ABSTRACT
OBJECTIVE: Determine the efficacy of computerized tomography (CT) in detecting the intranasal distribution of sprayed radio-enhanced particles and the effects of topical decongestion on particle distribution. STUDY DESIGN: Sinonasal distribution of a radio-enhanced spray solution was studied using CT imaging in 14 adults with no sinonasal symptoms. One nostril was sprayed with oximetazoline 5 minutes prior to particle application. Serial CT imaging of the sinonasal cavity in approximately 11 minutes was carried out to detect particle distribution into the nasal vestibule, turbinate surfaces, middle meatus and osteomeatal complex area, and the nasopharynx. RESULTS: Particle detection within the nasal vestibule was possible in all cases while distribution into the anterior nasal chamber was visible in 22 cases. Particles could be detected on the inferior turbinate in 7 nasal cavities (25%) and in only 2 cases on the middle turbinate (7.5%). Particles were detected in the middle meatus in 1 case and in no instances in the osteomeatal complex area. Oximetazoline application reduced the amount of particle deposition on the inferior turbinate but did not enhance distribution on the middle turbinate or into the middle meatus. CONCLUSION: Detection of radio-enhanced sprayed particles within the sinonasal cavity using CT imaging can be a reliable method to study the principles of intranasal particle distribution. Our study failed to show particle distribution into OMC, or any positive effects of nasal decongestion on particle distribution.
Subject(s)
Aerosols/administration & dosage , Contrast Media/pharmacokinetics , Iohexol/analogs & derivatives , Nasal Cavity/diagnostic imaging , Nasal Decongestants/administration & dosage , Paranasal Sinuses/diagnostic imaging , Tomography, X-Ray Computed , Administration, Intranasal , Adult , Contrast Media/administration & dosage , Follow-Up Studies , Humans , Iohexol/administration & dosage , Iohexol/pharmacokinetics , Male , Nasal Cavity/drug effects , Nasal Cavity/metabolism , Paranasal Sinuses/drug effects , Paranasal Sinuses/metabolism , Prospective Studies , Reference ValuesABSTRACT
Fungus balls are tangled mats of hyphae that are often found in the maxillary sinus. In approximately half of affected patients, radiologic evaluation will reveal areas of hyperdensity within soft-tissue masses. Histopathologic examination will reveal no invasion of the mucosa and no granulomatous reactions. Surgical removal is sufficient because fungus balls are not known to recur. We describe an interesting case of a sinonasal fungus ball that resembled dental filling material on radiologic imaging because of its extraordinary radiopacity. Histopathologic examination detected eosinophilic infiltration, hyphae in the submucosal tissues, and tissue necrosis.
Subject(s)
Aspergillosis/pathology , Eosinophilia/pathology , Maxillary Diseases/microbiology , Maxillary Diseases/pathology , Aspergillosis/surgery , Female , Humans , Maxilla/microbiology , Maxillary Diseases/surgery , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Primary headaches or other chronic headaches can be triggered by sinonasal pathologies, or variations within the sinonasal tract. Establishing a cause and effect relationship between certain sinonasal conditions and chronic headaches can justify sinonasal surgery for the relief of headaches and provide considerable relief to a subgroup of patients with chronic headaches resistant to medical treatment. A prospective study on 204 patients undergoing sinonasal surgery for an apperent symptomatic sinonasal pathology was conducted to determine the incidence and types of headaches in sinonasal patients preoperatively, the presence of potential sinonasal triggering mechanisms, and postoperative headache relief when such triggers are removed. The relationship between potential triggers and postoperative relief is analysed to determine a possible link. Headache was a major complaint in 50% of these patients and the overall incidence of primary type headaches was 25.5% (52 of 204 patients). Postoperatively, 83.4% of the patients expressed improvement of the headaches (85/102). High scores of preoperative Sinonasal Headache Quotient (SNHQ), obtained through a general questionnaire and endoscopic/radiologic work up seems to correlate well with postoperative relief of headaches (p < 0.0001), as well as a well defined lesion site and an ipsilateral pain localization (p < 0.02). A detailed sinonasal analysis of chronic headache patients may help identify a subgroup with potential sinonasal triggers and these patients may experience considerable relief of headache following surgery.
Subject(s)
Headache/etiology , Paranasal Sinus Diseases/complications , Adult , Chronic Disease , Female , Humans , Male , Nasal Obstruction/complications , Paranasal Sinus Diseases/surgery , Sinusitis/complicationsABSTRACT
Nasal polyposis is common among children with cystic fibrosis. We report the case of a 14-year-old girl with cystic fibrosis who experienced severe facial disfigurement as a result of massive polyposis. Her polyps were removed surgically, and she was referred for cosmetic surgery.
Subject(s)
Cystic Fibrosis/complications , Nasal Polyps/complications , Nasal Polyps/surgery , Adolescent , Female , Humans , Nasal Polyps/diagnostic imaging , Radiography , Severity of Illness IndexABSTRACT
Syphilis is an unusual diagnosis in an ENT practice. We evaluated a 55-year-old man who had generalized plaques on his face, neck, and upper extremities. Analysis of skin biopsy and serology specimens revealed that the patient had secondary syphilis. He responded rapidly to treatment. The purpose of this article is to remind otolaryngologists of the signs and symptoms of syphilis so that it can be recognized and treated in a timely fashion.
