Management of inner nasal valve insufficiency.

OBJECTIVE: To determine the efficacy of the upper lateral caudal edge management in treating patients with inner nasal valve insufficiency and collapse. DESIGN: This was a prospective study in a group of patients suffering from nasal obstruction owing to nasal valve insufficiency. Forty-three patients, who had undergone septoplasty and inferior turbinectomy, were included. All patients presented with nasal obstruction resulting in persistent functional problems. An anatomically narrow nasal valve, valve collapse, or both were found during the clinical examination. SETTING: A tertiary referral centre. METHODS: Revision was undertaken using a new technique to restore the nasal valve, based on upper lateral caudal edge management. MAIN OUTCOME MEASURES: Improvement in nasal airway patency evidenced by patient questioning, by clinical inspection of the nose, and by rhinomanometric results. RESULTS: None of the patients had major complications. In 28 (65.1%) patients, symmetrically improved nasal airway patency and elimination of the subjective sensation of inspiratory collapse was found. In 12 (27.9%) patients, a remarkable asymmetric improvement in nasal obstruction was evident. Two (4.6%) patients reported a moderate breathing improvement, and in only one (2.3%) patient, revision was needed. The mean follow-up time was 18 months. CONCLUSIONS: Our proposed method is an effective therapeutic approach in the management of inner nasal valve insufficiency. It reconstitutes the normal tension of the inner nasal valve and reestablishes the stiffness and resistance of the lateral nasal wall. It can be performed under local anesthesia in cooperative patients, with minimal morbidity and a high rate of success.

The use of trichloroacetic acid in the treatment of acute external otitis.

The purpose of this study was to evaluate the effectiveness of 5% trichloroacetic acid (TCA) in the treatment of acute external otitis (AEO) in comparison with a standard clinical treatment. All patients who consecutively presented in our emergencies with AEO during the summer months of the previous year were included in the study. They were randomly divided into two groups: the study group included 117 patients treated with TCA and the control group included 98 patients treated with ear drops containing antibiotic and corticosteroid. Occasionally, an antibiotic was administered orally for 7 days, in severe cases of AEO. All patients were evaluated on days 1, 3, 5, 7 and 10, whereas another review appointment was given 20 days later. Outcome measures included evaluation of efficacy using a six-step infection score and tolerability by visual analogue scale. Additionally, adverse reactions, complications and recurrencies were recorded. Treatment was successful for all patients of the study group, whereas 8 failures were found in the control group. The infection score improved faster in the study group than in the control group, resulting in an earlier clinical cure (mean 4.1 and 8.6 days, respectively). Tolerability was significantly better in the study group, on all points of evaluation. Complications and adverse reactions were minimal on both groups. Our results show that TCA is a very effective and nontoxic agent for the treatment of AEO. Rapid pain relief and prevention of recurrencies are its main advantages.