Type and severity of septal deviation are not related with the degree of subjective nasal obstruction.

BACKGROUND: Septoplasty is a frequently performed operation by otolaryngologists to relieve nasal obstruction complaints. When objective measurements tools are not available, preoperative decision-making is based on careful clinical examination. Our aim was to evaluate the relationship between type and severity of septal deviation and patient-reported nasal obstruction. METHODOLOGY: 196 Patients of a general otolaryngology population were included. Patients indicated subjective nasal obstruction experienced during the past 1 month on a Visual Analog Scale (VAS). Patients underwent clinical examination to evaluate type and severity of septal deviation. We compared clinical examination findings with patients VAS. RESULTS: We did not find a statistical difference of VAS score between the different types and severities of septal deviation. In 33.9% of the cases without septal deviation, there was a corresponding VAS score of 0. In 26,8% of the cases with septal deviation, there was no complaint of nasal obstruction (VAS = 0). In 7,4% of the cases, there was moderate to severe nasal obstruction complaint (VAS over 4) though no septal deviation was found. CONCLUSIONS: These results demonstrate that patient-reported nasal obstruction varies greatly among patients with similar type of deviation and similar degree of deviation. Classification of septal deviation into type and severity cannot predict the degree of subjective nasal obstruction. Therefore, the decision to proceed to septoplasty has to be thoughtful, with as much as information, based on the combination of patients history, clinical examination, surgeons experience and cautious interpretation of objective measurement tools.

Nine-year-old girl with a respiratory epithelial cyst of the orbit.

OBJECTIVE: Here we describe the clinical and histopathological characteristics of a nine-year-old girl with an intraorbital mass of the left orbit, and review the relevant literature. RESULTS: Imaging data and surgical biopsy revealed an intraconal cystic lesion in the medial-inferior quadrant of the left orbit. The cyst was lined with ciliated pseudostratified epithelium, consistent with a respiratory epithelial cyst of the orbit. Cyst marsupialisation and partial mass removal alleviated symptoms, and no cyst recurrence was observed during follow-up. The literature suggests that this is an uncommon cause of a cystic orbital mass. CONCLUSION: Respiratory epithelial cysts of the orbit should be considered in the differential diagnosis of intraorbital masses. Surgical excision of such a lesion should be limited to avoid damaging orbital structures. Respiratory epithelial cysts of the orbit generally follow a benign course, and recurrence of ocular symptoms is rare.

Wegener granulomatosis as possible cause of vertigo: case report and review.

OBJECTIVE: Wegener granulomatosis (WG) or granulomatosis with polyangiitis (GPA) is a multi-system necrotizing granulomatous vasculitis that classically affects the upper respiratory tract, lungs and kidneys. We report the unusual clinical course of a patient with WG, and we present a literature review on the association between WG and vertigo. RESULTS: In our case, a 56-year-old female presented with a several-month history of chronic sinusitis and otalgia that was refractory to all initiated outpatient therapies. During hospitalization, a diagnostic evaluation revealed serious nasal crusting, chronic otitis media, and hematuria. Serologic testing showed elevated anti-neutrophil cytoplasmic antibodies (c-ANCAs). The tentative diagnosis of Wegener granulomatosis was confirmed by renal biopsy. Upon admission, the patient developed an acute vertigo with nystagmus, nausea, and vomiting, accompanied by sensorineural hearing loss in one ear. CONCLUSIONS: Vestibular symptoms may be associated with Wegener granulomatosis.

Belgian guidelines for the treatment of acute rhinosinusitis in general practice.

Management and treatment guidelines for rhinosinusitis and nasal polyps have been published by the European Academy for Allergy and Clinical Immunology (EAACI) task force in 2005, and have recently been updated. These guidelines are evidence-based and internationally recognized, and form the basis for the here presented "Belgian Guidelines for the treatment of ARS in general practice", developed by the sinusitis committee. This document is intended to establish evidence-based management procedures for ARS, one of the most frequent upper airway diseases, mostly treated by the general practitioner. It is recommended to treat ARS with topical glucocorticosteroids 200 mcg BID. Antibiotics are recommended for the treatment of severe ARS, if need be, together with topical glucocorticosteroids BID.

Wegener's granulomatosis presenting as otomastoiditis. A case report.

A 55-year-old male presented with left-sided otorrhoea, hearing loss and tinnitus of 3 months duration. On clinical examination polypoid tissue was seen prolapsing in the external ear canal. A CT scan of the mastoid cells and middle ear showed otomastoiditis with osteolysis. Oral antibiotic therapy and eardrops were started. When a facial nerve paresis appeared one month later, a mastoidectomy was performed. The mastoid cells and middle ear were filled with a connective tissue-like substance. Postoperative corticosteroids were administered. Despite the therapy the facial nerve problem aggravated and the patient developed severe parietotemporal headache, meningeal irritation and somnolence. The diagnosis of neurosarcoidosis was hypothesised. Blood analysis, including c-ANCA's, culture of the otorrhoea and biopsies of the connective tissue were inconclusive. A CT scan of the brain showed thickening of the left tentorium. A biopsy of the dura indicated a diagnosis of Wegener's granulomatosis. The patient was treated with immunosuppressive medication with satisfactory results.

Congenital laryngeal cyst: a case report.

Congenital laryngeal cysts are a rare cause of stridor in the neonate. Nevertheless, delayed diagnosis and treatment can cause life-threatening airway obstruction. Even though the diagnosis is easily made by careful inspection, treatment results often in recurrence. These facts are illustrated by a case of a baby with a saccular cyst. Immediately after diagnosis and 5 days later the cyst was de-roofed using a CO2 laser via an endolaryngeal approach. Because of a second recurrence an excision of the cyst was performed via a lateral cervical approach.

Velopharyngeal anatomy in snorers and patients with obstructive sleep apnea.

Velopharyngeal structures play an important role in the pathogenesis of snoring and obstructive sleep apnea (OSA). Hence they form a tempting target for surgical interventions in the treatment of these sleep-related breathing disorders. The assessment of the patient with snoring should therefore include a thorough evaluation of the velopharynx. The clinical evaluation of the velopharynx is discussed in normals and patients who snore (with or without OSA), as well as the features obtained using cephalometry and CT and MR imaging.

Oncocytic laryngeal cysts: a case report and literature review.

Some 150 cases of oncocytic laryngeal cysts have been published. We report another case of laryngeal oncocytic cysts with atypical presentation of acute, progressive stridor and sore throat. Literature was reviewed with special regard to etiology, clinical presentation, imaging, incidence, localization, associated lesions and treatment options. Oncocytic laryngeal cysts are rare, but may be underreported. They represent a separate clinicopathological entity in the group of all laryngeal cysic lesions and occur in persons over 60 years. The symptomatology varies from asymptomatic to hoarseness and dyspnea. Diagnosis is made by histological examination. Treatment is surgical. Although it is a benign lesion, follow up is recommended, as recurrence is possible.

Treatment of the obstructive nose by CO2-laser reduction of the inferior turbinates: technique and results.

In our department we treat chronically enlarged inferior turbinates (not responding to adequate medical therapy) with the CO2-laser or by partial inferior turbinoplasty. In this work the technique is described and short- and long-term results are evaluated. We divided our study group into two populations: one group with a follow-up of 18 months for which we could obtain objective measurements of the nasal patency by means of a preoperative and postoperative active anterior rhinomanometry, and another group with a follow-up of more than 15 years, for which (because of the absence of a pre-operative rhinomanometry) we could only obtain a subjective evaluation of the results by means of a questionnaire. Relief of nasal obstruction was reported by 88.5% of the patients until 5 years after laser surgery on the inferior turbinates. There seems to be no functional impairment on the nasal mucosa after this kind of surgery. The advantages and drawbacks of this technique are discussed.

Long-term efficacy of our surgical approach to turbinate hypertrophy.

In our department, chronically enlarged inferior turbinates (not responding to adequate medical therapy) are treated with the CO2-laser or by partial inferior turbinoplasty. In this work, the latter technique is described and the short- and long-term results (up to 9 years of follow-up) are evaluated. Relief of nasal obstruction was reported by 93.5% of the patients. There was a good correlation between this success rate and the objective measurements of the nasal resistance by active anterior rhinomanometry. Rhinorrhea or postnasal drip was still present in 32.5%. Atrophic changes of the nasal mucosa were not observed in any of the patients. Early postoperative epistaxis was found in 6.5% of the patients. Late postoperative epistaxis did not occur.

Tonsillectomy and adenotomy as a one day procedure?

With special reference to the postoperative hemorrhage rate and its subsequent course, we retrospectively evaluated the outcome of 2,363 tonsillectomies and 3,295 adenotomies performed over the last 11 years at our department. The postadenotomy major bleeding frequency was 0.2%. After tonsillectomy the immediate postoperative major bleeding frequency was 2.6% and 3.0%, respectively in children and adults. Secondary bleeding after tonsillectomy occurred in 0.3% of the children and 0.5% of the adults. In contrast to adenotomy, which can be considered as a safe one day procedure, based on our results we propose to perform tonsillectomy as a more prolonged, one night stay procedure.

[Fixation of nasogastric tubes in agitated and uncooperative patients]. / Fixation des sondes naso-gastriques chez les patients agités et peu compliants.

To prevent extubation, nasogastric tubes (NGT) were attached to a fine bore polyurethane tube, which loops loosely around the nasal septum. In a prospective study 180 cases were evaluated concerning the efficacy and possible complications related to this techniques. On average, a nasal septal loop (NSL) remained 20.1 +/- 1.3 days and a NGT 14 +/- 0.9 days. Complications were rare. In 45 of the cases NGT had to be replaced after self extubation and in 2.2% extubation presented more than twice. We think NSL is an easy and useful technique to secure NGT in non-cooperative and/or agitated patients for a relatively short term enteral nutrition or gastric decompression.

Posterior epistaxis: our experience with transantral ligation and embolisation.

Transantral ligation of the arteria maxillares internae (AMI) (with or without ligation of the arteria ethmoidalis) and percutaneous embolisation of AMI in cases of intractable epistaxis (i.e. epistaxis not responding to classical posterior packing) are compared. Except when ethmoidal bleeding is suspected, we recommend embolisation for epistaxis not responding to classical measures as it leads to fewer complications and recurrences, to shorter hospital stay and to improved postoperative comfort.

Premalignant lesions of the vocal cords. A retrospective study of 62 cases treated with CO2 laser.

A series of 62 patients treated by (repeated) CO2 laser excision and/or vaporization for premalignant lesions of the vocal cords was analysed retrospectively. Of the 54 patients available for follow-up (ranging from 1 to 15 years), five patients (9%) developed an invasive glottic carcinoma and needed radiotherapy. Only two patients (4%) needed extensive surgery (total laryngectomy). One patient (2%) died of a recurrent carcinoma despite radiotherapy and laryngectomy, and six patients (11%) died of a metachronic lung carcinoma. The therapeutic results of (repeated) laser therapy were comparable to those in other reports regarding radiotherapy or stripping. The subjective functional results were satisfactory and tended to improve along with refinement of laser surgery techniques. Follow-up of patients who once had a premalignant laryngeal lesion is mandatory ad vitam, regardless of the grade of the lesion. For the screening of lung cancer, there is still no consensus on a standard-of-care. The classical chest X-ray remains the most accessible and comfortable screening procedure.

Our technique of partial inferior turbinoplasty: long-term results evaluated by rhinomanometry.

Conservative surgical technique (Partial inferior turbinoplasty) for enlarged inferior turbinates, not responding to adequate local and systemic therapy is described. Short and long term results are evaluated. Relief of nasal obstruction is reported in 94.7% of the patients. There is a good correlation between this success-rate and the objective measurements of the nasal resistance by active anterior rhinomanometry. Rhinorrhea or postnasal drip was still present in 34.2%. Atrophic changes in the nasal mucosa were not observed. Early post-operative epistaxis was found in 5.3% of the patients. Late post-operative epistaxis did not occur.

Securing nasogastric tubes in non-cooperative patients.

To prevent extubation, nasogastric tubes (NGT) were attached to a fine bore polyurethane tube, which loops loosely around the nasal septum. In a prospective study, 124 cases were evaluated for the efficiency and possible complications. On average, a Nasal Septal Loop (NSL) remained 21,2 +/- 1,8 days and a NGT 13,8 +/- 1,1 days. Complications were rare. In 16,9% of the cases NGT had to be replaced after self extubation and in 2.4% extubation occurred more than twice. We think NSL is an easy and useful technique for securing NGT in non-cooperative and/or agitated patients for relatively short term enteral nutrition or gastric decompression.

Surgical management of chronic otitis media with effusion.

Surgical management of chronic otitis media with effusion. One hundred and twenty six children suffering from chronic otitis media with effusion (OME) were operated. Ninety two point eight percent had a satisfactory outcome. Surgical management of chronic OME is discussed.

[Rupture of the round window. Differential diagnosis in sudden deafness and acute vestibular symptoms]. / Ruptuur van het ronde venster. Differentiaal diagnose bij plotse doofheid en plotse vestibulaire symptomen.

Rupture of the round window has to be considered in the differential diagnosis of sudden hearing loss with or without vertigo. The symptoms of this pathology vary a lot. No clinical examination with a sufficiently high selectivity and sensibility exists. The low therapeutical risk is stressed: exploratory and therapeutic tympanoscopy with grafting of the round and/or oval window.

Fibrous dysplasia in the frontoethmoidal complex: diagnosis and surgical aspects.

Fibrous dysplasia of the paranasal sinuses is rare and often presents a diagnostic challenge. We describe 3 cases of fibrous dysplasia and ossifying fibroma involving the paranasal sinuses. After introduction of the term fibrous dysplasia into the literature in 1938 by Lichtenstein, many authors accepted fibrous dysplasia and ossifying fibroma as one and the same entity. In more recent years most investigators have considered the two lesions as separate and distinct clinical entities. A brief update of the clinical aspects, radiographic appearance, diagnosis and management of craniofacial fibro-osseous lesions is provided.