The endoscopic Draf II frontal sinusotomy: non-navigated approach.

OBJECTIVE: Endoscopic endonasal Draf II frontal sinusotomy is indicated for a variety of pathologies such as mucocele and non-responsive chronic frontal sinusitis. However, this approach is challenged and controversial. The objectives were to evaluate the advantages, disadvantages, indications, and rate of complications of this approach, without the use of a navigation system. METHODS: The files and computed tomography (CT) scans of 25 patients who underwent endoscopic endonasal Draf II sinusotomy at Assaf Harofeh Medical Center between 1999 and 2002 were reviewed. RESULTS: Thirty-one frontal sinuses were operated on and follow-up was between 18 and 62 months (average 30.3). Twenty-two sinuses (71%) had previous surgery. The Draf II procedure was used in 3.7% of all cases during the survey period. The most frequent indication for surgery was inflammation (48%) followed by mucocele (28%). In all but 2 sinuses (93%), the frontal floor between the lamina papyracea and the middle concha was drilled out. Twenty-four patients (96%) were successfully ventilated. No major complications were noted. CONCLUSIONS: The Draf II approach can be used safely and successfully without a navigation system, including cases of revision endoscopic sinus surgery. Correct interpretation of the surgical field and a CT scan are crucial for success. Careful patient selection is essential for this procedure.

Streptococcal contamination of food: an unusual cause of epidemic pharyngitis.

The purpose of this article is to define the distinguishing characteristics of food-borne streptococcal pharyngitis by reviewing the literature. The main cause of this infection lies in poor handling and preservation of cold salads, usually those which contain eggs and are prepared some hours before serving. A shorter incubation period and a higher attack rate (51-90%) than in transmission by droplets was noted. The epidemics tend to occur in warm climates and in the hottest months of the year. Streptococcus pyogenes seems to originate from the pharynx or hand lesions of a food handler. In comparison to airborne transmission symptoms such as sore throat, pharyngeal erythema, and enlarged tonsils, submandibular lymphadenopathy are more frequent than coughing and coryza. Seven out of 17 reports revealed an M-untypeable serotype, which may possess virulent characteristics. Penicillin prophylaxis was shown to limit additional spread of the infection. There were no non-suppurative sequels, and suppurative sequels were very rare. We assume that the guidelines for the prevention of food poisoning would apply to food-borne streptococcal pharyngitis. Food handlers should be supervised to ensure they comply with strict rules of preparation and storage of food. Cold salads, especially those containing eggs, should not be left overnight before serving.

Hyperacusis: review and clinical guidelines.

OBJECTIVE: To review the current known causes of hyperacusis and the different hypotheses concerning its etiology, and to suggest clinical guidelines. DATA SOURCE: A review of the literature with the aid of the MEDLINE database, using the following key words: hyperacusis, intolerance to sound, loudness discomfort level, and phonophobia. DATA EXTRACTION: The data collected included clinical studies, case reports and laboratory studies. CONCLUSION: Hyperacusis was shown to be caused by pathologic conditions of the peripheral auditory system, diseases of the central nervous system diseases, and hormonal and infectious diseases. In some cases there was no known cause. The pathophysiology of hyperacusis probably involves a central mechanism rather than a peripheral one. Suggested clinical guidelines and treatment are discussed.