Long-term follow-up of KTP laser turbinate reduction for the treatment of obstructive rhinopathy.

We investigated the subjective, long-term, patient-reported symptom control after endoscopic potassium titanyl phosphate (KTP) laser reduction of the inferior turbinates. Symptoms were listed preoperatively and patients were asked, via telephone interview, the status of their symptoms. Chi-square analysis was used to assess statistical significance of the surgical intervention. Thirty-six patients (male:female ratio: 5:4) aged 13 to 80 years (mean: 37.2) were available for follow-up. The mean follow-up time was 68.47 months (range: 44 to 92). The principal symptom patients experienced was nasal obstruction (94.4%); postoperative improvement in this symptom at 44 months and beyond was reported by 85.3% of patients (chi-square 16.94, p < 0.001). Other symptoms, such as rhinorrhea and sneezing, showed no significant improvement at long-term follow-up. This study adds evidence to the long-term improvements in obstructive nasal symptoms using KTP laser reduction of the turbinates.

Posaconazole responsive cerebral aspergillosis in an immunocompetent adult.

Cerebral aspergillosis is a rare manifestation of invasive aspergillosis that usually affects immunocompromised patients. There are few treatment options for recurrent disease and experiences with immunocompetent patients are lacking. We report the clinical course of an immunocompetent patient with recurrent cerebral aspergillosis, following initial treatment with burr hole aspiration and voriconazole, who showed remarkable response to posaconazole. The patient remains clinically well with no evidence of recurrence on MRI 7 years following diagnosis. To our knowledge this is the first reported experience with posaconazole in an immunocompetent patient with cerebral aspergillosis.

Outcomes of endoscopic sphenopalatine artery ligation for epistaxis: a five-year series from a single institution.

Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis. This study examines the outcome of 33 ELSPA procedures over a 5-year period. Three of 4 cases that were not controlled with ELSPA were successfully managed with subsequent anterior ethmoidal ligation. Failed ELSPA procedures may represent an incorrect choice of procedure rather than a failure of the procedure. High-resolution computed tomography can identify the position of the anterior ethmoidal artery; it may be possible to infer vulnerability to hemorrhage from this artery and hence target procedure selection.

Short-term results of endonasal dacryocystorhinostomy with a mucosal flap and a bone dissection technique.

OBJECTIVE: To determine the short-term results of endonasal dacryocystorhinostomy (DCR) with a mucosal flap and a bone dissection technique. MATERIALS AND METHODS: A retrospective study including consecutive 22 patients who underwent endonasal DCR between June 2004 and January 2006. The study was designed to look at the patients' symptoms and satisfaction following the procedure; hence, a telephone survey was undertaken. The absence or improvement of symptoms was defined as a successful outcome. RESULTS: There were 22 patients in the study cohort. The mean follow-up was 12 months. The procedure was successful in 20 patients (90.9%), with no residual epiphora. Failure was noted only in 2 patients. CONCLUSION: The short-term success rate of endonasal DCR was 90.90%. In a previous study from our unit, the success rate with endonasal laser DCR at 1 year was 83% and the 5-year success rate was only 56%, which made us stop doing the laser approach. We currently favour endonasal DCR with the mucosal flap approach in our unit.

Long-term results of endonasal laser dacryocystorhinostomy.

OBJECTIVE: To determine the long-term success rate of endonasal laser dacryocystorhinostomy (DCR) in our unit. MATERIALS AND METHODS: This was a retrospective study including all the consecutive cases of endonasal laser DCR (ELDCR) between November 1996 and December 1999. Patients who underwent revision DCR were excluded. The absence or improvement of symptoms as reported by the patients was defined as successful outcome. Conversely, recurrence of epiphora was considered as failure. The results were reviewed at 1 year in the clinic and at further 3 years and 5 years by telephone consultation. RESULTS: There were 65 patients (73 procedures) in the study cohort, with a mean follow-up period of 74 months (range, 60-97). Early failure was noted in 13 patients at 1 year. Only 28 patients (of the possible 50) were free from epiphora after 5 years postsurgery. CONCLUSION: We found that the success rate of ELDCR has gradually declined over the years to 56% (confidence interval, 38-69) in patients who had at least 5 years of postoperative data. We do not advocate the use of laser in endonasal DCR for patients with epiphora. EBM RATING: C-4.