ABSTRACT
OBJECTIVE: Occult perilymph fistulas may be the cause of unexplained non-epidemic meningitis. MATERIAL AND METHOD: To review the case reports of 5 patients (3 females and 2 males aged 4-56) presenting with unexplained meningitis. All had sensorineural hearing loss of variable duration. RESULTS: All patients were submitted to CT, MRI and MRI cisternography. All underwent exploratory tympanotomy to seal the fistula. In all patients the fistula could be located and sealed. All had no further attacks of meningitis and those who had serviceable hearing did not show any further deterioration. CONCLUSION: In any case of recurrent meningitis an occult perilymph leak should be sought. A high degree of suspicion should exist if there are auditory or vestibular symptoms. Detecting and sealing of the defect will protect the patient against further attacks and deterioration of hearing.
Subject(s)
Ear Diseases/complications , Ear, Middle/pathology , Fistula/complications , Labyrinth Diseases/complications , Meningitis/etiology , Perilymph , Adult , Child , Child, Preschool , Ear Diseases/diagnosis , Female , Fistula/diagnosis , Hearing Loss, Sensorineural/etiology , Humans , Labyrinth Diseases/diagnosis , Male , Middle Aged , RecurrenceABSTRACT
Septal surgery is one of the most commonly performed nasal surgeries. It aims at restoring nasal patency and symmetrical air passages. However classical surgery may narrow the originally wider side necessitating additional surgery at the level of the turbinates. This study was performed to demonstrate that properly targeted and tailored surgery with limited interference at the level of specific areas may not only be enough but it may also more efficacious than more extensive surgery. The coronal CT scans of 16 patients with septal deviation were transferred to a computer and the cross-sectional areas (CSA) of both passages calculated before and after various simulations of septal surgery. In 8/16 cases the more limited surgery resulted in a wider total CSA and also more symmetrical right and left passages. This is more physiological both in terms of function and subjective feeling by the patients. We suggest that for all patients planned to undergo septal surgery a pre-operative coronal CT should be studied and the surgery planned to achieve the most optimal result rather than remove indiscriminately all deviated elements.
Subject(s)
Computer Simulation , Nasal Septum/abnormalities , Nasal Septum/surgery , Rhinoplasty/methods , Adult , Female , Humans , Male , Middle Aged , Preoperative CareABSTRACT
OBJECTIVE: A trial to determine a simple way to predict recurrence of nasal polypi to determine the need for long term medical therapy. METHODS: Retrospective clinical analysis of the records of 100 patients with nasal polypi and studying various parameters including radiological, intra-operative and bacteriological data. RESULTS: Among the various parameters studied, maxillary antral involvement, and positive bacterial cultures seemed the most predictive criteria of recurrence. Patients without polypoid involvement of the maxillary sinus and/or with negative cultures were less likely to have early recurrence of their disease. CONCLUSION: Using simple clinical criteria, two patient populations could be defined. One in which recurrence is inevitable requiring continuous local steroid therapy after surgery and another group requiring occasional local treatment after an initial short course of local steroid spray.
