Association of the laterality of chronic suppurative otitis media and sinonasal disease based on temporal bone CT scans and Lund Mackay scoring system

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the association between the laterality of chronic suppurative otitis media (CSOM) and the laterality of sinonasal disease, based on temporal bone CT scan results and Lund-Mackay Scoring system, among patients admitted for ear surgery in a tertiary government hospital in Metro Manila.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective review of records<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Ninety-eight (98) patients diagnosed with chronic suppurative otitis media admitted for otologic surgery in the Department of Otorhinolaryngology- Head and Neck Surgery from January 2011 to June 2014 were considered for inclusion. Hospital charts and temporal bone CT scan results were retrieved and analyzed for ear and sinonasal radiographic abnormalities and laterality. Excluded were those without CT scan plates, who underwent temporal bone surgery for reasons other than chronic suppurative otitis media, and those with incomplete records. the Lund-Mackay Scoring System was used to grade sinonasal findings which were compared to CSOM complications. Data was analyzed using t-test, ANOVA for homogenous numerical data, Kruskal-Wallis for heterogenous numerical data, and chi-square test for nominal type of data.<br /><strong>RESULTS:</strong> Of the 64 patients included in the study, 12 or 18.75% had radiographic sinonasal abnormalities. There was no significant association between the laterality of ear disease and the laterality of sinonasal pathology as there was no significant difference in the proportion of subjects with sinonasal disease according to laterality of CSOM (p=.32). When site of nose pathology was compared to Lund-Mackay graded scores, it was found that bilateral nose pathology generally had a higher Lund-Mackay score of 8.60 ± 5.60. However, there was no significant difference in the Lund-Mackay score according to the nose pathology site (p=.20). An association was seen between total LMS and patients with ear pathologies, but no significant difference was noted (p=.44). Although patients with ear complications had higher LM scores, this was not statistically significant.<br /><strong>CONCLUSION:</strong> Laterality of ear disease was not associated with the laterality of sinonasal disease, although CSOM complications were associated with high Lund-Mackay scores. Future, better-designed studies may shed more light on these associations.<br /><br /> </p>

Tracheal re-stenosis after resection and anastomosis of complete tracheal stenosis

@#Tracheal stenosis is a difficult complication to treat. It begins as a complication and eventually becomes serious enough to compromise the airway, leading to surgery. The treatment of complete tracheal stenosis is resection with tracheal end-to-end anastomosis.1 The incidence of tracheal re-stenosis following anastomosis is relatively high at about 10.5% for Caucasians.2 We are not aware of any studies on the incidence of this condition in the Philippines. In airway management, endotracheal intubation is the initial choice to secure the patient’s airway, followed by tracheostomy tube insertion. Both modalities require proper weaning for eventual decannulation. If decannulation has failed, the possibility of tracheal stenosis as a complication must be considered and investigated. In cases of re-stenosis after tracheal resection and anastomosis, what to do next is a challenge. Should another surgery for resection be planned? Will there be any changes in the technique of the surgery or additional medical treatment? Answering these questions may guide the surgeon’s next move and prevent re-stenosis and ultimately lead to decannulating the patient. We present a case of tracheal re-stenosis following two separate tracheal resections and end-to-end anastomosis procedures.