Seawater gel in allergic rhinitis: entrapment effect and mucociliary clearance compared with saline.

OBJECTIVE: We performed a prospective study to investigate the the efficacy of seawater gel in reducing symptoms in patients with mild allergic rhinitis. We also aimed to investigate the impact of nasal irrigation on mucociliary clearance with seawater gel compared with saline in this patient group. METHODS: The study was performed in 100 consecutive adult individuals with a history of allergic rhinitis that was not controlled by anti-allergic drugs. Patients were assigned to receive seawater gel nasal spray for 10 days. The efficacy of treatment was assessed by means of total nasal symptom score and clinical findings. RESULTS: A statistically significant difference was found between scores of 'nasal discharge, nasal obstruction, sneezing, nasal itching'before and after treatment (p < 0.001). Clinical findings evaluation revealed a statistically significant decrease in lower turbinate colour rating and turbinate congestion at the end of treatment (p< 0.001). Saccharin transit time decreased from baseline in the seawater trials by 12% compared with a 4% decrease for saline. The difference between the percent changes was statistically significant (t = 2.177; p < 0.05). CONCLUSIONS: The present study provides evidence that a four times daily regimen of seawater gel can be an adjunctive therapy in the patient with allergic rhinitis.

Neural control of eustachian tube function.

OBJECTIVES/HYPOTHESIS: It has been hypothesized that middle ear pressure can be controlled by the Eustachian tube through a neuronal reflex arc in animal models. We aimed to define the role of the neuronal control mechanisms in regulating middle ear pressure in humans. STUDY DESIGN: Prospective study. METHODS: The study population consisted of 95 ears of 95 volunteers. The mechanoreceptors on the tympanic membrane and the baroreceptors in the middle ear, which are assumed to form the afferent plexus of the neuronal reflex arc, were blocked by topical administration of lidocaine hydrochloride, in various patient groups. The Eustachian tube functions forming the efferent plexus of the neuronal reflex arc were evaluated by manometric tests both before and after blocking the possible afferent plexus in each study group. RESULTS: The baroreceptors established in the tympanic plexus might possibly have an effective role in this mechanism where the mechanoreceptors on the tympanic membrane seem to have a minor effect. CONCLUSIONS: Neuronal control mechanism could play an important role in regulating Eustachian tube function in humans. Laryngoscope, 2009.

Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome.

BACKGROUND: Mucormycosis is an uncommon, rapidly progressive, commonly fatal, opportunistic, fungal paranasal sinus infection. The most critical decision in the management of rhino-orbital mucormycosis is whether the orbit should be exenterated. The literature fails to provide a broad base of information of how physicians determine the need for exenteration in daily practice. The decision for exenteration often depends on the judgment of the treating otolaryngologist. The authors report their experience and outline that orbital exenteration may not be mandatory in all cases of rhino-orbital mucormycosis. METHODS: The medical records from Celal Bayar University Medical Faculty Department of Otorhinolaryngology/Head and Neck Surgery were retrospectively searched from 1995 to 2007 for three cases with rhino-orbital mucormycosis, treated without orbital exenteration. RESULTS: All patients with rhino-orbital mucormycosis who were treated without exenteration survived. CONCLUSION: The favorable outcome was attributable to rapid correction of the underlying medical condition; wide local excision and debridement of all involved and devitalized sinonasal and periorbital tissue, while establishing adequate sinus and orbital drainage; daily endoscopic assessment with multiple sinus debridement when necessary; daily irrigation of the involved areas; and high-dose i.v. amphotericin B.

Inverted papilloma with new bone formation: report of three cases.

BACKGROUND: An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density. The association of IPs and new bone formation is extremely rare; to the best of our knowledge, only one case has been reported in the literature to date. METHODS: We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically. RESULTS: The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma. CONCLUSION: We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.

Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: comparative radiologic analysis.

PURPOSE: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). STUDY DESIGN: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. METHODS: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. RESULTS: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). CONCLUSIONS: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.

Pleomorphic adenoma originated from the inferior nasal turbinate.

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.

Facial growth after middle turbinate resection: an experimental study in the rabbit.

BACKGROUND: The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. METHODS: Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8-10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test. RESULTS: Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones. CONCLUSION: This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.

Osteochondroma of the posterior nasal septum managed by endoscopic transnasal transseptal approach.

A case of osteochondroma of the posterior nasal septum is presented. A 57-year-old female patient presented with a history of bilateral nasal obstruction for 20 years. To the best of our knowledge, this is the second reported case of an osteochondroma of the nasal septum. It was treated by endoscopic transnasal transseptal surgery.

Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation.

The surgical outcome of endoscopic endonasal dacryocystorhinostomy was analyzed in 30 cases of postsaccal stenosis. Intubation with silicone tubing was used in 14 cases (46.7%) and not used in 16 cases (53.3%). Surgical success was evaluated subjectively and objectively. The patients' complaints were improved in 85.7% of cases in the intubation group, and in 81.3% of the group in which no stent was used. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 11 cases without intubation (68.8%) and 9 cases with intubation (64.3%). Six patients in the intubation group (42.9%) had granulation tissue at the rhinostomy site. Four patients (28.6%) had complaints regarding the intubation. Considering the similar surgical success rates, and the granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal canal.

The intracranial complication of acute isolated sphenoid sinusitis.

Acute isolated sphenoid sinusitis is a rare, potentially destructive entity, which has indistinct clinical findings and non-specific symptoms. Hence, it can be easily be misdiagnosed. We present and discuss a case of an isolated sphenoiditis with intracranial complication.