ABSTRACT
Cholesteatoma is a relatively common disease entity within the middle ear cavity, but it is rarely found in the paranasal sinuses. We describe a rare case of cholesteatoma in the maxillary sinus of an elderly man presenting with recurrent sinus infections and nasal obstruction refractory to medical treatment. The patient was treated using functional endoscopic sinus surgery with successful removal of the cholesteatoma. He has no recurrence of the cholesteotoma at a 13year follow-up. We review the literature and history on maxillary cholesteatomas and discuss the theories on the pathogenesis of cholesteatoma formation. We propose functional endoscopic sinus surgery with maxillary antrostomy and marsupialization of the cholesteatoma as a primary treatment option for a maxillary cholesteatoma.
Subject(s)
Cholesteatoma/diagnosis , Cholesteatoma/surgery , Maxillary Sinus/pathology , Paranasal Sinus Diseases/diagnosis , Paranasal Sinus Diseases/surgery , Aged , Endoscopy/methods , Follow-Up Studies , Humans , Male , Nasal Obstruction/diagnosis , Nasal Obstruction/etiology , Rare Diseases , Recurrence , Sinusitis/diagnosis , Sinusitis/etiology , Treatment OutcomeABSTRACT
OBJECTIVES/HYPOTHESIS: To review current knowledge on nasal airflow sensation in relation to empty nose syndrome (ENS). STUDY DESIGN: PubMed searches. METHODS: Current literature pertaining to measurement of nasal patency, mechanism of sensory perception of nasal airflow, and ENS. RESULTS: A reliance on pure anatomical analysis of the anatomy in ENS falls short of explaining the disorder. Our understanding of subjective nasal sensation has advanced, as has our understanding of the flow of air through the nose. Neural healing following a surgical insult may not result in a return to a normal physiologic state. Aberrations in neurosensory systems from improper healing may play a major role in the abnormal sensations ENS patients experience. CONCLUSIONS: An evidence-based hypothesis for the development and symptoms of ENS is offered.
Subject(s)
Nasal Mucosa/innervation , Nasal Obstruction/physiopathology , Postoperative Complications/physiopathology , Pulmonary Ventilation/physiology , Sensory Receptor Cells/physiology , Turbinates/physiopathology , Turbinates/surgery , Wound Healing/physiology , Brain/physiopathology , Computer Simulation , Dyspnea/physiopathology , Humans , Olfactory Pathways/physiopathology , Syndrome , Thermoreceptors/physiopathology , Tomography, X-Ray Computed , Trigeminal Nerve/physiopathologyABSTRACT
BACKGROUND: Nasal obstruction is a common otolaryngologic complaint, yet the mechanism of sensing airflow is not commonly understood. The objective of this work was to review current knowledge on the physiological mechanism for sensing nasal airflow. METHODS: Current literature pertaining to nasal sensation to airflow was retrieved using PubMed and Google Scholar searches. RESULTS: The primary physiological mechanism that produces the sensation of ample nasal airflow is activation of trigeminal cool thermoreceptors, specifically transient receptor potential melastatin family member 8 (TRPM8), by nasal mucosal cooling. The dynamic change in temperature is ultimately sensed. Nasal mucosal cooling is a result of conductive heat loss, driven by temperature gradient, and evaporative heat loss, driven by humidity gradient. The perception of ample nasal airflow is dependent on the overall nasal surface area stimulated by mucosal cooling, which is mainly governed by air flow patterns. Cool thermoreceptors in the nasal mucosa are connected to the respiratory centers and consequently can alter respiration patterns. Mechanoreceptors do not seem to play a role in sensing nasal airflow. Computational fluid dynamics (CFD) modeling could be a valuable objective tool in evaluating patients with nasal congestion. CONCLUSION: Understanding the physiological mechanism of how the nose senses airflow can aid in diagnosing the cause behind patient symptoms, which allows physicians to provide better treatment options for patients.
