Computed tomography scan of rhinosinusitis, current practice, and requirements for endoscopic surgery of paranasal sinuses

To evaluate the current practice in requesting and performing paranasal sinuses CT scan for patients scheduled for endoscopic sinus surgery, and to describe the current hospital's practice in performing these scans. This cross-sectional questionnaire study was conducted in the King Hussein Medical Center, Amman, Jordan between April and May 2010. Three forms were designed to collect data from our study groups, which included: Ear, Nose and Throat [ENT] surgeons, radiologists, and the radiology sections in 3 hospitals. The first was designed for ENT surgeons and aimed at investigating, whether or not they perform endoscopic sinus surgery, and if they have specific requirements for a CT scan of the sinuses. The second was designed for the radiologist to investigate their specifications in performing CT of the sinuses. The last was designed to evaluate the current practice of performing CT of the sinuses at the 3 hospitals. Twenty-four ENT surgeons participated, 83.3% surgeons performed endoscopic sinus surgery, and 83.3% requested specific specifications for the sinuses CT scan, and the most requested specification was coronal plane in 42%. Of the 24 radiologists, 71% prefer the prone position, 71% prefer the coronal plane, and 71% preferred direct coronal. In all 3 hospitals, the axial plane with reconstructed coronal images, the current practice with a slice thickness of 2-3 mm, and the total number of images was 40-50. Differences between ENT surgeons, radiologists, and hospital's practice and other hospitals guidelines found in literature are present. Therefore, we are in need of an agreed upon guideline protocol to obtain the best data with the least radiation dose

Solitary extramedullary plasmacytoma of the tonsil

We report a rare case of extramedullary plasmacytoma of the left tonsil in a 45 year old male patient. He presented with a two months history of left sided throat discomfort, clinical examination revealed a left sided diffuse tonsillar enlargement. Histopathologic examination of the tonsillectomy specimen was consistent with plasmacytoma. Serum electrophoresis failed to detect any myeloma component. Assays for Bence Jones protein were negative. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. The patient received full course of radiotherapy and he is currently without evidence of disease twelve months postoperatively

Evaluation of post-tonsillectomy hemorrhage

The major risk for tonsillectomy is postoperative hemorrhage, which can traditionally be classified as: 1] Primary post-tonsillectomy hemorrhage, 2] secondary hemorrhage. Recent studies have focused on the control of primary hemorrhage in order to determine the appropriate length of postoperative observation. The main aim of this study was to ascertain the number of episodes of post-tonsillectomy hemorrhage that required surgical treatment under general anesthesia and to identify the sufficient follow up period for tonsillectomy patients. The sample of this study comprised 202 patients who undergone inpatient tonsillectomy in Queen Alia Hospital, between July 2003 and July 2004. Patients were discharged two days after the surgery and were followed up for one month. Eleven patients [5.4%] had experienced post- tonsillectomy bleeding that required surgical hemostasis under general anesthesia. Seven patients from this group [63.6%] had experienced primary hemorrhage and were treated immediately, four patients [36.4%] experienced secondary hemorrhage. The results of this study suggest that patients can be safely discharged from hospital at the second post-operative day. Bleeding episodes that occur beyond 10 days are very rare therefore a follow-up period of 10 days appears to provide sufficient time to control all cases of secondary post-tonsillectomy hemorrhage