Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study.

PURPOSE: Nasal douching is commonly used as a postoperative management strategy for chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies to date have compared the effectiveness of nasal douching in CRSwNP phenotypes after endoscopic sinus surgery (ESS). We evaluated the efficacy of seawater types in eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP) after ESS. METHODS: Patients with bilateral CRSwNP who had undergone ESS were blindly randomized to receive buffered hypertonic seawater (BHS) (n = 48) or physiological seawater (PS) (n = 45). CRSwNP patients were stratified by phenotypes (ECRSwNP and nonECRSwNP) retrospectively according to whether tissue eosinophils exceeded 10%. Follow-up evaluations were conducted at 2, 8, 16, and 24 weeks after surgery. Evaluations included the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events. RESULTS: All of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups. CONCLUSIONS: BHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.

The intraoperative use of polydioxanone foil to reduce the risk of sino-orbital fistula formation in orbital exenteration.

BACKGROUND: Orbital exenteration is a radical surgical procedure resulting in deformity. It involves removal of the globe, optic nerve, extra-ocular muscles, orbital fat, lacrimal gland, and peri-osteum. Sino-orbital fistula (SOF) formation is a common documented post-operative complication, usually connecting the orbit and the ethmoid sinus. SOFs can cause leaks of serous fluid, and act as an entry site for pathogens into the orbit leading to socket infection and breakdown. METHODS: This retrospective study analyzed exenterations performed over a 22-year period (1993-2015) at the National Ocular Oncology Service Centre for Scotland. PDS is a crystalline, biodegradable polyether-ester that is strong with good shape-memory and flexibility. Orbital exenterations with and without the use of PDS foil were compared in terms of SOF formation. RESULTS: A total of 30 exenterations were performed during the study period. A total of 29 were analyzed. Choroidal malignant melanoma was the most common indication for performing orbital exenteration (n = 7, 24.14%). The most common post-operative complications seen were SOF (n = 8, 27.59%). A total of 8 out 21 (38.10%) cases not using PDS developed SOFs. By contrast, none of nine patients receiving PDS plates developed SOFs (p = 0.0332). CONCLUSIONS: This is the first study to compare SOF rate in patients undergoing exenteration with and without the use of PDS foil. PDS foil is a safe material, which has effectively reduced the incidence of SOF formation.

Evaluación fisioanatómica de senos maxilares para realizar futuro tratamiento quirúrgico de aumento de volumen óseo / Physio-anatomic evaluation of maxillary sinuses for future bone volume augmentation surgical treatment

El seno maxilar representa la estructura anatómica más importante del maxilar superior y, al mismo tiempo, el límite principal anatómico de la inserción de losimplantes en este sector. Por este motivo el aumento de volúmen óseo o levantamiento de piso de seno maxilaren caso de maxilares edéntulos con senos neumatizados es una opción viable de desarrollar mediante diferentestécnicas, siempre que los senos maxilares se encuentren en condiciones fisiológicas de ventilación óptimas

Maxillary sinnus is the most important anatomicstructure in the maxillary one. It is the limit because ofimplant pleacement.1For that reason, the augmented thebone tissue in sinus floor elevation of edentulous poste-rior maxilla with pneumatisation is an excellent optionto be developed with differents techniques, in the casemaxillary sinnus were without any pain to work.

Evaluación fisioanatómica de senos maxilares para realizar futuro tratamiento quirúrgico de aumento de volumen óseo / Physio-anatomic evaluation of maxillary sinuses for future bone volume augmentation surgical treatment

El seno maxilar representa la estructura anatómica más importante del maxilar superior y, al mismo tiempo, el límite principal anatómico de la inserción de losimplantes en este sector. Por este motivo el aumento de volúmen óseo o levantamiento de piso de seno maxilaren caso de maxilares edéntulos con senos neumatizados es una opción viable de desarrollar mediante diferentestécnicas, siempre que los senos maxilares se encuentren en condiciones fisiológicas de ventilación óptimas (AU)

Maxillary sinnus is the most important anatomicstructure in the maxillary one. It is the limit because ofimplant pleacement.1For that reason, the augmented thebone tissue in sinus floor elevation of edentulous poste-rior maxilla with pneumatisation is an excellent optionto be developed with differents techniques, in the casemaxillary sinnus were without any pain to work.(AU)

Newly designed double-vascularized nasoseptal flap to prevent restenosis after endoscopic modified Lothrop procedure (Draf III): laboratory investigation.

Despite advances in endoscopic approaches, instrumentations and imaging guidance systems, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the newly formed ostium have been demonstrated even with large frontal sinusotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after endoscopic modified Lothrop procedure (EMLP). Five fresh, double-injected cadavers were dissected through an endoscopic endonasal approach. Posteriorly based nasoseptal flap on one side and laterally based nasoseptal flap on the other side were harvested before performing wide EMLP. Feasibility of the procedure, versatility of the flap, coverage area and measurements were calculated. Harvesting the mucoperichondrial/mucoperiosteal flap over the septectomy site was straightforward step. Two different designed flaps (one on each side) are more practical to avoid torsion of the flap. The flap measures 2 × 3 cm on average that was able to cover the bare bone of the anterior and posterior wall of frontal sinus. Osteoneogenesis and progressive osteoplastic activity after EMLP plays a major role in restenosis of frontal sinus. Vascularized nasoseptal flap helps in preventing closure of the newly formed ostium. Applying these flaps over the bare bone enhances the healing process and minimizes the crust formation.

Documento de consenso sobre etiología, diagnóstico y tratamiento de la sinusitis / Consensus document on the aetiology, diagnosis and treatment of sinusitis

Presentamos el Documento de consenso sobre sinusitis de la Sociedad de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap), la Sociedad Española de Pediatría Extrahospitalaria y de Atención Primaria (SEPEAP) y la Sociedad Española de Otrorrinolaringología Pediátrica (SEORL). La sinusitis es una enfermedad de diagnóstico difícil, a menudo no reconocida. Se analiza la etiología, la clínica y los criterios diagnósticos más aceptados, y se realizan recomendaciones terapéuticas acordes con la situación epidemiológica actual. Se propone la amoxicilina por vía oral como tratamiento antibiótico de elección en dosis de 80 mg/kg/día repartidas cada 8 horas. Se indican tratamientos alternativos en casos especiales y en ausencia de eficacia de la amoxicilina. Se revisan las principales complicaciones de esta entidad (AU)

The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases,Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitisis presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. Aproposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80 mg/kg/day divided every 8 hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed (AU)

Enfermedades nasosinusales en el buceo y la aviación / Nasosinusal disorders in diving and flying

El barotrauma sinusal es una manifestación patológica resultante de una diferencia de presión entre los gases contenidos en las cavidades anexas de las fosas nasales y el medio ambiente. En nuestro mundo de hoy en día, en el que los vuelos aéreos son un medio común de transporte y el buceo un deporte ampliamente extendido, es importante tener un buen conocimiento de su existencia, ya que podemos encontrarlo fuera de las situaciones de profesionales de la inmersión y de los vuelos aéreos o espaciales. El diagnóstico se realiza sobre todo por la sintomatología de dolor y epistaxis, apoyado con exploraciones de imagen, preferiblemente, la tomografía computarizada. Es muy importante establecer el diagnóstico diferencial entre la cefalea por barotrauma sinusal y todas las otras cefaleas que se pueden presentar o ser consecuencia de medios y situaciones disbáricas. Es fundamental la prevención de estos procesos en las personas que se van a exponer a situaciones disbáricas de forma repetida con adecuadas revisiones previas, consejos y tratamientos para las contextos que puedan favorecer esta enfermedad, técnicas adecuadas de exposición al disbarismo y exclusión de los sujetos no aptos para ellas. El tratamiento es predominante médico, con medidas locales y utilización de corticoides y antibióticos por vía general en los casos más graves. El tratamiento quirúrgico se propone para las situaciones recidivantes, de evolución tórpida y las complicaciones. Se recomienda que los tratamientos quirúrgicos, preferentemente conservadores por vía endoscópica, sean realizados por equipos expertos en esta enfermedad (AU)

Sinus barotrauma results from differences in pressure between the gases contained in the cavities surrounding the nasal fossa and the environment. In today’s world, when airline flights are a common mode of transport and diving a widely practiced sport, familiarity with this disorder isimportant, since it can be found outside professional diving or air or space travel. Diagnosis is mainly established on the basis of symptoms of pain and nosebleed, supported by imaging techniques, preferably computed tomography. It is important to establish the differential diagnosis between headache due tosinus barotrauma and all other types of headache that can result from dysbaric situations. The prevention of these processes in persons who will be repeatedly exposed to dysbaric situations is essential through prior examinations, advice and treatments in contexts that could encourage these alterations, adequate techniques of exposure to dysbaric situations, and exclusion of individuals unfit for these activities. Treatment is mainly medical, with local measures and the use of systemic corticosteroids and antibiotics in the most severe cases. Surgical treatment is indicated in recurrent processes, those with poor clinical course, and complications. Surgical treatments, preferably conservative procedures through the endoscopic approach, should be performed by teams highly experienced in this entity (AU)

[Experience in the use of present day immunomodulators for prophylaxis of exacerbations of chronic adenoiditis and development of pharyngeal tonsil hypertrophy in poor health children]. / Opyt primeneniia sovremennykh immunomoduliatorov dlia profilaktiki obostrenii khronicheskogo adenoidita i razvitiia gipertrofii glotochnoi mindaliny u chasto boleiushchikh detei.

Children having frequent acute respiratory infections and chronic adenoiditis were given immunomodulators (ridostin, IRS-19, polyoxidonium). As a result of such prophylaxis, respiratory infections and exacerbations of chronic adenoiditis occurred in poor-health children 2-2.5 times less frequently. Their local immunity and nonspecific resistance improved. Thus, modern immunomodulators can be used in poor-health children with chronic adenoiditis to prevent acute respiratory viral infection and development of pharyngeal tonsil hypertrophy as well as to treat them.

Prevention and prophylaxis of invasive fungal sinusitis in the immunocompromised patient.

Fungal infections are a leading cause of morbidity and mortality among immunocompromised patients. Invasive fungal sinusitis is a devastating complication of immunosuppression. Treatment options are limited and often ineffective, making prevention important. Measures to decrease environmental exposure, indications for antifungal prophylaxis, and limitations of current regimens are discussed.

Allergy for the laryngologist.

Allergic disease can affect any portion of the respiratory tract, including the larynx, trachea, bronchial tree, nasal cavity, paranasal sinuses, nasopharynx, and pharynx. This review evaluates laryngeal manifestations of allergic disease and the impact of allergic mechanisms in disorders, within the scope of laryngology.

The use of micro-titanium mesh for maxillary sinus wall reconstruction.

Operations on the maxillary sinus can lead to extensive bony defects of the facial and laterodorsal walls of the sinus. If there is no autogenous bone material available, the problem is to find a suitable substitute for reconstruction. We examined the suitability of micro-titanium mesh for reconstruction of the walls of the maxillary sinus. In 13 adult patients large defects of the walls of the maxillary sinus were reconstructed using micro-titanium mesh. Indications for operation were tumours, large dental-type cysts, traumatic bone loss and chronic inflammation in sinuses which had been previously operated on. Clinical and radiological examinations were carried out immediately after surgery and after a 3 months interval. Control by sinuscopy was performed in all patients. Great importance was attached to the following aspects: 1. correctly shaped reconstruction of the maxillary sinus 2. prevention of soft tissue prolapse into the sinus 3. aeration of the maxillary sinus 4. preservation of the facial contour