Epidemiology, etiology, genetic variants in non- syndromic hearing loss in Iran: A systematic review and meta-analysis.

OBJECTIVES: Hearing loss is one of the most common heterogeneous complicated disorders worldwide. We previously analyzed the results of published data on non-syndromic hearing loss in the Iranian population systematically. A broad range of genes is a challenge for molecular screening and clinical diagnosis in our populations on the ground of distinct genetics. The aim of this study was to analyze the role and frequency of the variants accountable for non-syndromic hearing loss (NSHL) in the Iranian population. These were identified with different methods including whole exome sequencing (WES), next-generation sequencing (NGS), targeted genomic enrichment and massively parallel sequencing (TGE + MPS), autozygosity mapping, STR markers, linkage analysis, and direct sequencing. This is the comprehensively study focusing on classifying 13 common NSHL genes according to their frequencies. Previous studies have not studied different regions and the Iranian population, and this is the definitive study on the topic. METHODS: We searched Scopus, PubMed, Science Direct databases, and Google Scholar. After a systematic review of the evidence 95 studies were considered then 31 studies were eligible for meta-analysis. In total, 6995 families, 358 variants, and 117 novel variants were included. Statistical analyses were conducted using Stata SE version 11 software. The inverse variance method enjoyed combining data. Heterogeneity of the preliminary results was assessed using Q (Cochrane test), and I square index. Random effects or fixed models were applied to combine the results, relying on the degree of heterogeneity. Point and pooled prevalence of variants acting on different regions were illustrated by forest plots. RESULTS: The total prevalence of at least one variant of GJB2 and SLC26A genes was estimated at 26% and 5%, respectively. Variant c.35delG accounted for 18% of the GJB2 variants while 1% of these variants were novel ones. The next most common variants in the GJB2 gene were c.109G>A at 3.5% and c.-23+1G>A at 2.3%. Moreover, the prevalence of GJB2 gene variants varied on average 0.002% from one region to another in Iran (p=0.849). Our meta-analysis also showed that the frequency of at least one variant of MYO15A varied between 1.2% and 12.5%. Corresponding prevalences for the other variants were as follows: ILDR1 (3.5%-3.7%), CDH23 (2%-10%), PJVK (1.4%-33%), TECTA (1.3%-6.7%), MYO6 (2%-4.8%), TMC1 (1.8%-2%), MYO7A (0.7%-5%), MARVELD2 (0.7-5%), OTOF (0.7%-4%), LRTOMT (0.7%-2.5%). Finally, we did not find any relationship between geographic area and the presence of these variants. CONCLUSION: GJB2 gene variants were the most common cause of NSHL in Iran. Understanding the prevalence of NSHL gene frequency in Iran may be the foundation for future studies in an Iranian population which may lead to future NSHL therapy.

COVID-19 and anosmia in Tehran, Iran.

Patients with acute olfactory disorders typically present to the otolaryngologist with both acute hyposmia and less often with anosmia. With the onset of COVID-19 we have noticed an increase in the number of patients who have presented with new onset of complete smell loss to the senior author's practice in Tehran, Iran. This anosmia and the frequency with which patients present is highly unusual. Coronaviruses have been known to cause common cold symptoms. COVID-19 infections have been described as causing more severe respiratory infections and the symptoms reported by authors from Wuhan, China have not specifically included anosmia. We describe patients who have presented during a two-week period of the COVID-19 pandemic with complete loss of sense of smell. Most had either no symptoms or mild respiratory symptoms. Many had a normal otolaryngologic exam. A relationship between COVID-19 and anosmia should be considered during the pandemic. We hypothesize that the mechanism of injury is similar to that of other coronavirus infections that cause central and peripheral neurologic deficits.

Improvement of sinonasal mucociliary function by endoscopic sinus surgery in patients with chronic rhinosinusitis.

OBJECTIVES: Mucociliary clearance is an important defense mechanism for upper and lower airway. Chronic rhinosinusitis has been frequently associated with mucociliary dysfunction. Endoscopic sinus surgery (ESS) is recommended for treatment-resistant sinusitis in order to improve mucociliary function. The present study investigated the effect of ESS on the saccharin time (mucociliary clearance time) in relation to symptom profile assessed by the Sino-nasal Outcome Test (SNOT)-22, and disease severity based on the Lund-Kennedy endoscopic scores and Lund-Mackay computed tomographic (CT) scores. METHOD: The present cohort study included 22 patients with chronic rhinosinusitis who were considered a candidate for ESS due to lack of response to medical treatment. Saccharin test was used before and 3 months after ESS to evaluate changes in mucociliary function. The CT scan was used for preoperative assessment of sinonasal anatomy. In addition, diagnostic nasal endoscopy was performed before and 3 months after ESS. The CT scan and nasal endoscopy findings were respectively analyzed based on the Lund-Mackay and the Lund-Kennedy staging systems recommended for chronic rhinosinusitis. Symptom severity was assessed from before to 3 months after ESS using SNOT-22. RESULTS: The present study showed decreased saccharin time in patients with chronic rhinosinusitis three months after ESS. The mean pre-operative and post-operative saccharin time were 23.4 and 16.9 min, respectively. There was also a trend toward significance for the effect of changes in the SNOT-22 scores on changes in saccharin time. By contrast, no effects of age, gender, pre-operative Lund-Mackay CT scores, and changes in Lund-Kennedy endoscopy scores were observed on post-ESS saccharin time. CONCLUSION: The study confirms that ESS in patients with treatment-resistant chronic rhinosinusitis confers improvement in performance on the saccharin test of mucociliary function.

Interest in Aesthetic Rhinoplasty Scale.

Interest in cosmetic surgery is increasing, with rhinoplasty being one of the most popular surgical procedures. It is essential that surgeons identify patients with existing psychological conditions before any procedure. This study aimed to develop and validate the Interest in Aesthetic Rhinoplasty Scale (IARS). Four studies were conducted to develop the IARS and to evaluate different indices of validity (face, content, construct, criterion, and concurrent validities) and reliability (internal consistency, split-half coefficient, and temporal stability) of the scale. The four study samples included a total of 463 participants. Statistical analysis revealed satisfactory psychometric properties in all samples. Scores on the IARS were negatively correlated with self-esteem scores (r = -0.296; p < 0.01) and positively associated with scores for psychopathologic symptoms (r = 0.164; p < 0.05), social dysfunction (r = 0.268; p < 0.01), and depression (r = 0.308; p < 0.01). The internal and test-retest coefficients of consistency were found to be high (α = 0.93; intraclass coefficient = 0.94). Rhinoplasty patients were found to have significantly higher IARS scores than nonpatients (p < 0.001). Findings of the present studies provided evidence for face, content, construct, criterion, and concurrent validities and internal and test-retest reliability of the IARS. This evidence supports the use of the scale in clinical and research settings.

Development and Validation of the Expectations of Aesthetic Rhinoplasty Scale.

BACKGROUND: There is a growing concern in the field of aesthetic surgery about the need to measure patients' expectations preoperatively. The present study was designed to develop and validate the Expectations of Aesthetic Rhinoplasty Scale (EARS), and to compare expectations between rhinoplasty patients with and without body dysmorphic disorder (BDD). METHODS: In total, 162 college students and 20 rhinoplasty candidates were recruited. The measures included the newly developed EARS, a measure of psychopathology, and demographics. The DSM-IV structured clinical interview for BDD was used to confirm the diagnosis in rhinoplasty patients. RESULTS: The EARS was constructed of six items based on their significant content validity. In the scale development phase, Cronbach's alpha was 0.87. The test-retest reliability coefficient of the scale was satisfactory (intraclass correlation coefficient, 0.94; 95% confidence interval, 0.82-0.98) over a four-week period. Scores on the EARS were significantly positively correlated with psychopathological symptoms (r=0.16; P<0.05). Moreover, comparison of EARS scores between BDD (M=25.90, standard deviation [SD]=6.91) and non-BDD rhinoplastic patients (M=15.70, SD=5.27) suggested that BDD patients held significantly higher expectations (P<0.01). CONCLUSIONS: The expectations of aesthetic rhinoplasty patients toward surgery may play a crucial role in their postoperative satisfaction. While the value of patients' expectations is clinically recognized, no empirical study has measured these expectations in a psychometrically sound manner. The current study developed and validated the EARS. It may be easily used as a valid and reliable instrument in clinical and research settings.

When Aesthetics, Surgery, and Psychology Meet: Aesthetic Nasal Proportions in Patients Having Rhinoplasty and Normal Adults.

The aesthetic nasal proportions have played a significant role in rhinoplasty practice. On the other hand, psychological variables also play a crucial role in rhinoplasty. It is of paramount importance for facial plastic surgeons to consider both sides to achieve a more satisfactory outcome. The present study aimed to compare aesthetic nasal proportions between primary rhinoplasty candidates and a demographically matched control group to determine whether patients having rhinoplasty have different aesthetic nasal proportions compared with healthy adults who are not interested in rhinoplasty. Sixty patients having rhinoplasty were selected consecutively from a surgical clinic. A control group ( n = 60) with the same demographic characteristics was selected. Photographs were taken using a digital camera on a fixed zoom setting. All images were captured at a distance of 1.5 m. Frontal and right lateral views were used to compare nasolabial angle, nasofrontal angle, nasofacial angle, alar width, intercanthal distance, nasal length, and width-to-length ratio. Independent t tests were used for comparisons. Independent t tests verified that nasofrontal angle, nasal length, and width-to-length ratio were significantly different between the two groups ( p < 0.01). Effect sizes ranged between 0.11 and 0.69. Aesthetic proportions were not significantly different in four factors. Nasolabial angle, nasofacial angle, alar width, and intercanthal distance were not different ( p > 0.05). Four major aesthetic nasal proportions were statistically similar in a group of patients having rhinoplasty and a control group with no interest in rhinoplasty. Surprisingly, the patients having rhinoplasty showed a mean width-to-length ratio closer to aesthetic ideal. Therefore, applying for rhinoplasty may have strong psychological reasons (e.g., body dysmorphic symptoms) compared with realistic aesthetic appraisals.

Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach.

BACKGROUND: Although intracranial extension of juvenile nasopharyngeal angiofibroma (JNA) occurs commonly, intradural penetration is extremely rare. Management of such tumors is a challenging issue in skull-base surgery, necessitating their removal via combined approaches. In this work, we share our experience in management of extensive intradural JNA. METHODS: In a university hospital-based setting of 2 tertiary care academic centers, retrospective chart of 6 male patients (5 between 15 and 19 years old) was reviewed. Patients presented chiefly with nasal obstruction, epistaxis, and proptosis. One of them was an aggressive recurrent tumor in a 32-year-old patient. All cases underwent combined transnasal, transmaxillary, and craniotomy approaches assisted by the use of image-guided endoscopic surgery, with craniotomy preceding the rhinosurgical approach in 3 cases. RESULTS: Adding a transcranial approach to the transnasal and transmaxillary endoscopic approaches provided 2-sided exposure and appreciated access to the huge intradural JNAs. One postoperative cerebrospinal fluid leak and 1 postoperative recurrence at the site of infratemporal fossa were treated successfully. Otherwise, the course was uneventful in the remaining cases. CONCLUSION: Management of intracranial intradural JNA requires a multidisciplinary approach of combined open and endoscopic-assisted rhinosurgery and neurosurgery, because of greater risk for complications during the dissection. Carotid rupture and brain damage remain 2 catastrophic complications that should always be kept in mind. A combined rhinosurgical and neurosurgical approach also has the advantage of very modest cosmetic complications.

A comparison of depression scores between aesthetic and functional rhinoplasty patients.

Depression is a mood state of sadness, gloom, and pessimistic ideation with loss of interest or pleasure in normal activities. This mood disorder has been reported to occur more frequently among cosmetic surgery patients. The purpose of the current study was to compare the score of depression among aesthetic rhinoplasty candidates and functional rhinoplasty patients as control group. The Beck Depression Inventory (BDI) and Depression (DE) subscale of Symptom Check List-90-Revised (SCL-90-R) were administered on a sample of aesthetic rhinoplasty patients (n=21) as well as a sample of functional rhinoplasty patients (n=21). Those with both cosmetic and functional purposes were categorized regarding their primary objective. Questionnaires were given to patients preoperatively. Cohen's d was also calculated as a measure of Effect Size (ES). BDI and SCL-90-R-DE scores were analyzed using t-test for independent groups. Statistical analyses suggested that the mean BDI and SCL-90-R-DE scores of aesthetic surgery patients were significantly higher than those of functional surgery patients (P<0.05). The results showed that age, sex, and Socio-Economic Status (SES) were not significantly different between the two groups as they can be capable of influencing the depression score. Effect size was above the moderate level: d=0.51, d=0.72 for BDI and SCL-90-R-DE, respectively. Using two different depression instruments, the findings of this study showed that aesthetic rhinoplasty patients were more depressed in comparison with functional rhinoplasty patients. The measures of ES also supported the hypothesis that aesthetic rhinoplasty candidates had higher scores in depression.

Evaluation of pediatric voice handicap index and pediatric voice related quality of life before and after adenotonsillectomy in pediatric population.

OBJECTIVE: To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. METHODS: Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. RESULTS: Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). CONCLUSION: Adenotonsillectomy improved PVHI and PVRQOL scores in children with adenotonsillar problems, regardless of obstructive or infectious surgical indications.

De Sanctis-Cacchione syndrome: A case report and literature review.

De Sanctis-Cacchione (DSC) syndrome is one of the rarest, most severe forms of xeroderma pigmentosum (XP). These patients with XP are of short stature, have mental disabilities, and develop progressive neurologic degeneration because of a severe inability to repair damaged DNA. Herein, we will present the case of a 9-year-old boy who had DSC syndrome with microcephaly, severe psychomotor retardation, ataxia, and hearing loss. The cutaneous manifestations included giant squamous cell carcinoma (SCC) that covered the eye, multiple facial SCCs, and pigment changes on sun-exposed areas. In addition, we include a review of reported rare cases and a brief discussion of disease management.

Comparison of patterns of psychopathology in aesthetic rhinoplasty patients versus functional rhinoplasty patients.

OBJECTIVES: To determine whether candidates for aesthetic rhinoplasty show more severe symptoms of psychopathology in comparison with functional rhinoplasty patients. STUDY DESIGN: Case-control study. Aesthetic rhinoplasty candidates were taken as cases and functional rhinoplasty patients comprised the control group. SETTING: A surgical center for rhinoplasty. SUBJECTS AND METHODS: Forty-two patients seeking either aesthetic rhinoplasty (n = 21) or functional rhinoplasty (n = 21) were included in this study in winter 2012 using a convenience sampling method. All patients were asked to complete the Symptom Check List-90-Revised (SCL-90-R) preoperatively. An independent t test was performed for each subscale of the instrument. Cohen's d was calculated as a measure of effect size. Pearson's correlation was also performed between the subscales. RESULTS: Independent t test verified that aesthetic rhinoplasty patients scored significantly higher in 8 subscales of the SCL-90-R in comparison with functional rhinoplasty patients as control group. Aesthetic rhinoplasty seekers showed more severe symptoms in obsessive-compulsive disorder (P < .01), depression (P < .01), interpersonal problems (P < .01), psychoticism (P < .05), paranoia (P < .05), hostility (P < .05), phobia (P < .01), and general psychopathology (P < .01). All subscales were correlated strongly in the current sample. CONCLUSION: This study demonstrated that a sample of patients seeking aesthetic rhinoplasty had higher symptoms in various components of psychopathology compared with a control group. Therefore, preoperative psychological screening of aesthetic rhinoplasty candidates may be useful.

Quality of life comparison in common rhinologic surgeries.

Various questionnaires are used in patients who undergo rhinologic surgeries but a unique comprehensive questionnaire is needed to evaluate quality of life (QOL) in rhinologic surgeries. The purpose of this study was to prepare a comprehensive questionnaire and compare QOL among four common rhinologic surgeries including functional endoscopic sinus surgery, septoplasty, septorhinoplasty, and septoplasty with turbinoplasty preoperatively and 6 months postoperatively. This was a prospective interventional before-and-after study. Preoperative and 6 months postoperative evaluations were performed with a Modified Health-Related Quality of Life (HRQL) questionnaire designed to cover all needed QOL aspects and the 22-item Sino-nasal Outcome Test questionnaire to cover all needed QOL aspects. The Modified HRQL included 33 items in six subgroups (nasal symptoms, sleep problems, headache, nonnasal symptoms, and practical and emotional problems) and general feeling. From 202 patients who completed the questionnaire before the procedures, 146 (72% of all patients) who were interviewed 6 months postoperatively were included in this study. Comparing preoperative data between followed up patients and missed patients showed no statistical difference among surgeries (p = 0.90). Comparison of patient's pre- and postoperative QOL showed a significant improvement in global QOL and in all questionnaire items (p < 0.0001 in all comparisons). Comparison of QOL changes before and after surgery among different surgeries revealed no statistical difference (p = 0.282). Our data showed a significant improvement in each surgery but the amount of improvement in different surgeries was almost constant.

Endonasal endoscopic dacryocystorhinostomy: how to achieve optimal results with simple punch technique.

Endonasal endoscopic dacryocystorhinostomy (EEDCR) has been popularized as a minimally invasive technique. Although preliminary reports revealed less success in comparison with external approaches, recent endonasal endoscopic surgeries on various types of DCR have preserved advantages of this technique while diminishing the failures. We described our experience on EEDCR, including the main advantages and disadvantages of it. Hundred consecutive cases of lachrymal problems underwent EEDCR utilizing simple punch removal of bone, instead of powered instrumentation or lasers. The medial aspect of the sac was removed in all of patients, while preserving normal mucosa around the sac. Hundred cases of EEDCR were performed on 81 patients, with 19 bilateral procedures. Nine procedures were performed under local anesthesia. Based on a mean 14 months follow-up, 95 cases were free of symptoms, revealing 95% success rate. The punch technique diminishes the expenses of powered or laser instrumentation with comparable results. It seems that preserving normal tissues and creating a patent rhinostomy with least surgical trauma and less subsequent scar, plays the most important role in achieving desirable results.

Regression of polypoid nasal mucosa after systemic corticosteroid therapy: a proteomics study.

BACKGROUND: Nasal polyposis (NP) treatment and pathophysiology have always been challenging for otolaryngologists. Among the medical treatments for NP, glucocorticoids (GCs) have been always one of the mainstays but the mechanisms of their action are not well defined. Identifying and comparing the protein profile of chronic rhinosinusitis (CRS) with NP before and after treatment with GCs can help to clarify NP pathogenesis and mechanisms of corticosteroid effects on NP. METHODS: Samples of nasal polyps were taken from selected NP patients in workup for endoscopic sinus surgery. None of the patients used local or systemic GCs within 30 days before the sampling. The patients were given prednisone, 30 mg/day, for 4 days before the surgery to shrink the NP tissue. Nasal polyp samples were collected during surgery. Proteins from samples were extracted and separated by immobilized pH gradient-based two-dimensional difference gel electrophoresis (2D DIGE). Resulting 2D-gel images were statistically analyzed using Delta2D software and differently expressed protein spots were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. RESULTS: A reference map of 1963 proteins could be established. Expression of 20 proteins changed significantly (twofold, p<0.05) after treatment of NP with GCs. Heat shock proteins and retinoic acid were induced by GCs. Ingenuity pathway analysis of all identified proteins indicated that apoptosis pathway is triggered in NP after GC administration. CONCLUSION: Identifying the changes of NP proteome due to GCs and the biological functions of proteins can lead to new ways of treatment and open new fields in NP research.

Nitric oxide metabolites as biomarkers for follow-up after chronic rhinosinusitis surgery.

BACKGROUND: Nitric oxide (NO) has a variety of effects on the pathophysiology of the nasal cavity and seems to play an important role in inflammation. It is increased in the common cold but decreased in acute and chronic rhinosinusitis (CRS). Exhaled NO increases after endoscopic sinus surgery in CRS. In our previous study we showed that NO metabolite (nitrate and nitrite) levels are increased in the sinus cavity of CRS patients. We hypothesized that NO metabolite levels are increased to normal in the nasal lavage of CRS patients after endoscopic sinus surgery and NO metabolites in the nasal lavage can be used as indicators of the disease status after surgery. METHODS: This study was performed on 52 patients with CRS who did not respond to medical therapy and who underwent surgery. NO metabolite levels were measured in nasal lavages of the patients before surgery and 2 months after surgery. RESULTS: NO metabolite levels (mean +/- SEM) were 18.11 +/- 3.08 micromol/L and 35.97 +/- 4.64 micromol/L in nasal lavages of patients before and after surgery, respectively. The levels of NO metabolites were increased significantly (p < 0.01) after surgery in nasal lavages and patients reported significant improvement based on the visual analog scoring after the operation. CONCLUSION: NO metabolite levels were decreased in nasal lavages of CRS patients and were increased to normal levels after surgery along with improvement of the disease. NO metabolite levels may be used as an indicator for the follow-up of patients after endoscopic sinus surgery.

Immunologic evaluation of patients with recurrent ear, nose, and throat infections.

PURPOSE: In this study, we aimed to study the frequency of possible underlying immunodeficiency responsible for susceptibility to ear, nose, and throat (ENT) infection. MATERIALS AND METHODS: One hundred three (72 males and 31 females) consecutive children and adult patients with history of recurrent or chronic ENT infections, referred by otolaryngologists to the Department of Allergy and Clinical Immunology, Children's Medical Center, Tehran University of Medical Sciences (Tehran, Iran), were enrolled to the study from March 2003 to March 2006. For each patient, demographic information and medical histories of any ENT infections were collected by reviewing the patient's records. We measured immunoglobulin isotype concentrations and immunoglobulin (Ig) G subclasses by nephelometry and enzyme-linked immunosorbent assay methods, respectively. Of 103 patients, 75 received unconjugated pneumococcus polyvalent vaccine, and blood samples were taken before and 21 days after vaccination. Specific antibodies against whole pneumococcal antigens were measured using enzyme-linked immunosorbent assay method. Existence of bronchiectasis was confirmed in each patient using high resolution computed tomography scan. RESULTS: Among 103 patients, 17 (16.5%) patients were diagnosed to have defects in antibody-mediated immunity including 6 patients with immunoglobulin class deficiency (2 common variable deficiency and 4 IgA deficiency), 3 with IgG subclass deficiency (2 IgG2 and 1 IgG3), and 8 with specific antibody deficiency against polysaccharide antigens. In our series, bronchiectasis was detected in 5 cases associated with primary immunodeficiency. CONCLUSIONS: Long-standing history of ENT infections could be an alarm for ENT infections associated with primary antibody deficiency.

Nitric oxide: a new concept in chronic sinusitis pathogenesis.

PURPOSE: Exhaled NO is produced mainly in paranasal sinuses and nasal mucosa. Nasal NO has been suggested to have a variety of effects in nasal cavity. Decreased exhaled NO is found in chronic sinusitis, and NO metabolite levels are increased in animal models of chronic sinusitis, suggesting a role for them in sinusitis pathogenesis. There was no data available on human NO metabolite level. MATERIALS AND METHODS: We lavaged maxillary sinuses in a control and 2 patient groups. The control group was patients who underwent functional endoscopic sinus surgery (FESS) due to any other reason than chronic sinusitis. The patient groups had chronic rhinosinusitis with and without polyposis who underwent FESS. Maxillary sinuses were lavaged during FESS, and NO metabolites (nitrate and nitrite) were lavaged in the lavage fluid. RESULTS: Nitric oxide metabolite levels (mean +/- SEM) were 8.085 +/- 1.43 mumol/L in healthy maxillary sinus lavage fluid and 18.04 +/- 3.51 and 16.78 +/- 2.91 mumol/L in chronic rhinosinusitis with and without polyposis, respectively. Lavage fluid of sinuses with chronic sinusitis had elevated levels of NO metabolites, which were significantly higher than the control group. The difference between the chronic sinusitis with and without polyposis groups was not significant. CONCLUSIONS: Nitric oxide metabolites were significantly higher in maxillary sinuses of patients with chronic sinusitis. Elevated levels of NO and NO metabolites in sinusitis might damage healthy sinus epithelium. NO metabolites may have an important role in sinusitis pathogenesis.

Endonasal endoscopic resection of ethmoido-orbital osteoma compressing the optic nerve.

Osteomas are the most common benign tumors of the paranasal sinuses. Open procedures for removal of ethmoid osteomas have been the method of choice, but debate over optimal treatment continues. We report resection of a large ethmoido-orbital osteoma via endonasal endoscopic approach with minimal morbidity. A 42-year-old man presented with a 1-year history of slowly progressive proptosis and lateral gaze diplopia. Imaging studies of orbits and sinuses revealed a large bony mass in left ethmoid sinus extending into the left orbit. The mass had compressed and slightly diverted the optic nerve. The patient had also bilateral extensive polyposis for which bilateral ethmoidectomy and sphenoidotomy were performed. Using a curved blunt elevator, the osteoma was gently and meticulously detached from adjacent structures. Finally, frontal recesses were cleaned form the polyps. The postoperative period was uneventful. After 18 months, he is still free of symptoms. The previously used management modality of symptomatic osteomas has mostly consisted of open approaches. Endonasal endoscopic approach provides a safe and effective alternative to open approaches, offering cosmetic advantages and lowering the morbidity. This approach could be judiciously used in large ethmoido-orbital osteomas in selected cases.

Endoscopic resection of nasopharyngeal angiofibromas by combined transnasal and transoral routes.

PURPOSE: To determine the role of endoscopic surgery in decreasing intraoperative bleeding, morbidity, and hospitalization period of juvenile nasopharyngeal angiofibroma resection and to describe combined endoscopic transnasal and transoral approaches. PATIENTS AND METHODS: Twelve cases of juvenile nasopharyngeal angiofibroma diagnosed by endoscopic examination, computed tomography, and angiography were selected for endoscopic resection. Tumor staging ranged from stage I(A) to II(B). Ten patients underwent preoperative selective arterial embolization, and in 1 case selective arterial ligation was used. In general, the tumors were approached endoscopically through nasal and oral cavities with 0 degrees and 30 degrees 4-mm telescopes without any incision and no packing at their termination. RESULTS: The patients were followed by endoscopy and computed tomography. There was a dramatic decrease in intraoperative bleeding and postoperative morbidity. No early postoperative complications were seen. Two recurrences were observed in 12 patients up to a mean follow-up of 15 months. CONCLUSIONS: Minimal bleeding, decreased morbidity, and shorter hospitalization period were the main reasons that prompted us to use endoscopic technique for the removal of juvenile nasopharyngeal angiofibroma. Adding transoral endoscopic approach to the transnasal endoscopic approach provides 2-sided exposure and appreciate access to angiofibroma.

Endonasal endoscopic treatment of medial orbital wall fracture via rotational repositioning.

Various surgical approaches have been employed to treat the medial orbital wall fracture. It has been necessary to use grafts or splints in these approaches. We introduced a new technique to treat our patient with diplopia resulting from medial orbital fracture. In this new method, rotational repositioning of the fractured segment eliminates the use of any graft or synthetic material in the nose, ethmoid sinuses, or the orbit. The procedure could be done under local anesthesia, which facilitates intraoperative monitoring of the ocular movements to evaluate improvement of diplopia. Rotational repositioning technique could be an effective alternative method to previous approaches in treatment of selected medial orbital wall fractures.