Postoperative improvement in acoustic rhinometry measurements after septoplasty correlates with long-term satisfaction.

BACKGROUND: Not much is known about long-term satisfaction of septoplasty. Our goal was to compare pre- and postoperative acoustic rhinometry measurements with satisfaction 11 years after surgery. METHODOLOGY: Acoustic rhinometry measurements were performed preoperatively and 3 months postoperatively. Satisfaction was evaluated with semi-structured interviews by telephone 11 years after surgery. Symptoms were evaluated using the NOSE score. RESULTS: In total, 222 patients were interviewed and eligible to enter the study. Of these, 213 had preoperative acoustic rhinometry and 159 had postoperative acoustic rhinometry. In total, 157 patients had a complete data set. Mean follow-up time was 11.3 years. Patients satisfied with surgery had a bigger improvement in total minimum cross-sectional area before decongestion and total nasal cavity volume after decongestion. NOSE scores were not correlated with acoustic rhinometry measurements. CONCLUSION: Acoustic rhinometry could be a valuable tool for evaluating the results of septoplasty. Satisfaction at 11 years follow-up was associated with 3 months postoperative acoustic rhinometry improvements. Acoustic rhinometry did not show preoperative patient selection potential.

Are too many septal deviations operated on? A retrospective patient`s satisfaction questionnaire with 11 years follow-up.

BACKGROUND: Not much is known about long-term satisfaction of septoplasty. The goal of this study was to assess disease specific quality of life outcomes as well as satisfaction at more than 10 years follow-up after septoplasty. METHODOLOGY/PRINCIPAL: The study was conducted as a retrospective questionnaire study (based on the NOSE scale) in which a questionnaire was sent to every patient and followed up by a telephone interview conducted in a tertiary otorhinolaryngologic clinic. RESULTS: 238 out of 369 patients who underwent septoplasty accepted to participate of which 222 were eligible. We found a significant reduction in NOSE score from 56.9 before surgery to 31.9 at follow-up. 68.0% experienced improved nasal breathing and 55.9% were satisfied with the overall outcome. Predictive analysis showed that only severity of symptoms before surgery was predictive of all final outcome parameters. CONCLUSIONS: Long-term outcome of septoplasty appears to be in line with shorter follow-up. Surprisingly a sizable difference was noted between rate of satisfaction and improvement in nasal breathing. It is important that the surgeon and patient have the same expectations to septoplasty as to avoid any inappropriate disappointment, which is more likely to occur if symptoms are not severe.

Growth kinetics in a strained crystal film on a wavy patterned substrate.

We study the combination of the Asaro-Tiller-Grinfeld morphological instability of a strained film and the organizing effect of an underlying patterned substrate. We use a continuum description of surface diffusion accounting for elasticity, surface energy and wetting interactions. We solve both the mechanical equilibrium and the growth dynamics during annealing at linear order in the film modulation amplitude. We characterize the kinetic phase diagram as a function of time, the film thickness and the ratio between the substrate and the instability wavelengths. We find that the film surface can skip from a configuration in phase with the substrate to either an out-of-phase or a non-ordered configuration, depending on the pattern wavelength and annealing time.

Demonstration of intravital microfissures in undecalcified plastic-embedded temporal bones with the prestaining technique.

Microfissures in the human otic capsule have been observed since the start of the century, but it was Otto Mayer, in 1930, who first realized that some of them were of intravital origin and not just processing artifacts. Since then, a small number of publications, based on decalcified temporal bones, have mostly confirmed his findings. With the introduction by Frost in the late 1950s of the undecalcified bone technique and the bulk staining technique for peripheral bones, a method was developed and refined for identifying even very small intravital microfissures (microdamage). Bulk staining of undecalcified otic capsules has not yet been used to verify the findings from the previous decalcified specimens. The present report presents our experience with the pertinent techniques, and suggests modifications and shortcuts pertinent to temporal bone research. Both large and tiny microfissures of intravital genesis are demonstrable within bulk-stained undecalcified human otic capsules. The importance of microfissures in the petrous bone in the causation of otosclerosis and perilymphatic leakage has long been discussed, and the present techniques may advance our understanding of these pathological conditions

Recognition of basic fuchsin prestained microfissures of intravital origin with fluorescence microscopy: validation of a shortcut.

For 70 years it has been suspected that not all microfissures in histological bone sections are artifacts, but that some are provoked in vivo through repetitive stress. The development of undecalcified bone techniques and of the bulk staining technique has established a method for demonstrating the existence of intravital cracks and enhanced the discrimination towards artifactual microfissures in the load-bearing skeleton. Recently the presence of intravital microfissures has also been ascertained in temporal bones by these techniques. Due to the fluorescent properties of basic fuchsin it is possible to use epifluorescence microscopy for analysis of microfissures after bulk staining with basic fuchsin. This provides a more steady microscopic background and a sharper delineation of surface level structures since no projection from lower levels interfere. Artifactual cracks, which in transmitted light microscopy may look like darkly stained intravital microfissures due to refraction phenomena, become invisible or colorless. Epifluorescence microscopy enhances the detection of both smaller and larger prestained intravital microfissures, and leaves only a minor part of the cracks without certain categorization. The epifluorescence mode of analysis has the further advantage of being independent of slice thickness, making feasible whole-specimen analysis by serial stepwise grinding. The present study shows that the number and the length of microfissures in the human otic capsule, counted and measured under the epifluorescence microscope, equals numerically the findings in light microscopy, enabling the routine use of this mode of analysis. This may prove to be of particular value in the research into the etiology and pathogenesis of otosclerosis as well as perilymphatic fistulae.

Quantification of osteoclastic resorption of the bovine otic capsule in vitro by an enzyme-linked immunosorbent assay.

The bony shell surrounding the inner ear is known to have a very pronounced centripetal inhibition of remodelling in vivo, with almost no bone turnover immediately adjacent to the perilymphatic spaces and a gradually increasing turnover rate towards outer parts of the bony otic capsule. By the use of in vitro markers of bone resorption, including an enzyme-linked immunosorbent assay for quantification of type I collagen degradation and a colorimetric enzyme assay for quantification of osteoclast tartrate-resistant acid phosphatase activity, this study demonstrates that there are no ex vivo differences in bone matrix resorption between the inner and outer parts of the otic capsule when exposed to seeded osteoclasts from rabbits. Thus, the unique spatial distribution of perilabyrinthine bone turnover is not caused by a shift in resorbability from inner to outer capsular bone that is due to inherent bone quality differences particular to these bone compartments. More likely, the sustained action of some intravital 'field force', originating from the inner ear spaces, is responsible for the unique spatial distribution of the otic capsular bone turnover found in vivo. Though the character of this force is not yet defined, it is appealing to relate it to the large electromagnetic potential gradient present in the inner ear.

Predilection of otosclerotic foci related to the bone turnover in the otic capsule.

Using multiple fluorochrome tagging of eight mongrel dogs and a newly established methodology of measuring bone turnover (BTO) in the otic capsule, it has previously been demonstrated that BTO in the canine otic capsule is highly reduced close to the perilymphatic spaces (PLS) compared to the normal level of BTO in the periphery. Reanalysis of these data shows that this inhibition of BTO is far more pronounced around the cochlea and vestibule than around the semicircular canals. Similar tendencies are seen for the numerical density and mean label area of the bone remodelling units. With increasing distance to the PLS, these patterns are weakened, but still recognizable. In otosclerosis, foci of abnormal bone deposition are particularly frequent around the oval and round windows and in the cochlear capsule, i.e. where inhibition of bone remodelling is most prominent. A surpassing (or failure) of this pronounced inhibition must precede the tumultuous but delimited osteogenesis of otosclerosis. Otosclerosis may be a deviation of the normal BTO process in an osteometabolically abnormal site, perhaps initiated as an osteogenetic response to abnormal stress exposure.

Estimation of volume referent bone turnover in the otic capsule after sequential point labeling.

Using fluorochrome labeling and a newly validated method for bone turnover estimation, we determined absolute values for canine perilabyrinthine bone remodeling. The overall capsular bone turnover was found to be 2.1% per year, compared to 13.9% per year for the neighboring cranial bones and 7.4% per year for the humerus compacta. This gross 2.1% per year conceals a vast range, from 0.13% per year for the innermost perilymphatic zone, through a centrifugal increment toward 8% to 10% per year in the periphery. The underlying individual bone remodeling units exhibit a similar centrifugal pattern in numerical density and size. These findings indicate an inhibition of remodeling, seemingly emanating from the perilymphatic spaces, and affecting both the activation of osteoclasts and the extent of resorption by the osteoclasts. These values satisfactorily explain the preservation of such fetal remnants as the globuli ossei, the interglobular spaces, and the skein bone. In humans, local ineffective inhibition of bone resorption may play a role in the initiation of otosclerosis.

Volume-referent bone turnover estimated from the interlabel area fraction after sequential labeling.

In the compact bony otic capsule remodeling is low, and bone remodeling units are distributed centrifugally in relation to inner ear tissues and spaces. Fluorochrome-labeled bone remodeling units are scarce, abortive, and tortuous with no uniform direction of movement. This study presents a method for the estimation of volume-referent bone turnover based on measurements of the fractional area between labels after sequential labeling with osteofluorochromes. The applicability of this method is tested against a classical quantification method in undecalcified cortical specimens from the canine humerus, where both methods can be used. The estimate of bone turnover derived from the new sequential labeling in eight dogs is 7.4% (SEM 2.1%) per year and the classic estimate derived from calculations of the formative osteonal area and the formative period yields 6.9% (SEM 2.1%) per year. Agreement is sufficient to justify future measurements of absolute bone turnover in sequentially labeled perilabyrinthine bone.

Outcome for the first 85 patients treated with the functional endoscopic sinus surgery technique.

Out of 85 patients operated on with the functional endoscopic sinus surgery (FESS) technique, 62 patients (73%), representing 105 operated sides, participated in an endoscopic follow-up with concomitant questionnaire concerning symptoms and patient's evaluation of the result. On 61 operative sides were performed polypectomies, 43 sides were operated on because of chronic recurrent sinusitis. Twelve patients (corresponding to 17 sides) were re-operated on. The mean follow-up period was 16 months for the patients with one operation, for those with re-operation it was 10 months. Eighty-two per cent of the patients reported subjectively marked or full improvement, 18% had experienced no change or slight improvement. By endoscopy, 43 operated sides (41.0%) were considered fully normal at follow-up. Residual polyposis was seen in 21 of 61 operated sides (35.9%) with pre-operative polyposis, and purulent discharge was seen in 11 sides (10.5% of all operated sides). The discrepancy between subjective satisfaction and objectively-assessed recurrent or residual pathology indicates a need for further elucidation of the aetiologies for chronic inflammatory sinonasal diseases. Obstruction of the drainage pathways around the ostiomeatal complex cannot explain all cases of sinusitis and is hardly aetiological in polyposis. Nevertheless, FESS is presently an adequate treatment in obtaining immediate relief in most cases of medically resistant sinusitis and polyposis.

Excitability in liquid crystal.

The spiral waves observed in a liquid crystal submitted to a vertical electric field and a horizontal rotating magnetic field are explained in the framework of a purely mechanical description of the liquid crystal. The originality of the experiment described in this paper is the presence of the vertical electric field which allows us to analyze the spiral waves in the framework of a weakly nonlinear theory.

[Observer variation in clinical practice. A review]. / Observatørvariation i klinisk praksis. En oversigt.

Observer variation denotes the discrepancy between two consecutive observations of the same indicant. Principles and results of observer variation studies are outlined. Observer variation seems to be present wherever it is searched for, in history taking as well as in physical examination. It has been found unanimously to be smaller for intra- than for inter- observer variation while it is still controversial whether clinical experience lessens observer variation. Even fundamental clinical observations and particularly evaluations of borderline cases between normal and abnormal exhibit observer variation. The possibilities of reducing observer variation, and the importance of observer variation to clinicians and patients, and also the influence on research and society are referred to briefly. The future role of observer variation studies is discussed. Observer variation often is evaluated by the Kappa statistics whose statistical advantages and clinical disadvantages are outlined.

[Observer variation and accuracy in the clinical diagnosis of ascites]. / Observatørvariation og akkuratesse ved klinisk ascitesbedømmelse.

Seventeen observers participated in an observer variation study of the clinical evaluation of ascites. In a blinded design, eight patients with diagnoses of liver disease were examined. Fourteen observers examined the patients twice in order also to estimate the intra-observer variation. The accuracy of the observers' statements was compared with ultrasound findings, by which mean ascites was demonstrated in two patients. Poor correspondance between the observers' gradings and volume estimations, and poor accuracy of the gradings, make qualitative and quantitative ascites estimations useless. The inter-observer agreement was found to be low although the intra-observer agreement was good. The observers' subjective certainty of correctness of their own findings, marked as certain/uncertain, did not reflect the chance of making a correct statement on each particular occasion. The individual patient's general ability of inducing certainty did relate the chance of forming a correct diagnosis. Ultrasonic investigation of the abdomen is recommended in all situations in which demonstration of ascites is essential to diagnosis or therapy.