Turbinate reduction during septoplasty; to do it or not? Clinical and radiological study

The objective was to determine whether during Septoplasty, turbinate reduction procedure should be done in every case of compensatory turbinate hypertrophy [CTH], or not. It is a prospective randomised study. 86 patients with septal deviation and compensatory turbinate hypertrophy were divided randomly into 2 equal groups; group A for whom septoplasty was done alone and group B for whom coblation-assisted turbinate reduction for CTH was done in addition. Both groups were compared as regard patient symptoms and CT measurements of the turbinate 9 months after surgery. 34.9% of group A complained of nasal obstruction in the side of CTH, compared to only 6.9% in group B. While turbinate reduction as measured by CT was significant in group A [p<0.05]; it was highly significant in group B [p<0.0001]. It was also found that there was a highly significant statistical difference between the postoperative results in the both groups in favour of group B [p<0.0001]. During septoplasty, turbinate reduction should be done in every case of CTH, as it improves patient symptoms and does not add to the complications

Radiofrequency volumetric tissue reduction with and without turbinate lateralization in the management of inferior turbinate hypertrophy

Inferior turbinate hypertrophy is one of the major causes of chronic nasal obstruction. Many procedures have been suggested, however, there is no agreement on how to deal with this problem. To evaluate and compare the efficacy and morabidity of radiofrequency volumetric tissue reduction [RFVTR], with and without turbinate lateralization in the management of inferior turbinate hypertrophy. A prospective clinical study was conducted on 36 patients with chronic nasal obstruction due to inferior turbinate hypertrophy. The cases were divided into two groups, group A: 18 patients who had RFVTR and group B: 18 patients who had RFVTR in addition to lateralization of the inferior turbinate. Procedures were done under local anaesthesia. Pstoperative follow-up visits were scheduled at 3, 7 days, 3, 6, 12 and 18 months after surgery. A standard 0-to-10 visual analogue scale [VAS] was conducted by the patients preoperatively and at every follow-up visit and video-endoscopic evaluation was used to grade nasal obstruction preoperatively and one week, 3, 18 months postoperatively. Among the 36 patients included [25 males and 9 females], the age ranged between 16 and 52 years, with a mean age of 31.5 years. No marked operative or postoperative complications. VAS scores [mean +/- SD] of group A patients for the degree of nasal obstruction changed from a preoperative score of 7.52 +/- 2.18 to 2.49 +/- 1.82 at 18 months postoperatively, and in group B, it changed from a preoperative score of 7.63 +/- 2.6 to 2.45 +/- 1.37 at 18 months postoperatively. There were no statistically significant difference between the outcomes of the two groups allover the study period or in each group when comparing early and late results [3 and 18 months postoperative] regarding the degree or the frequency of nasal blockage by VAS, or the endoscopic evaluation of airway blockage [p>0.05]. RFVTR is an effective modality in treatment of chronic nasal obstruction due to inferior to turbinate hypertrophy. Although lateralization of the inferior turbinate might be a safe and easy addition to the procedure, it did not give an addional impact on the outcome

Anterior ethmoidal artery, a surgical and radiological study

Anterior ethmoidal artery [AEA] has a great clinical and surgical importance. It is a particularly important landmark for the fovea ethmoidalis and the base of the anterior cranial fossa. It is a possible sight of traumatic or intraoperative bleeding. Accurate localization of the anterior ethmoidal canal [AEC] and anterior ethmoidal artery [AEA] both radiologically and surgically and their relation to nasal lamellas and skull base in order to avoid the serious complications that might happen after violation of the canal or the artery. 50 patients diagnosed to have chronic rhinosinusitis [CRS] with or without sinonasal polyposis were selected. All the cases were subjected to: a] preoperative computerized tomography. b] operative intervension in the form of endoscopic sinus surgery [ESS], with dissection of the roof of the ethmoid sinuses for indentification of the anterior ethmoidal canal [AEC]. Radiological evaluation was done by axial, helical thin cuts and reconstructed saggital views, while assessment during surgery was encountered after direct endoscopic visualisation, using palpation with a probe and simple ruler measurements. Twelve patients had ESS performed on one side and 38 patients ESS on both sides. Thereby, a total of 88 AEC identifications were performed. In all dissections the AEC and AEA were successfully identified surgically and radiologically. On comparing surgical and radiological localization of the AEC in relation to the lamellas, it was found that the location of the AEC was the same in 86 dissections, while not in 2 dissections. AEC was positioned inside the skull base without bony defects in 82 dissections, and in 6 dissections, 2mm below the skull base, connected to it by a mesentry. Endoscopic localization of the AEC during surgery and the results of CT imaging were comparable. It was found that the AEA, the anterior turbinate axilla and the superomedial edge of the nostril were in a straight line. This finding was extremely helpful in the endoscopic search for the AEA

Intratympanic gentamicin injection in unilateral meniere's disease: effects on vertigo attacks and hearing level

It is generally accepted that there is no specific therapy to cure Meniere's disease. The use of intratympanic gentamicin appears to be quite popular and may replace vestibular surgery. To evaluate the use of intratympanic gentamicin injection in eliminating incapacitating vertigo, while preserving hearing in Meniere's disease. 18 patients [11 males and 7 females] diagnosed as definite unilateral Meniere's disease, in accordance with the 1995 AAO-HNS guidelines, were selected. Each patient had 3 successive intratympanic gentamicin injections with one week interval. Patients evaluation was done pre-treatment and 1, 3, 6, 12, 18 and 24 months posttreatment regarding level of functional disability, vertigo control, hearing level, tinnitus and ear Fullness. 2 patients were lost during follow-up, so they were excluded from the study. Based on the 1985 AAO-HNS guidelines, vertigo control was complete in 12 patients [75%], substantial in 3 patients [18.75%] and insignificant in 1 patient [6.25%]. After exclusion of 2 additional patients with dead ears, hearing was not changed in 10 patients [71.43%], improved in 2 patients [14.28%] and worsened in 2 patients [14.28%]. No functional disability was encountered in 10 patients [62.5%], mild disability in 5 patients [31.25%] and moderate disability in one patient [6.25%] two years post-treatment. Intratympanic gentamicin injection is an excellent alternative to invasive surgical procedures in cases of Menicre's disease that resist medical treatment. It is an easy, effective office-based procedure, but with variable degrees of hearing level affection