Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps.

Nasal polyps are commonly treated surgically. Intranasal administration of topical corticosteroids has gained increased acceptance as a treatment alternative. The aim of our study was to compare the efficacy of treatment of two formulations of budesonide with placebo on nasal polyps. At four Danish clinics 138 patients suffering from moderate or severe nasal polyps were randomized to a twice daily treatment with Rhinocort Aqua 128 micrograms, Rhinocort Turbuhaler 140 micrograms or placebo (Astra Draco, Sweden) for 6 weeks. Polyp size (primary efficacy variable), nasal symptoms, sense of smell, and patients' overall evaluation of treatment of efficacy were assessed by scores. Polyp size was reduced significantly in both budesonide treated groups compared with placebo, but there was no statistical difference between the two actively treated groups. Patients' nasal symptom scores was significantly more reduced in the Aqua compared to the Turbuhaler treated group, and both reduced symptom scores were significantly better compared to placebo. Sense of smell was significantly improved in the actively treated groups compared to placebo. The proportion of patients rating substantial or total control over symptoms after 6 weeks treatment was 60.9% and 48.2% in the Aqua and Turbuhaler-treated groups, respectively, which was significantly better compared with 29.8% in the placebo-treated group. Rhinocort Aqua and Rhinocort Turbuhaler were equally well tolerated.

First branchial cleft anomaly.

A first branchial cleft anomaly is an unusual clinical condition and the clinical picture is similar to that seen in other much more common diseases. This combination may result in a diagnostic delay and insufficient and dangerous primary surgery, resulting in facial nerve damage. This paper reviews the embryological background of first branchial cleft anomalies, the varying clinical presentation and the surgical treatment, illustrated by three case histories. A revision of the most common classification system is proposed.

Outcome for the first 85 patients treated with the functional endoscopic sinus surgery technique.

Out of 85 patients operated on with the functional endoscopic sinus surgery (FESS) technique, 62 patients (73%), representing 105 operated sides, participated in an endoscopic follow-up with concomitant questionnaire concerning symptoms and patient's evaluation of the result. On 61 operative sides were performed polypectomies, 43 sides were operated on because of chronic recurrent sinusitis. Twelve patients (corresponding to 17 sides) were re-operated on. The mean follow-up period was 16 months for the patients with one operation, for those with re-operation it was 10 months. Eighty-two per cent of the patients reported subjectively marked or full improvement, 18% had experienced no change or slight improvement. By endoscopy, 43 operated sides (41.0%) were considered fully normal at follow-up. Residual polyposis was seen in 21 of 61 operated sides (35.9%) with pre-operative polyposis, and purulent discharge was seen in 11 sides (10.5% of all operated sides). The discrepancy between subjective satisfaction and objectively-assessed recurrent or residual pathology indicates a need for further elucidation of the aetiologies for chronic inflammatory sinonasal diseases. Obstruction of the drainage pathways around the ostiomeatal complex cannot explain all cases of sinusitis and is hardly aetiological in polyposis. Nevertheless, FESS is presently an adequate treatment in obtaining immediate relief in most cases of medically resistant sinusitis and polyposis.

[Acute epiglottitis. 27 years of experience with and future development of nasotracheal intubation]. / Epiglottitis acuta. Syvogtyve års erfaring med nasotrakeal intubation og den fremtidige udvikling.

During a 27-year period 295 patients in Copenhagen County were treated for acute epiglottitis. One hundred and eight-two were adults and 113 were children. Most children were treated by nasotracheal intubation while only a few adults required nasotracheal intubation in order to secure the airway. The incidence of acute epiglottitis in children less than five years old was calculated to be 8.7/100,000 with minor annual variation. Since vaccination against Haemophilus influenzae type b has been implemented in Denmark from May 1993, this figure will probably be markedly reduced, and the disease even may be even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b. It is emphasized that this reduced incidence will make it even more important that each department engaged in the treatment of suspected acute epiglottitis have a departmental protocol for management of the condition, so that the future rarity of acute epiglottitis does not cause the mortality rate to rise.

[Late diagnosis of retropharyngeal abscess in an infant]. / Sen diagnose af retrofaryngeal absces hos et spaedbarn.

In patients with respiratory distress and difficulty in swallowing life-threatening conditions should be born in mind. We report a case in which the diagnosis of retropharyngeal abscess was established with considerable delay in an eight-month girl. The etiology and clinical picture is discussed. We conclude that patients with stridor and drooling should be admitted to hospital at once and should be examined with equipment for tracheotomy/intubation ready. If the epiglottis is found to be normal the possibility of a retropharyngeal abscess should be considered.

Acute epiglottitis--25 years experience with nasotracheal intubation, current management policy and future trends.

During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital. Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children. The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis. The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.

Allograft stapes-incus assembly. Long-term results.

In 35 patients with absence of the stapedial arch, with a history of radical surgery, and without ossicles, the head of an allograft stapes was placed on the patients' footplates and an allograft incus body on the top of this. The long-term results of this assembly, judging by different methods of analysis, are still somewhat better than those of 98 ears with approximately the same pathologic condition treated by an allograft incus as the columella between the footplate and fascia. The allograft stapes-incus assembly is an alternative method to the commonly used incudal columella. The allograft stapes has not been resorbed to a significant degree during the years after surgery.

Tympanosclerosis of the middle ear: late results of surgical treatment.

The late results of one stage operation for middle ear tymanosclerosis in 73 patients during the period January 1965 to December 1980 are presented. Mean observation time was 11.2 years (range 3-20.2 years), with a follow-up rate 86 per cent. Among 64 patients with stapes fixation, 59 had removal of tympanosclerotic masses and stapes mobilization, and five cases underwent stapedectomy. The series was divided into six groups and the results analyzed. The best and most stable results occurred in the group with stapes mobilization and an intact ossicular chain followed by the group with stapes mobilization and Type II tympanoplasty with incus interposition. The poorest late results were obtained in ears with lacking stapes crura and stapes mobilization, and in ears subjected to stapedectomy. No case of post-operative sensorineural hearing loss occurred. We recommend that care is taken to preserve an intact ossicular chain at stapes mobilization performed at the same stage as myringoplasty. Also in ears with a defective ossicular chain but intact stapes with tympanosclerotic fixation we recommend stapes mobilization in one stage. In ears with fixation of the stapes footplate and defective crura, we recommend stapedectomy or stapedotomy in two stages.

Acute epiglottis in children and adults. Nasotracheal intubation, tracheostomy or careful observation? Current status in Scandinavia.

A review was performed of the treatment of 92 patients with acute epiglottitis with special reference to the different procedures employed in children and adults. Intubation was performed in 74 per cent of the children but in only six per cent of the adults. More than half of the children were initially observed only, but of these 58 per cent eventually needed intubation. No deaths occurred. We present our management protocol as well as a survey of the routine management of acute epiglottitis in children in the five Scandinavian countries. The number of initially observed patients ranged from nil per cent in Iceland to 35 per cent in Finland. When an artificial airway is needed, 92-100 per cent of the patients are intubated, 0-8 per cent tracheostomized, and 0-5 per cent one or the other, as a standard procedure. Tracheostomy is performed in departments where the facilities do not permit sufficient observation of patients treated by intubation.

Middle-ear damage caused by a defective portable headphone.

We report a case in which a defective portable headphone caused ablation of the malleus and removal of the drum. In addition to the warnings already given against the risk of noise-induced hearing loss, a warning should be given against the use of headphones of poor quality. Alternatively, headphones consisting of ear-plugs and electric wire without a metal holder should be recommended.