Nasal valve pull-up a method for treating nasal valve dysfunction

Problems with the nasal valve are easily overlooked unless one deliberately and consciously seeks to evaluate them. Thirteen percent of patients presenting with nasal obstruction have nasal valve pathology as an associated etiology. The aim of this study was to evaluate the efficacy of supero-lateral nasal valve pull-up as a method for treating the obstructed nasal breathing caused by nasal valve dysfunction. A nonrandomized study of 32 patients with symptoms of obstructed nasal breathing. The follow-up duration ranged from 5 to 12 months. The inclusion criteria were: 1] Obstructed breathing with medial displacement of the nasal valve complex. 2] A significant nasal valve inward displacement during inspiration. 3] A lack of response to medical and/or surgical correction of other factors associated with the 2 previous criteria. 4] A positive Cottle's sign. The nasal valve was pulled-up with 2 permanent 4-0 polypropylene sutures and fixed superolaterally to the maxillary periosteum and the overlying soft tissue. The point of suspension is midway between the inner canthus and the junction of the pinform aperture and the cheek. Subjective self assessment scores were collected on a 10-point scale [10 as worst] for nasal blockage, headache, snoring, perceived activity restriction from nasal airway obstruction [tiredness] and hyposmia. The objective data were obtained by nasal endoscopy and photographic analysis of the nasal valve angle [NVA]. All patients reported improvement of nasal blockage. The mean NVA showed significant postoperative increase with significant correlation to the improvement in nasal blockage score. The score is inversely proportion al to the angle degree. The surgery markedly improved patients' headache [84% of patients], snoring [64% of patients] and tiredness [75% of patients] with significant decrease of visual analog scores. The superolateral nasal valve pull up technique has the advantages of being less invasive, more safe and effective in treatment of nasal valve dysfunction. It corrects the static narrowing by increasing the nasal valve angle as well as the cross-sectional area and the dynamic collapse by spanning support for the lateral wall of the nasal valve

Tragal cartilage tympanoplasty for management of atelectatic tympanic membrane: palisade versus cross hatched cartilage

The purpose of this study was to analyze the outcomes of two cartilage tympanoplasty techniques for management of posterosuperior pars tensa atelectasis to achieve an acceptable compromise between sufficient mechanical stability and acceptable acoustic transfer characteristics of the cartilage graft. A prospective clinical study included patients who underwent cartilage tympanoplasty between April 2003 and March 2006. The study included 42 [patients with grade 3 posterosuperior pars tensa atelectasis, twenty males and twenty two females, their ages ranged between 22 and 48 years [mean age 32 +/ 3.6]. Eight patients had bilateral ear diseases operated separately with 6 months interval 50 cartilage tympanoplasties were performed. Of these procedures, 24 ears were grafted with tragal cartilage palisades [group A] and 26 ears [group B] were grafted with tragal cross hatched cartilage [modified cartilage plate]. Hearing results were reported using a four-frequency [0.5, 1, 2, 4 kHz] pure-tone average air-bone - gap [PTA-ABG]. Patients were follow up for 12 months through regular visits [weekly for the first month then monthly till the end of follow-up period]. Data were analyzed using Wilcoxon analysis for unpaired data and Chi-square [X[2]] test for comparisons of non-parametric results. The criteria for success were complete healing, prevention of further retraction in posterosuperior quadrant, and air-bone gap less than 20 dB. In palisade group [group A], 2 patients developed posterosuperior retraction [8%] and 2 patients developed anterior retraction. Compared with the outcomes of cross hatched cartilage tympanoplasty group [group B] in which 2 patients developed posterosuperior retraction and three patients develop anterior retraction, there was no significant difference. In group A, the hearing threshold improved in all patients except the two with recurrent retraction. The air- bone gap significantly decreased at all frequencies with significant decrease of mean PTA-ABG from 19.9 +/- 3.4 dB preoperative to 16.7 +/- 3 dB postoperative. Also, the cross hatched cartilage tympanoplasty had a significant decreasing effect on air-bone gap from 29.9 +/- 3.3 dB preoperativeiy to 13.4 +/- 2.6 dB postoperative. Comparing the postoperative hearing threshold of group [A] and group [B] revealed significant better acoustic outcome of cross hatched tympanoplasty technique. The cross hatched tragal cartilage tympanoplasty is a promising method for management of grade 3 postersuperior pars tensa retraction with good stability and acoustic outcomes