSF leak.
TL;DR: The impression is that the transnasal endoscopic approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.
Abstract: The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidit...
TL;DR: These results failed to show a significant difference between the different lasers for inferior turbinate reduction, and overall, the results were not impressive.
Abstract: Lasers using different wavelengths and delivery systems have been used to reduce the inferior turbinate mass when hypertrophic inferior turbinates obstruct the nasal airway. Different laser systems produce different laser-tissue interactions. This study presents a comparison between three laser systems: CO2, Nd:YAG, and Diode lasers for inferior turbinate reduction surgery, all performed under endoscopic control. A total of 46 patients were randomized into three treatment groups and followed for more than 1 year. Subjective and objective data were collected. Subjective impressions of improved nasal airway was achieved in 41% (Diode), 47% (Nd:YAG) and 57% (CO2) and was not statistically significant. There was more postoperative bleeding in the CO2 laser group, with 3 patients requiring tamponade. The CO2 laser procedure also took longer to perform. These results failed to show a significant difference between the different lasers for inferior turbinate reduction. Overall, the results were not impressive.
TL;DR: A case report of a cavernous carotid artery injury during functional endoscopic sinus surgery is presented and relevant anatomy, preventive measures, and treatment approaches are discussed.
Abstract: Injury to the cavernous portion of the internal carotid artery is a well recognized and dreaded complication of functional endoscopic sinus surgery. Little information, however, has been presented in the Otolaryngology literature regarding the etiology, prevention, or treatment of this complication. The purpose of this study is to present a case report of a cavernous carotid artery injury during functional endoscopic sinus surgery. Relevant anatomy, preventive measures, and treatment approaches are discussed for this difficult problem.
TL;DR: The management of four patients with significant sinus complications is discussed, the otolaryngologist's role in the preoperative and postoperative care of these patients is evaluated, and the techniques of sinus augmentation and osseointegration are discussed.
Abstract: Osseointegrated dental implants are a widely used method of replacing lost or missing teeth. Resorption of the alveolar ridge of the edentulous posterior maxilla may necessitate augmentation before...
TL;DR: The acute selective migration of eosinophils after allergen challenge is not fully understood, nor is the role of chemokines in allergic and viral rhinitis.
Abstract: This review summarizes our current knowledge of nasal allergic inflammation based on studies of cytokines, chemokines, and adhesion molecules in allergic rhinitis. The article also includes some aspects of viral rhinitis. Due to artificial or natural allergen exposure, an increase in the number of eosinophils and basophils, mast cells, IgE-positive cells, macrophages, monocyte-like cells, Langerhans cells, and activated T-cells can be observed within the mucosa and on the mucosal surface. Mediators are known to be released in response to allergens, but do not seem to be adequate to initiate the cell recruitment. After antigen challenge, the release of proinflammatory and regulatory cytokines could be demonstrated, and TH2-type cytokine mRNA upregulation in allergic mucosa has been shown. Proinflammatory cytokines initiate an adhesion cascade and activate T-cells that create an "atopic" cytokine environment within the tissue, which also may be linked to the long-term selective recruitment of eosinophils. However, the acute selective migration of eosinophils after allergen challenge is not fully understood, nor is the role of chemokines in allergic and viral rhinitis. Allergic rhinitis clearly represents an inflammatory reaction.
TL;DR: It is concluded that the severity of HTN and a history of epistaxis were not associated in a cohort of hypertensive patients and the identification of other risk factors for epistaxis, including the duration ofHTN, deserves further study.
Abstract: Hypertension (HTN) has frequently been cited as a general risk factor for epistaxis. However, studies dealing with this association have yielded equivocal results. In this study, a sample of 121 hypertensives (blood pressure > or = 140/90 mmHg) was selected to evaluate the association between the severity of HTN and a previous history of epistaxis. Patients with an average blood pressure > or = 160/100 mmHg were classified as suffering from a more severe form of HTN and were compared with those with a less severe form of the disease (160/100 mm Hg or = 140/90 mm Hg). The frequency of epistaxis did not differ among patients categorized by the severity of HTN. Users of aspirin were found to be twice as likely to have a history of epistaxis. In addition, there was a statistical tendency for an association between a history of epistaxis and the duration of hypertension. We conclude that the severity of HTN and a history of epistaxis were not associated in a cohort of hypertensive patients. The identification of other risk factors for epistaxis, including the duration of HTN, deserves further study.
TL;DR: This study suggests that, when snoring and nasal obstruction coexist, nasal surgery should be considered as the first line of surgical treatment.
Abstract: Patients with nasal obstruction often have associated snoring. It is uncertain whether surgery, which relieves the nasal obstruction, will also relieve the snoring. We have reviewed 96 patients who complain of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 48 patients (50%), was less loud in a further 38 patients (40%), unchanged in 8 patients, and louder in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after nasal surgery is postulated to be important in influencing snoring relief. This study suggests that, when snoring and nasal obstruction coexist, nasal surgery should be considered as the first line of surgical treatment.
TL;DR: Preliminary evidence demonstrates that mucociliary transport correlates with ciliary structure and orientation as investigated with transmission and scanning electron microscopy, and an ultrastructural distinction is proposed among normal, light, moderate, and severe secondary ciliary dyskinesia.
Abstract: Mucociliary transport is one of the most important defense mechanisms of the airway. Mucociliary transport time or rate, as measured using the saccharin test or the radioisotope technique, respectively, is clinically the most relevant parameter, although subject to large intra- and interindividual variability. There is no correlation between mucociliary transport in vivo and ciliary beat frequency ex vivo. Preliminary evidence demonstrates that mucociliary transport correlates with ciliary structure and orientation as investigated with transmission and scanning electron microscopy. A correlation is presented between ciliary beat frequency and secondary ciliary abnormalities. This correlation can best be described according to the logistic sigmoid model (r = 0.69). Based on these functional data, an ultrastructural distinction is proposed among normal (less than 5%), light (5 to 15%), moderate (15 to 25%), and severe (more than 25%) secondary ciliary dyskinesia.
TL;DR: This is the second report of rhinocerebral mucormycosis caused by Apophysomyces elegans, a newly recognized genus and species classified in the family Mucoraceae in immunocompetent individuals with no underlying medical problems.
Abstract: Mucormycosis is an uncommon fungal disease and one of the most fulminant infections known This is the second report of rhinocerebral mucormycosis caused by Apophysomyces elegans, a newly recognized genus and species classified in the family Mucoraceae The patient was a 54-year-old man being treated for a severe sinus infection with antibiotics and oral steroids Recovery occurred in our patient after prompt surgical debridement and drainage of his maxillary sinuses This case fits the reported characteristics of other A elegans infections including warm climate, intimate contact with the soil, and an incubation period measured in days Several reported cases indicate A elegans can cause mucormycosis in immunocompetent individuals with no underlying medical problems
TL;DR: Regular and prophylactic use of topical corticosteroids is a well tolerated and effective treatment for allergic rhinitis.
Abstract: Regular and prophylactic use of topical corticosteroids is a well tolerated and effective treatment for allergic rhinitis. The symptomatology of allergic rhinitis is considered to be the result of ...
TL;DR: In conclusion, constitutively active secretory processes that regulate continuous production of nasal secretions are not altered in FM/CFS, and future studies should examine alternative mechanisms such as inducible, irritant-activated, or reflex-mediated effects.
Abstract: Rhinitis symptoms are present in approximately 70% of subjects with fibromyalgia and chronic fatigue syndrome (FM/CFS) Because only 35% to 50% have positive allergy skin tests, nonallergic mechani