Endoscopic anterior ethmoidal artery ligation: a cadaver study.

OBJECTIVE: The objective of this study was to investigate the radiologic and endoscopic anatomy of the anterior ethmoidal canal (AEC) and feasibility of endoscopic ligation of the anterior ethmoidal artery (AEA). STUDY DESIGN: The authors conducted a prospective analysis of computed tomography (CT) of the paranasal sinuses and endoscopic cadaver dissection. METHODS: Twenty-two cadaver heads had CT scans of the paranasal sinuses. The height of the lateral lamella of the cribriform plate was calculated and staged according to the Keros staging system. The presence of a bony mesentery, distance from AEC to the skull base, and dehiscence of the AEC were documented. Forty-four dissections were performed, the AECs identified, and AEA ligation attempted. RESULTS: The mean height of the lateral lamella was 5.4 mm on the right and 4.7 mm on the left. In all cadaver heads with asymmetry, the right lateral lamella was longer (P<.005). A Keros type 1 pattern was seen in 23%, type 2 in 50%, and type 3 in 27%. Thirty-six percent of AECs were in a bony mesentery. AEC distance from the skull base was greater on the right (P<.009). A longer lateral lamella was correlated with the artery being in a mesentery. Sixteen percent of the AECs were dehiscent. Sixty-six percent of AEAs were unable to be clipped. Twenty percent were clipped effectively, all in a mesentery. In 14%, the AEA was not effectively clipped. CONCLUSIONS: Endoscopic AEA ligation may be possible in some patients. The AEA should be in a mesentery for an effective clip to be placed and be associated with a dehiscence of the AEC. If the lateral lamella is classified as Keros grade 2 or 3, it is likely the AEC will be found in a mesentery.

Effect of using multiple culture media for the diagnosis of noninvasive fungal sinusitis.

BACKGROUND: This study was designed to assess the relative efficiency of three different culture media for isolating fungi in patients suspected of having noninvasive fungal sinusitis. METHODS: A prospective study was performed of 209 operative samples of sinus "fungal-like" mucin from 134 patients on 171 occasions and processed for microscopy and fungal culture in Sabouraud's dextrose agar, potato dextrose agar, and broth media. RESULTS: Ninety-three (69%) of 134 patients had evidence of fungal infection. Two-thirds of patients had negative microscopy samples yet 56% of these went on to positive cultures. Forty-five percent cultured Aspergillus genus. Discrepancy between the fungi cultured in different media and on different occasions was common. With a single culture medium up to 19% of patients and 15% of samples would have been falsely labeled fungal negative. CONCLUSION: Increasing the number and type of fungal culture media used increases the number and range of fungal isolates from mucin in patients with the features of fungal sinusitis. Negative specimen microscopy is unreliable. All specimens should be cultured in multiple media and on multiple occasions when fungal sinusitis is suspected.

Prevalence of noninvasive fungal sinusitis in South Australia.

BACKGROUND: The aim of this study was to document the prevalence of noninvasive fungal sinusitis in patients with chronic sinusitis and thick viscous secretions in South Australia. METHODS: We studied of 349 patients with chronic rhinosinusitis undergoing endoscopic sinus surgery in a specialized rhinology practice. Patients with nasal polyposis and thick fungal-like sinus mucin had operative samples sent for microscopy and fungal culture. Evidence of atopy was taken as positive radioallergosorbent or skin-prick tests to fungi. RESULTS: One hundred and thirty-four (38%) patients were noted to have thick, viscid sinus mucin, raising suspicion of fungal disease. Ninety-three patients had positive fungal cultures or microscopy (26.6%). It was possible to classify 95.5% of the patients into subgroups of noninvasive fungal sinusitis or nonfungal sinusitis: 8.6% of patients with allergic fungal sinusitis, 1.7% of patients with allergic fungal sinusitis-like sinusitis, 15.2% of patients with chronic fungal sinusitis, one patient with a fungal ball, and the remaining 69% of patients with nonfungal chronic sinusitis. CONCLUSION: This is the first prospective study to evaluate the prevalence of these increasingly widely recognized conditions. It highlights the need for otolaryngologists to be alert to these not uncommon diagnoses in order for early, appropriate medical and surgical management to be instituted.