[Update on Current Care Guideline: Sinusitis]. / Sivuontelotulehdus.

Patients with common cold have often symptoms similar to sinusitis. These symptoms often resolve in time, but symptomatic treatment (e.g. analgesics, decongestants) may be used. If symptoms continue for over 10 days, or severe symptoms continue for over 3 days, or symptoms turn worse in the course of the disease, bacterial sinusitis should be suspected. Diagnosis is based on clinical findings, and can be confirmed with ultrasound examination. Amoxicillin, penicillin or doxicyclin are recommended for bacterial sinusitis. Patients with chronic or recurrent sinusitis should be referred to specialist care.

[Emergency rhinology]. / Päivystysrinologiaa.

The nose counteracts chemical, biological and mechanical insults from the outside word. Mechanical injuries to the nose are usually managed within few days. Fracture of the nasal septum and possible hematoma should be managed within one day. Nasal or paranasal infection will in most cases heal by symptomatic treatment or antibiotic medication. Sometimes the condition gets rapidly complicated, resulting even in a life-threatening infection. Nose-bleeding originates in most cases from the frontal part of the nose, whereby treatment with silver nitrate is simple and effective. Gauze packing or anterior-posterior tamponade with a balloon serve as first aid for bleeding of the posterior part.

Incidence of pituitary adenomas in Northern Finland in 1992-2007.

CONTEXT: Data on the incidence of pituitary adenomas (PAs) are scant and outdated. A population-based regional cohort with thorough case identification was used to evaluate the incidence of clinically detected PAs in the era of magnetic resonance imaging. OBJECTIVE: The objective of the study was to describe the age- and sex-specific incidence of all PA subgroups, with data on incidentally found PAs, pituitary apoplexies, and time trends. DESIGN, SETTINGS, AND PATIENTS: This was a retrospective descriptive analysis of PA patients diagnosed during 1992-2007 in Northern Finland (NFi). MAIN OUTCOME MEASURE: World Health Organization 2000-standardized incidence rates (SIRs) of PAs per 100,000 were measured. RESULTS AND CONCLUSION: The final cohort consisted of 355 PAs. The incidence rates of the Oulu University Hospital regional district were used as a reference to assess the applicability of our case finding over the rest of NFi. Incidence rates of all PA subgroups except microprolactinomas were statistically equal between these areas; thus, all presented SIRs are based on the NFi's cohort except Oulu University Hospital regional district-based prolactinomas and PAs overall. Overall SIR of PAs was higher (4.0 per 100,000) than in previous reports. Prolactinomas had the highest SIR: 2.2 per 100,000, followed by clinically nonfunctioning PAs (1.0) and GH-secreting (0.34), ACTH-secreting (0.17), and TSH-secreting (0.03) PAs. The gender-specific SIR was 2.2 per 100,000 in males and 5.9 per 100,000 in females. Pituitary apoplexy occurred as a presenting symptom in 11% of clinically nonfunctioning PA patients. The SIR of incidentally discovered PAs increased significantly from 1992-1999 to 2000-2007 (0.59 to 1.6, respectively; P < 0.01), which accounted for the perceived increasing trend in the overall SIR of PAs (3.8 to 4.2; P > 0.05).

Acoustic rhinometry and rhinomanometry in the preoperative screening of septal surgery patients.

BACKGROUND: The preoperative assessment of septal surgery patients with acoustic rhinometry (AR) or rhinomanometry (RMM) is still a controversial subject. This study was designed to apply AR and RMM in preoperative screening of septal surgery patients. METHODS: The gold standard is postoperative satisfaction expressed by patients as "very high," "high," "moderate," or "low" subjective total benefit from the operation to the nasal obstruction 1 year after surgery. One hundred fifty-seven consecutive patients presenting for septal surgery because of an obstructing septum deviation in anterior rhinoscopy, sufficient pre- and postoperative data were available in 110 patients. Anterior rhinoscopy, AR, and RMM were performed before and 1 year after surgery. RESULTS: The preoperative AR and RMM had a statistically significant impact (p < 0.01) in predicting the postoperative satisfaction. The best single preoperative parameter for predicting postoperative satisfaction was the postdecongestion overall minimum cross-sectional area on the deviation side in AR; the estimated optimal cutoff value was 0.40 cm(2). The most predictive preoperative RMM parameter was the postdecongestion intercavital flow ratio (the flow on the deviation side divided by the flow on the wide side); the estimated optimal cutoff value was 1:2. For both parameters the sensitivity/specificity for the cutoff values was around 65/60% in finding patients with high or very high postoperative satisfaction. For anterior rhinoscopy the optimal cutoff was a deviation between severe and moderate with sensitivity/specificity around 55/55%. CONCLUSION: In patients with a very severe deviation, anterior rhinoscopy was sufficient for preoperative screening but in milder deviations AR and RMM significantly predicted postoperative success.

3D modeling-based surgical planning in transsphenoidal pituitary surgery--preliminary results.

CONCLUSION: The preoperative three-dimensional (3D) modeling of the pituitary adenoma together with pituitary gland, optic nerves, carotid arteries, and the sphenoid sinuses was adopted for routine use in our institution for all pituitary surgery patients. It gave the surgeon a more profound orientation to the individual surgical field compared with the use of conventional 2D images only. OBJECTIVE: To demonstrate the feasibility of 3D surgical planning for pituitary adenoma surgery using readily available resources. SUBJECTS AND METHODS: The computed tomography (CT) and magnetic resonance imaging (MRI) data of 40 consecutive patients with pituitary adenoma were used to construct 3D models to be used in preoperative planning and during the surgery. A freely available, open source program (3D Slicer) downloaded to a conventional personal computer (PC) was applied. RESULTS: The authors present a brief description of the 3D reconstruction-based surgical planning workflow. In addition to the preoperative planning the 3D model was used as a 'road map' during the operation. With the 3D model the surgeon was more confident when opening the sellar wall and when evacuating the tumor from areas in contact with vital structures than when using only conventional 2D images.

Effects of the Cottle's maneuver on the nasal valve as assessed by acoustic rhinometry.

BACKGROUND: The nasal valve is the narrowest segment of the nasal cavity and plays an essential role in breathing. There has been plenty of discussion in the literature concerning the location and function of the nasal valve. The Cottle's maneuver (CM) is a test in which the cheek on the side to be evaluated is gently pulled laterally with one to two fingers to open the valve. This test is used to determine if the most significant site of nasal obstruction is at the valve or farther inside the nasal cavity. The aim of this study was to determine the dimensional changes caused by the CM in the nose as measured by acoustic rhinometry (AR). METHODS: Eight adult volunteers with no nasal symptoms were recruited and their nasal cavities were measured by AR. The measurements were done with and without the CM both before and after decongestion with a mixture of 1:1000 epinephrine and 4% lidocaine in cotton pledgets. The MCA1 and MCA2 and their distances from the nostril, as well as the volume-measured from the zero point to the MCA2 point--were determined. RESULTS: The main effect of the CM was a mean increase in MCA1 by 33% (p = 0.001) and 44% (p < 0.001) before and after decongestion, respectively. The distance of MCA1 increased significantly, because of the CM, by 12% (p = 0.006) before and 7% (p = 0.008) after decongestion. The percentage increases in volume were 33% (p = 0.001) and 44% (p < 0.001), respectively. Decongestion of the nasal mucosa induced a statistically significant (p = 0.001) increase in both MCA1 (by 21%) and MCA2 (by 28%). CONCLUSION: The CM significantly increased MCA1 in AR, and the increase was more evident after decongestion of the nasal mucosa. The changes in MCA2 were nonsignificant. We conclude that the value of the CM in investigating a possible valve insufficiency may be greater if the nose is studied both before and after decongestion of the nasal mucosa.