Frequency of sinus disease in normal subjects and patients with benign paroxysmal positional vertigo.

BACKGROUND/AIMS: To determine if patients with benign paroxysmal positional vertigo (BPPV) have a higher frequency of rhinosinusitis than people with normal vestibular function. METHODS: The subjects were 52 patients with BPPV and 46 normal people. Every subject had a sinus CT scan, a blood draw for IgE and a rhinologic examination by an otolaryngologist. RESULTS: The frequency of rhinosinusitis based on physician diagnosis was 49% and based on CT scan findings 59%. This difference approached significance (p = 0.08). The observed frequency of rhinosinusitis was higher than predicted by survey data about the southern US region. The data trended toward higher prevalence of rhinosinusitis (by physician diagnosis) in the BPPV patients versus controls (58 vs. 39%, p = 0.06). CONCLUSION: BPPV patients have a higher frequency of sinus disease compared to people with normal vestibular systems, perhaps due to age differences, but physiologic factors may also be involved. The higher frequency of rhinosinusitis in this geographical area than reported rates based on survey data raises concerns about the usefulness of questionnaire data for estimating population prevalence.

Contemporary surgical management of HIV-associated facial lipoatrophy.

OBJECTIVES: The purpose of this study is to describe our experience with facial volume restoration in 39 HIV-associated facial lipoatrophy patients, and formulate a treatment algorithm that can be utilized for these patients based on their disease severity. METHODS: Preoperative and postoperative photographs were evaluated by 2 experienced facial plastic surgeons using grading scales. The reviewers' scores were then compared and the distribution of scores was analyzed. RESULTS: Thirty-nine patients underwent malar silastic implantation. Seven patients required postoperative adjuvant filler injection. Most patients' results were rated good to excellent. There were 4 late complications. CONCLUSION: HIV-associated facial lipoatrophy is a socially disabling condition that causes noticeable disfigurement and stigmatizes the patient. We demonstrate the importance of combining a reliable grading scale with a strategic treatment algorithm that utilizes multiple modalities for volume restoration. EBM RATING: C-4.

Scar contractures, hypertrophic scars, and keloids.

A scar contracture is the result of a contractile wound-healing process occurring in a scar that has already been reepithelialized and adequately healed. Keloids and hypertrophic scars (HTSs) are fibrous tissue outgrowths that result from a derailment in the normal wound-healing process. The exact incidence of keloids and HTSs remains unknown. Beyond the common belief that trauma is the initiating event of keloid and hypertrophic scar formation, the remainder of the process remains uncertain. A combination of biochemical factors, skin tension, endocrinologic factors, and genetic factors are the likely culprits. Treatment begins by educating the patient about the etiology of the scarring process. All treatment protocols are individualized, but the standard approach to keloids and HTSs begins with corticosteroid injection followed by surgical excision, pressure dressings, and long-term follow-up.