Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy.

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is a common cause of nasal airway obstruction. In cases unresponsive to conservative treatment, various surgical techniques are commonly performed, but the issue of the optimal surgical procedure is still controversial. The objective of the present study was to evaluate the effectiveness and safety of ultrasound treatment of the hypertrophied inferior turbinates, which is a technique recently applied in rhinologic surgery. We aimed, also, to compare this method with the radiofrequency cold coblation turbinate reduction and the traditional submucosal monopolar inferior turbinate cauterization. We studied prospectively 60 patients with chronic hypertrophic rhinitis of nonallergic etiology, who underwent different surgical methods of turbinate reduction, divided into two groups: (1) in 30 patients, inferior turbinate volume reduction using ultrasound procedure on the left side and monopolar diathermy on the right was performed; (2) in 30 patients, radiofrequency coblation technique on the left side and ultrasound turbinate reduction on the right side was undertaken. Subjective evaluation of nasal obstruction and pain was performed using visual analog scales and objective evaluation of the surgical outcome was obtained using active anterior rhinomanometry and acoustic rhinometry. Examinations were performed preoperatively, and 1, 3 and 6 months after surgery. Both subjective and objective evaluation showed significant postoperative improvement in all cases. The best results were obtained with the ultrasound procedure, and second with the radiofrequency technique. The least improvement was observed in the electrocautery group, although its results did not differ significantly from the radiofrequency group. It may be, thus, concluded that ultrasound turbinate reduction is an effective and safe procedure for the management of chronic hypertrophic rhinitis, in patients failing to respond to medical treatment. Using this method, better results were obtained in decreasing subjective symptoms and nasal obstruction, in comparison with radiofrequency and electrocautery.

Therapeutic approach to Gradenigo's syndrome: a case report.

INTRODUCTION: Traditional management of Gradenigo's syndrome requires aggressive and radical surgery without any attempt to preserve hearing. Recent reports, however, describe a successful outcome after conservative surgical intervention without labyrinthectomy. A similar outcome has also been reported in patients who were only prescribed with antibiotics and did not undergo myringotomy. CASE PRESENTATION: We report the case of a 24-year-old Caucasian Greek woman with Gradenigo's syndrome who was treated by draining her petrous apex via an infralabyrithine approach between her posterior semicircular canal and the jugular bulb. Her inner ear was not sacrificed during the procedure. She presented pre-operatively with ipsilateral conductive hearing loss, which recovered completely four weeks after the surgery. CONCLUSIONS: Patients with Gradenigo's syndrome may be successfully treated with a combination of long-term permanent drainage and ventilation of the apical cells with corresponding hearing preservation. This can be achieved via a combination of transmastoid, infralabyrinthine and suprajugular approaches, if such would be allowed by the anatomy of the region or if there is enough space between the posterior semicircular canal and the jugular bulb.

Rhinology resources on the internet: an update.

AIM: There has been a significant increase in the number of clinically useful biomedical resources available through the Internet over the last few years. The aim of this article is to present an updated list of all the worldwide web sites of rhinology. METHODS: All rhinologic links, which appear on the web site of the journal "Rhinology" were accessed and updated. Non-responding links were discarded and a new extensive survey of all rhinologic sites on the Internet was performed using on-line available search engines. All sites were accessed more than once at different times and their uniform resource locator (URL) address was recorded. RESULTS: The URL addresses of all rhinologic sites on the Internet appear in categories. Main categories include endoscopy and operative techniques, allergy, olfaction, rhinology clinics and research centers, organizations and societies, scientific journals, discussion groups, news and medical conferences, collective otolaryngology resources, and miscellaneous other sites of interest to rhinologists. CONCLUSIONS: This paper summarizes several types of resources available to rhinologists on the Internet. A complete universal list was composed, in which links to almost all interesting rhinologic links were included.

Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction.

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is one of the most common problems encountered in rhinology. Various forms of conservative therapy have been used, but these are often ineffective and surgical reduction techniques have been successfully applied. However, the issue of postoperative histological changes in the nasal mucosa has not been adequately addressed. The aim of the present study was to comparatively evaluate the effect of the methods of submucosal monopolar diathermy, radiofrequency coblation and ultrasounds on the nasal mucosa. Sixty patients with chronic hypertrophic rhinitis of nonallergic etiology underwent different surgical methods of turbinate reduction, divided into two groups: (1) 30 patients underwent tissue volume reduction of the inferior nasal turbinates using ultrasound procedure on the left side and monopolar diathermy on the right; (2) 30 patients underwent radiofrequency coblation technique on the left side and ultrasound reduction on the right. We studied 20 preoperative specimens of the inferior turbinate mucosa taken randomly from both groups of patients, 5 from each side of each group. Normal nasal mucosal specimens taken from ten healthy persons were used as controls. Specimens of the inferior turbinate were taken after 1, 3, and 6 months after surgery, from the same patients. All specimens were examined by electron microscopy. Preoperative observation revealed degeneration of epithelial cells, loss of cilia, disruption of intercellular connections, edema, nasal mucus overproduction and inflammatory infiltration in chorium. Postoperative observations revealed decrease of intercellular edema, reduction of mucus, overproduction of collagen and degeneration of the epithelium to flattened stratified. Only specimens after use of ultrasounds showed islands with normally organized epithelium of columnar ciliated cells. It may be concluded that epithelial changes owed to chronic hypertrophic rhinitis do not significantly improve postoperatively after turbinate tissue volume reduction. Only in several cases operated with ultrasounds, regeneration of epithelium occurs, resulting to anatomical and functional restoration of the nasal physiology.

The influence of laryngopharyngeal reflux in the healing of laryngeal trauma.

The aim of this clinical study was to evaluate the effect of laryngopharyngeal reflux (LPR) on the healing process of surgical laryngeal trauma. A total of 112 consecutive patients, who suffered from LPR and were scheduled for operation of Reinke edema or laryngeal polyps/nodules (40 and 72 patients, respectively) during a period of 5 years, were included. Diagnosis of LPR was made on the basis of both history and dual pH probe recording during 24 h in the inferior esophagus and the hypopharynx. The reflux finding score (RFS) and the reflux symptom index (RSI) were used to estimate the clinical severity of LPR. In patients with LPR, proton pump inhibitors (PPI) were initiated in half of them, randomly chosen. Fifty LPR-free subjects operated for Reinke edema or laryngeal polyps during the same time period (19 and 31 patients, respectively) were used as controls. In six patients who had been administered PPI, resolution of the disease was observed and no surgical treatment was undertaken. The remaining patients were operated on under general anesthesia by a single surgeon. All patients had 1-year postoperative follow-up. Epithelization was complete in all vocal cords of both the control group and the group of patients who had been administered PPI. Within the group of patients who had not taken PPI, six patients presented granulation tissue or recurrence of the polyps and in two of them revision surgery was needed. RFS and RSI scores showed significant improvement postoperatively, across all the three groups of patients, with major differences observed in the group treated by PPI. Comparison of the postoperative RFS and RSI scores between the two groups of patients with LPR showed statistically significant differences in both, indicating better treatment outcome in those patients who had received PPI. It may be thus concluded that LPR influences epithelization and recurrence of laryngeal polyps or Reinke edema in vocal cords, after partial or total decortication. Surgical outcome is superior in patients with LPR with preoperative and postoperative anti-reflux treatment.

Serous labyrinthitis as a manifestation of cat scratch disease: a case report.

INTRODUCTION: Cat scratch disease is an infectious disease transmitted by young cats, in which the principal causative factor is Bartonella henselae. The typical course of cat scratch disease is usually benign and self-limited and requires only supportive therapy. However, cases lasting up to 2 years have been reported, and more serious complications may occur. Many manifestations of the disease have been reported by different medical disciplines. CASE PRESENTATION: A case of cat scratch disease in a 71-year-old Greek woman with an unusual clinical course is presented here. Serous otitis media was combined with rotational vertigo due to labyrinthitis. The invaded ear was ipsilateral to the inoculation site. CONCLUSION: Cervicofacial lymphadenopathy has been demonstrated as the most common otolaryngologic manifestation of cat scratch disease. Manifestation in the middle and inner ear has, to the best of our knowledge, not been reported before. Our report presents a patient with cat scratch disease with clinical signs and symptoms in the middle and inner ear.

Aesthetic reconstruction of a crooked nose via extracorporeal septoplasty.

BACKGROUND: The aim of this study was to evaluate the effectiveness, indications, and contraindications of the extracorporeal approach in treating a severely deviated nose. METHODS: Sixty-four patients operated on for aesthetic correction of a severely deviated nose were studied. Forty-six of them were first operations and 18 were revision cases. The surgical procedure of choice was the closed technique. Septal cartilage was prepared and then dislocated, followed by external alignment and reimplantation. Hump reduction with lateral osteotomies and, occasionally, medial dislocation of nasal bones was carried out. RESULTS: Cosmetic results were satisfactory in all first operation cases. In 11 of the 18 revision cases, septal preparation was impossible; in 2, septal sagging was observed; and in 1, perforation was noted. CONCLUSIONS: Extracorporeal septoplasty is an effective, safe, and reliable technique, especially for twisted noses undergoing surgery for the first time. However, it is strongly contraindicated in a revised deviated nose.

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.

Functional tension nose as a cause of nasal airway obstruction.

OBJECTIVE: The purpose of this prospective study was to evaluate the influence of functional tension nose in nasal obstruction and to discuss its frequency and management. METHODS: Over the years 2000-2006, 153 patients underwent revision operation for nasal obstruction in our rhinoplastic center. Twenty-two of them (14.37%) suffered from functional tension nose. All 22 patients refused rhinoplasty during primary septoplasty. Sixteen of them had a kyphotic nose and the rest six cases suffered from hanging columella (drooped nose). Eighteen of them underwent primary rhinoplasty in combination with caudal diminution under general anesthesia. The other four patients refused rhinoplasty, and under local anesthesia their tip was deprojected and reprojected. RESULTS: Marked improvement in nasal airflow was noted at the most recent follow-up evaluation in 20 patients out of 22 (90.91%). The mean length of follow-up was 8 months (ranging from 4 to 12 months). All follow-up results were based on office examination and pre- and post-operative computer-assisted rhinomanometry evaluation. In only two cases results were not efficient enough. CONCLUSION: Our study strongly suggests that tension nose is a usual misdiagnosed cause of nasal obstruction. This problem is concealed under a "kyphotic", "big", or "pinocchio" nose. Usually the functional defect is spontaneously corrected during conventional rhinoplasty. However, tip should be deprojected and reprojected in cases where the patient refuses cosmetic intervention and surgeon tries to resolve his functional problem.

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.

Midfacial Degloving: The Best Alternative for Treatment of Trans-sphenoidal Meningocele of the Pterygopalatine Fossa.

Trans-sphenoid anterobasal temporal lobe meningoceles are rare and can be associated with temporal lobe epilepsy or recurrent meningitis. Surgical treatment is described via complicated infratemporal or intracranial approaches with high morbidity. A 32-year-old man presented with an 18-year history of two types of seizures and confirmed epileptic activity in electroencephalogram. A trans-sphenoid meningocele in the left pterygopalatine fossa was found on computed tomography and magnetic resonance imaging. A midfacial degloving was chosen instead of a large neurosurgical approach to remove it and to repair the dura defect with lyophilized dura, collagen, and abdominal fat. The postoperative course was uneventful without visible scars and the patient remains free of seizures without antiepileptic medication 3 years after surgery. Although midfacial degloving is not described yet as a treatment of trans-sphenoid meningoceles, this approach proved to be fast, safe, effective, and reliable and should be considered as the only alternative to large external approaches.