Endodontic treatment: a significant risk factor for the development of maxillary fungal ball

Objectives

The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.

Methods

One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.

Results

There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).

Conclusion

Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

Autoimmune disease as a risk factor for globus pharyngeus: a cross‐sectional epidemiological study

Clin. Otolaryngol. 2011, 36 , 24–29 Objective: To assess the prevalence and severity of globus‐type symptoms in individuals who have a prior diagnosis of autoimmune disease. Design: Cross‐sectional questionnaire. Participants and setting: One hundred and nine patients with autoimmune disease (rheumatoid arthritis, seronegative spondarthritis, connective tissue disease, systemic vasculitis) and 41 patients with non‐autoimmune disease (osteoarthritis/osteoporosis) attending a rheumatology tertiary referral clinic at Norfolk & Norwich University Hospitals NHS Foundation Trust. The results from this study were compared to previous published figures in patients with globus pharyngeus (n = 105) and normal population (n = 174). Main outcome measures: Glasgow Edinburgh Throat Scale questionnaire; Reflux Symptom Index; Anxiety/Depression Scale. Results: Patients with autoimmune disease demonstrate a significantly higher prevalence for 5/10 symptoms on the Glasgow Edinburgh Throat scale score when compared to the non‐autoimmune control group (P ≤ 0.01). This significant difference increases to 9/10 symptoms when compared to published results for the normal population (P = 0.01). No significant difference was found when comparing the autoimmune and non‐autoimmune control group reflux symptom index (P = 0.64) or anxiety depression scale (P = 0.71). Conclusion: Patients with autoimmune disease have a significantly increased prevalence of globus symptoms when compared to the healthy population. A further prospective study is required to decipher the effect of pharmacotherapy as a possible causative factor.     

Nasal polyposis as a risk factor for hypertension

Arterial hypertension was found in 78 of 224 consecutive patients operated for nasal polyposis. An exacerbated degree of hypertension was significant in groups aged above 50 years. In total, 46% of patients whose nasal polyposis was of a duration of more than 10 years suffered from hypertension. Fifty of 78 patients developed hypertension after nasal polyposis was established and the mean duration time from polyposis to hypertension was 11.1 years. Hypertension was established in 50% of patients suffering from the triad asthma, intolerance to acetylsalicylic acid and nasal polyposis. In analogy with knowledge that sleep apnoea and snoring are aetiological factors for arterial hypertension, we propose that long-standing nasal obstruction by nasal polyposis be a risk factor for arterial hypertension.     

Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage

The literature suggests that tonsillectomy techniques are not standardized throughout the world although certain techniques were identified as risk factors for post-tonsillectomy hemorrhage (PTH). This survey was undertaken to evaluate whether surgical techniques are uniformly performed in a nation of 82 million people and if they are related to the incidence of PTH or lethal outcome. A questionnaire was sent personally to the chairmen of 156 departments of otorhinolaryngolog, yincluding 37 University Hospitals to assess the surgical training techniques of tonsil dissection and hemostasis, incidence of primary (<24 h) and secondary (>24 h) PTH, number of tonsillectomies performed in 2006 and the number of cases with lethal outcome. The responses were made anonymous for further analysis. The response rate was 88.5% (138/156). A total of 54,572 procedures were performed (mean 395.4, median 361.5, SD 199.5, range 100–975 annually per clinic). Cold dissection was the teaching method of choice (117). Hemostasis was either achieved by suture ligation or bipolar cautery in 91 departments. Secondary bleeding clearly prevailed in the responses (97). One patient experienced a fatal bleeding after tonsillectomy indicated for tumour removal. Two other cases with lethal outcome had undergone surgery elsewhere including one patient who had undergone tonsillotomy. Lethal outcome occurred with an estimated incidence of 1/75,000. The term “conventional tonsillectomy” is loosely defined and includes various surgical techniques for tonsil dissection and methods to achieve hemostasis. The incidence of secondary PTH is related to electrosurgery with statistical significance. Lethal outcome may occur, if ever, rarely but even after intracapsular tonsillectomy.     

Obesity as a risk factor for primary spontaneous rhinoliquorrhea

OBJECTIVE: To determine whether obesity is a potential risk factor of primary spontaneous cerebrospinal fluid rhinorrhea (CSFR). DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND METHODS: The clinical data of 79 patients diagnosed with CSFR who had been treated at our hospital between 1991 and 2001 were assessed. The data of 61 (77%) of 79 cases were complete and could be used for this study. Patients were segregated according to the cause of their CSFR: 21 (34%) due to head trauma, 14 (23%) due to previous surgery, 7 (11%) due to congenital malformation, and 2 (3%) due to tumor adjacent to the anterior cranial fossa. Of the 61 subjects, 17 (28%) had CSFR without any detectable reason. This group was therefore designated as primary spontaneous CSFR. The body mass indexes (BMIs) of all patients were compared and statistically evaluated. RESULTS: The mean BMI (calculated as weight in kilograms divided by the square of height in meters) of the 17 patients with primary spontaneous CSFR was 34.87, which was significantly higher (P<.001) than the mean BMI of the other 44 patients (28.53). The mean BMI of the group of patients with CSFR due to previous surgery or trauma was significantly lower than the BMI of the group with primary spontaneous CSFR (P<.003), whereas in relation to the group afflicted with tumors and malformations, only a tendency (P<.28) was found. CONCLUSION: Our data suggest that obese patients are at an increased risk to develop primary spontaneous CSFR.     

Noise exposure as a risk factor for acoustic neuroma: a systematic review and meta-analysis

Objective: To investigate whether acoustic neuroma is associated with noise.

Design: PubMed, Cochrane, Embase and CINAHL databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) using quality-effect models.

Study sample: A total of eight studies with moderate or high quality involving 75,571 participants met the inclusion criteria.

Results: There was no significant relationship between overall noise exposure and acoustic neuroma (OR:1.02, 95% CI: 0.64–1.63). However, further subgroup analysis showed that leisure noise exposure (OR: 1.73, 95% CI: 1.10–2.73), above five years’ exposure (OR: 1.81, 95% CI: 1.14–2.85) and continuous exposure (OR:2.77, 95% CI: 1.70–4.49) were associated with an increased risk of acoustic neuroma.

Conclusions: These results suggest an elevated risk of acoustic neuroma among individuals who have been exposed to occupational noise when some subgroup analysis are conducted. Leisure noise in particular seems to play a significant role in the development of acoustic neuroma. However, due to the heterogeneity among the included studies, this conclusion should be interpreted with cautions, even though the continuous long-term consequences should not be ignored.     

Low birth weight as a risk factor of hearing loss

The purpose of this study was the audiological evaluation of low birth weight children as well as to investigate any possible relation between very low birth weight and the associated risk factors and the subsequent hearing loss. A group of 110 children was examined audiologically. The prenatal, perinatal and postnatal risk factors were related to the audiological diagnosis. Depending on the patient's age, audiological examination consisted of auditory brainstem responses, pure tone audiometry and impedance audiometry. The presence of more than two risk factors in the perinatal and postnatal categories was connected with profound hearing loss in later life. No such relation was found with the cumulation of the prenatal risk factors. In our material the greatest risk of the acquired profound hearing loss and deafness occurring in low birth weight children was connected with the general physical status of the neonates and the treatment programme in the neonatal intensive care unit.     

The role of laryngopharyngeal reflux as a risk factor in laryngeal cancer: a preliminary report

Objectives

To evaluate the significance of laryngopharyngeal reflux (LPR) as a risk factor in laryngeal cancer.

Methods

We performed a case-control study with 29 consecutive laryngeal cancer patients who had undergone 24-hour ambulatory double pH monitoring from 2003 to 2006. The control group included 300 patients who had undergone 24-hour ambulatory double pH monitoring due to LPR-related symptoms. We analyzed the prevalence of LPR and numerous parameters from the 24-hour ambulatory double pH monitoring in the laryngeal cancer patient and control groups. Pathologic LPR is defined when more than three episodes of LPR occur in 24 hours.

Results

The prevalence of pathologic LPR was significantly higher in the laryngeal cancer group than the control group (P=0.049). The reflux number of the upper probe was significantly higher in the laryngeal cancer group (P<0.001). However the effects of pathologic LPR on laryngeal cancer risk were diluted after adjusting for smoking and alcohol consumption in the multivariable logistic regression.

Conclusion

The pathologic LPR might be a possible risk factor in the development of laryngeal cancer. A further study should be necessary to verify the exact role of LPR in laryngeal cancer.     

Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective,multicenter study in Korea

European Archives of Oto-Rhino-Laryngology - Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10&nbsp;years. The aim of...     

Allergic rhinitis in children as a risk factor of bronchial asthma

This study was designed to measure hyperreactivity of bronchi in patients aged from 7-8 to 13-14 years presenting with allergic rhinitis. The efficiency of the bronchoprovocative test with physical exercises was shown to be higher than the study of external respiratory function at rest.     

ABO blood type as a risk factor for secondary post-tonsillectomy haemorrhage

Introduction

Blood type-O is associated with decreased expression of von Willebrand factor. Type-O patients suffer fewer thrombotic problems and may be more prone to haemorrhage. Secondary post-tonsillectomy haemorrhage is the most common severe complication of tonsillectomy. We propose that type-O blood may be over-represented in patients presenting with secondary bleeds.

Methods

We reviewed patients treated in the Royal Victoria Eye and Ear Hospital and the Midwestern Regional Hospital for secondary post-tonsillectomy haemorrhages from 2001 to 2006.

Results

Three-hundred and three patients suffered secondary post-tonsillectomy haemorrhages over the study period. Blood group data was available in 206 cases (68%). Sixty-three percent of patients studied were blood group O, compared with 55% of the general population (p = 0.01).

Conclusions

Blood group O is disproportionately represented in secondary post-tonsillectomy haemorrhage patients. Although we cannot demonstrate causality, this association suggests that patients with type-O blood are more likely to suffer from secondary bleeds following tonsillectomy.