Systematic functional assessment of nasal dyspnea: surgical outcomes and predictive ability.

OBJECTIVE: Evaluate the ability of a systematic preoperative evaluation to determine the most appropriate procedures for patients undergoing functional septorhinoplasty and to accurately predict postoperative outcomes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care military hospital. SUBJECTS AND METHODS: Fifty-nine consecutive patients from a quality control database who underwent functional rhinoplasties for nasal dyspnea were evaluated. All patients underwent a full preoperative assessment using intranasal manipulation to determine the area(s) contributing to their nasal dyspnea. Rates of success for the predictive ability and for the functional outcome were determined for each side of the nose by comparing preoperative visual analog scale (VAS) scores (1-10) to postoperative scores. RESULTS: Overall there was a 91% success rate in predicting the outcome of surgery and a 95% success rate in improving nasal dyspnea at 1 year. There was no statistically significant difference in improvement between different surgical groups (septoplasty ± alar strut grafts ± spreader grafts) or between primary surgeries and revisions. CONCLUSION: Using a systematic approach to evaluate patients for nasal dyspnea, it is possible to predict and improve outcomes by choosing the most appropriate surgery for each individual.

Microbiology of sinusitis: does allergy or endoscopic sinus surgery affect the microbiologic flora?

PURPOSE OF REVIEW: To explore the role of bacteria in the pathogenesis of chronic rhinosinusitis and how the presence of allergies or endoscopic sinus surgery may affect the bacterial flora. RECENT FINDINGS: As our understanding of the etiologies of chronic rhinosinusitis continues to evolve, the role of bacteria as either a primary or an exacerbating factor remains controversial. It is clear that healthy paranasal sinuses are sterile, but in chronic rhinosinusitis bacteria are often present. It has also been shown that the bacteria found in chronic rhinosinusitis vary significantly from those found in acute rhinosinusitis. In patients with allergic rhinitis an association has been found with higher carriage rates of Staphylococcus aureus. The significance of this is unclear but may be related to bacterial superallergen production leading to TH2-mediated inflammation. Endoscopic sinus surgery does not appear to change the bacterial flora, though it may decrease the presence of bacterial biofilms in sinus cavities. SUMMARY: Bacteria are likely to play a role in both the development and the exacerbation of chronic rhinosinusitis. Further studies are needed to determine in which subtypes of chronic rhinosinusitis bacteria play the greatest roles and how our treatments can be individualized to improve patient outcomes.

Epidemiology of recurrent respiratory papillomatosis.

Recurrent respiratory papillomatosis (RRP) was first described in the 1800s, but it was not until the 1980s when it was convincingly attributed to human papilloma virus (HPV). RRP is categorized into juvenile onset and adult onset depending on presentation before or after the age of 12 years, respectively. The prevalence of this disease is likely variable depending on the age of presentation, country and socioeconomic status of the population being studied, but is generally accepted to be between 1 and 4 per 100 000. Despite the low prevalence, the economic burden of RRP is high given the multiple procedures required by patients. Multiple studies have shown that the most likely route of transmission of HPV in RRP is from mother to child during labor. Exceptions to this may include patients with congenital RRP who have been exposed in utero and adult patients who may have been exposed during sexual contact. Although cesarean section may prevent the exposure of children to the HPV virus during childbirth, its effectiveness in preventing RRP is debatable and the procedure itself carries an increased risk of complications. The quadrivalent HPV vaccine holds the most promise for the prevention of RRP by eliminating the maternal reservoir for HPV.

Audiologic and temporal bone imaging findings in patients with sensorineural hearing loss and GJB2 mutations.

OBJECTIVES/HYPOTHESIS: Our objectives were to determine genotype-phenotype correlations in patients with sensorineural hearing loss (SNHL) who undergo testing for GJB2 mutations and to examine the relationship of temporal bone anomalies seen on computed tomography (CT) and GJB2 mutations. STUDY DESIGN: We conducted a retrospective review of all children diagnosed with SNHL and who underwent GJB2 testing from 1997 to 2006. RESULTS: Of 840 patients, 146 (17.4%) had mutations. Seventy-six (9.1%) had biallelic GJB2 mutations and 70 (8.3%) had heterozygous mutations. When biallelic mutations were categorized as missense or nonsense mutations, the presence of at least one missense mutation was associated with mild or moderate SNHL. Biallelic nonsense mutations were associated with severe to profound SNHL. Among patients with GJB2 mutations, those with heterozygous mutations (n = 14 [20%]) had a higher rate of asymmetric SNHL loss than those with biallelic mutations (n = 6 [7.9%], P = .03). Those with heterozygous mutations were more likely to experience progression than were those with biallelic mutations, though this difference was only marginally significant (26.5% vs. 12.3%, respectively; P = .06). Patients who were wild type for GJB2 were more likely to have an enlarged vestibular aqueduct (EVA) than were those with biallelic and heterozygous mutations (29% vs. 11.9%, respectively; P = .004). Compared to patients who were wild type, those with biallelic mutations had a significantly lower rate of EVA. CONCLUSIONS: This is the largest single-institution study of pediatric patients with GJB2 mutations and SNHL. The functional consequences of GJB2 mutations correlated with the degree of hearing loss. Patients with M34T mutations and/or mild SNHL had a low risk of progression. Temporal bone anomalies were uncommon in patients with GJB2 mutations.