[Workup and treatment of Eustachian tube dysfunction in adults].

Symptoms of Eustachian tube dysfunction are frequent and multiple. Therefore, clear definitions and diagnostic criteria are important in order to achieve appropriate patient flow. So far, there has been a lack of consensus on this subject, but the proposed definitions and diagnostic criteria in this review may aid to achieve this. Tubomanometry is a diagnostic tool to evaluate Eustachian tube function, and balloon dilation of the Eustachian tube can be a helpful treatment in patients with Eustachian tube dysfunction.

[Balloon dilation of Eustachian tube is a new treatment of chronic otitis media].

Balloon dilation of Eustachian tube is a novel method for managing chronic ventilatory dysfunction in patients with chronic otitis media, as an alternative to classic grommet insertion. Although few retrospective studies have been conducted the method seems to be rapid, simple and safe with promising short-term results. This paper presents the method and summarizes the results of available studies. Optimization of patient selection is needed and we discuss the development of better objective measurement methods as well as the need for randomized prospective studies, which are currently being conducted.

National long-lasting effect of endonasal endoscopic sphenopalatine artery clipping for epistaxis.

CONCLUSION: We consider sphenopalatine artery ligation to be a safe and effective treatment of posterior epistaxis as the long-term need for revision surgery and the complication rates are low. Surgery should be considered earlier in the treatment of posterior epistaxis. OBJECTIVES: Posterior epistaxis is common and surgical endoscopic ligation of the sphenopalatine arteries is indicated in severe cases. Knowledge about long-term effects and complications is sparse. METHODS: Within 2001-2006, 78 patients underwent endonasal endoscopic-guided surgery for posterior epistaxis in one of the eight ENT clinics in Denmark treating these patients. In 2011, 45 patients were still alive and eligible for the study. Patients were contacted by telephone and invited to complete an interview questionnaire on late adverse affects and recurrence. RESULTS: In all, 42 of 45 patients participated in the mean follow-up. The mean follow-up was 6.7 years: 90% of patients (n = 38) obtained an effect of the treatment during follow-up; 78% (n = 33) had no recurrent epistaxis, 12% (n = 5) had recurrent epistaxis but only needed non-surgical specialized treatment; 10% (n = 4) required revision surgery due to recurrent epistaxis within the 6.7 mean years of follow-up; and 26% of the patients had minor postoperative complications, permanent nasal crusting being most persistent and frequent.

Petechial hemorrhages of the tympanic membrane in attempted suicide by hanging: A case report.

It is important to determine whether a person has been strangulated and the diagnosis is not always straightforward since ligature marks are not always present. In forensic medicine the physical examination recommended is careful inspection of the head and neck region, oral cavity, examination of the eyes including the conjunctiva on both the upper and lower eyelids and photo documentation. Petechial hemorrhages of the conjunctiva are considered marker of life threatening hanging or strangulation. Hemorrhage from ears, perforated tympanic membrane and haematotympanum are scarcely described in case reports of strangulated patients. To our knowledge we are the first to report petechial hemorrhages of the tympanic membrane in a patient following attempted suicide by hanging. We believe that the petechial hemorrhages develop from the capillaries located in lamina propria of the epidermal layer above the fibrous layer. This assumption is made on the basis of our assessment of a normal tympanic membrane with light microscopy. Petechial hemorrhages of the tympanic membrane might in fact be the only sign of life threatening pressure applied to the neck. This is a very important finding and prospective studies should be conducted for further clarification on the matter.

[Epistaxis]. / Epistaxis.

Epistaxis is a common clinical condition that can be challenging. Anterior epistaxis is managed by compression, cauterization or diathermy. Merocel and Rapid Rhino nasal packs are often successfully used. Refractory posterior epistaxis should be handled by otorhinolaryngologists. If conservative strategies such as combined anterior and posterior nasal packing fail the patient should be referred to surgical intervention. The evidence for early endoscopic ligation and/or diathermy of the sphenopalatine or etmoidal anterior arteries is significant, and the patients experience less co-morbidity.

[Perforation of maxillary sinus following fall against nutcracker]. / Perforeret sinus maxillaris efter fald mod nøddeknækker.

We present a case of open fracture of maxillary sinus following fall against a nutcracker. The only pathological findings were a small wound and subcutaneous emphysema in the front of and behind the right maxillary sinus. There was no flattening of the anterior wall of the maxillary sinus, consequently no surgical intervention was performed. The patient was treated with prophylactic antibiotics and sutures. No sequelae were observed.

Stimulation of aquaporin-5 and transepithelial water permeability in human airway epithelium by hyperosmotic stress.

Osmotic water permeability (P(f )) was measured in spheroid-shaped human nasal airway epithelial explants pre-exposed to increasing levels of hyperosmotic stress. The fluid-filled spheroids, derived from nasal polyps, were lined by a single cell layer with the ciliated apical cell membrane facing the outside. The P(f ) was determined from diameter changes of the spheroids in response to changes in bathing medium osmolarity forth and back between 300 and 225 mOsm x l(-1). Continuous diameter measurements also allowed determination of spontaneous fluid absorption. Hyperosmotic pretreatment (increase from 300 up to 600 mOsm x l(-1)) caused a time- and osmolarity-dependent increase (up to approximately 1.5 times) in epithelial P(f ) which was of similar magnitude in cystic fibrosis (CF) and non-CF spheroids. The effect saturated at approximately 450 mOsm x l(-1) and at approximately 24 h. Expression of aquaporin-5 (AQP5), studied by immunofluorescence and confocal microscopy, showed an increase in parallel with the increase in P(f ) following hyperosmotic stress. The AQP5 was localized both in cytoplasmic vesicles and in apical cell membranes. Spontaneous fluid absorption rates were equal in CF and non-CF spheroids and were not significantly influenced by hyperosmotic stress. The results suggest that hyperosmotic stress is an important activator of AQP-5 in human airway epithelium, leading to significantly increased transepithelial water permeability.

The influence of air current on goblet cell density in the mucosa of the normal uncinate process in the nasal cavity.

AIM: To determine the density of goblet cells in the mucosa at the medial site of the uncinate process in the nasal cavity where the air current is high and compare with the goblet cell density on the protected lateral site of the uncinate process, thus establishing the function of the uncinate process in protecting the integrity of epithelium, in the meatus medius, from the distress caused by continuous airflow. Determining this function could have clinical implications, as patients routinely undergo removal of the uncinate process during endoscopic sinus surgery. MATERIAL AND METHODS: The material comprised pieces of mucosa of 11 uncinate processes from the nasal cavity of 11 autopsies. The material was stained with PAS-Alcian blue after which the goblet cells were counted using a whole-mount method. Counting was done by only 1 of the authors and was not blinded. RESULTS: The density of goblet cells was significantly higher on the lateral site than on the medial site of the uncinate process. Furthermore, goblet cell density was found to be higher on the superior part of the uncinate process, than on the inferior part. CONCLUSION: The results seem to indicate that air current has consequential impact on the normal differentiation patterns of the epithelium in the nose. The significantly higher goblet cell density on the unexposed lateral site of the uncinate process suggests that at this site the sinus outlets are protected from air current trauma.

Water permeability in human airway epithelium.

Osmotic water permeability (P(f)) was studied in spheroid-shaped human airway epithelia explants derived from nasal polyps by the use of a new improved tissue collection and isolation procedure. The fluid-filled spheroids were lined with a single cell layer with the ciliated apical cell membrane facing the outside. They were capable of surviving hours of experiment involving continuous superfusion of the bathing medium and changes of osmolarity. A new image analysis technique was developed for measuring the spheroid diameters, giving high time and measurement resolutions. The transepithelial P(f), determined by the changes of the apical solution osmolarity, was not influenced by the presence of glucose, Na(+), or Na(+)/glucose-cotransport inhibitors in the bath, but was sensitive to the aquaporin (AQP) inhibitor HgCl(2). The measured P(f) levels and the values of activation energy were in the range of those seen in AQP-associated water transport. Together, these results indicate the presence of an AQP in the apical membrane of the spheroids. Notably, identical values for P(f) were found in CF and non-CF airway preparations, as was the case also for the calculated spontaneous fluid absorption rates.