CT仿真内窥镜在鼻科的临床应用

目的：探讨CT仿真内窥镜在鼻腔、鼻窦中的应用价值。材料与方法：正常16例，鼻窦炎12例，鼻窦囊肿15例，鼻窦息肉6例。对其进行CT仿真内镜重建。结果：CT仿真内窥镜准确显示鼻腔、鼻窦，并可多方位多角度观察，与手术所见具有良好的对应性。结论：CTVE可作为1种准确而无创伤性的检查方法，有助于临床医师治疗、手术计划的制定和实施。     

Headache With Autonomic Features in a Child: Cluster Headache or Contact‐Point Headache?

Headache and facial pain due to diseases of the nose and sinuses are not uncommon in children. However, nasal contact-point associated with headache is relatively uncommon and has unclear etiological significance. We herein report a child having headache with autonomic features and contact-point in the nose, and discuss the difficulties in diagnostic categorization.     

Sounding airflow enhances aerosol delivery into the paranasal sinuses

BACKGROUND: The use of aerosol therapy is commonly suggested in the treatment of paranasal disorders but it is difficult to achieve an effective penetration of drugs into the sinuses. The authors have recently shown that an oscillating airflow produced by phonation (nasal humming) causes a large increase in the gas exchange between the nose and the paranasal sinuses. This is reflected by a high peak in nasally exhaled nitric oxide (NO) levels because NO accumulated in the sinuses is rapidly washed-out via the sinus ostia. OBJECTIVE: This study was designed to test whether the increase in sinus gas exchange caused by an oscillating airflow could be used to enhance penetration of a drug into the sinuses. MATERIALS AND METHODS: In six healthy subjects a nitric oxide-synthase inhibitor L-NAME was administrated into the nostrils by a jet nebulizer connected to a duck call, which could be modified to generate either a sounding airflow or a non-sounding airflow. The degree of L-NAME penetration into the sinuses was judged from the reduction in nasal NO during humming exhalations. Sinus drug deposition was also studied in a model of the nose and sinus. RESULTS: In humans the delivery of L-NAME with the non-sounding airflow had no effect on the NO levels achieved during humming, whereas L-NAME administration with sound caused a significant 22-35% reduction in nasal NO. In the model the aerosol delivery with the sounding airflow caused a fourfold increase in sinus drug deposition as compared with an aerosol without sound. CONCLUSION: A sounding airflow increases the delivery of an aerosolized drug into the paranasal sinuses.     

Chronic daily headache: When to suspect sinus disease

Migraine may be responsible for many headaches thought to be caused by the sinuses. Patients complaining of “sinus headache” must have a complete ear, nose, and throat examination. Occasionally, chronic headaches may arise from the sinuses; a thorough history is important to search for symptoms of facial pain and pressure along with other nasal sinus symptoms.     

Sinusitis: hidden source of sepsis in postoperative pediatric intensive care patients

Paranasal sinusitis is reported as a complication of prolonged nasal intubation and the source of sepsis in adult intensive care patients. In surgical neonates with congenital malformations, prolonged intubation with a nasotracheal (NT) or NG tube is often necessary, but sinusitis with complicating sepsis is seldom reported. Sinus x-rays may confirm the diagnosis; in infancy, prolonged nasal intubation delays the pneumatization of the sinuses and the mastoids, resulting in additional diagnostic problems. In a 1-yr period, we saw three patients with multiple septic episodes in which the source of sepsis was undetectable. Despite the absence of clinical symptoms and radiologic evidence of sinusitis or mastoiditis, surgical drainage revealed pus and led to the disappearance of septic episodes and ear, nose, and throat problems. There is an association between prolonged NT and NG intubation, and sinusitis or mastoiditis as an unrecognized source of sepsis in young infants. Absence of radiologic evidence of sinusitis or mastoiditis causes pitfalls in diagnosis and is related to delayed pneumatization of the sinuses and the mastoid in prolonged nasal intubation in young infants.     

Using Animal Models to Understand Cancer Pain in Humans

The interplay between head pain caused by sinus disease and primary headaches is complex. Classification of secondary headaches, attributed to disorders of the nose or paranasal sinuses has been recently updated. New treatments including office- based procedures are emerging for patients with chronic sinusitis. This paper briefly reviews sinus disease and headache.     

Sinusitis

Early and aggressive treatment of allergic, inflammatory, and infectious diseases of the nose and paranasal sinuses should reduce the potential for chronic and irreversible disease of the sinus mucosa. Identification of underlying allergies, reactive mucosa, impaired mucosal transport, anatomic obstruction, or narrowing are key elements in establishing an effective treatment plan and the ultimate resolution of these disease processes.     

Management of the thick antral wall in sub-labial antroscopy

Minimally invasive endoscopic surgical procedures upon the nose and paranasal sinuses frequently require adequate visualization of the maxillary sinus. This may conveniently be achieved by introducing a cannula sub-labially through the bony anterior maxillary wall but this approach may prove difficult when the bone is excessively thick. A simple technique is described that greatly facilitates this approach.     

Manifestations of AIDS in the head and neck.

BACKGROUND: A significant number of patients with the acquired immunodeficiency syndrome (AIDS) are initially seen with symptoms related to the head and neck. It is becoming increasingly challenging for clinicians to accurately diagnose new lesions, considering the vast array of manifestations of AIDS in this region and their many atypical presentations. A comprehensive review is a valuable clinical tool. METHODS: A MEDLINE search of the English language literature from 1984 to the present was done for this study. RESULTS: Dermatologic, otologic, nose/paranasal sinuses/nasopharynx, oral cavity/oropharynx, laryngeal, and neck manifestations are reviewed. The gross and microscopic appearances of lesions are described, with particular emphasis on various presentations of the same lesion and lesions that may mimic the appearance of others. Practical treatment strategies are also discussed. CONCLUSIONS: Accurate and early recognition of the many common and uncommon manifestations of AIDS in the head and neck is of critical importance to the timely and effective management of these patients.     

The microbiology of paranasal sinus infections: diagnosis and management.

Study of the bacteriology of sinusitis and its diagnosis and treatment has been difficult. One problem is the anatomy of the paranasal sinuses; all communicate with a bacteriologically contaminated cavity. Access to all but the frontal sinus involves traversing either the nasal or oral cavity, both of which are teeming with aerobic and anaerobic bacteria. The criteria used to establish the diagnosis of sinusitis has varied widely. There are a number of examination techniques available, but none are foolproof. Therefore, patient populations may not be comparable. The absolute elimination of the possibility of contamination of culture specimens is impossible. Investigators have taken cultures in several ways: of the purulent secretions within the nose, of the contents lavaged from the sinus into the nose, of material aspirated from the sinus, and of tissue removed from the sinus. In most studies prior to 1974, anaerobic cultures were not performed. Studies of various treatment programs have used differing criteria to monitor the progress of treatment. No single method is completely reliable. Clinical signs and symptoms, radiologic appearance, the results of irrigation, and thermography have been used to follow patients. Many studies have used multiple therapeutic maneuvers concurrently, for example, antibiotics, lavage, and a decongestant. In some there were no controls. Because of these problems, as is true in many clinical areas of investigation, meaningful comparisons of various studies are difficult. Despite this, there are some areas of consensus in the literature.     

鼻腔及副鼻窦内翻性乳头状瘤的CT诊断

目的：探讨鼻腔及副鼻窦内翻性乳头状瘤的CT诊断价值。材料与方法：回顾分析19例经手术病理证实的鼻腔及副鼻窦内翻性乳头状瘤的CT检查资料。结果：本组19例鼻腔及副鼻窦内翻性乳头状瘤基底部均位于中鼻道,仅位于鼻腔者4例,累及邻近副鼻窦者15例,其中1例侵及眶后间隙。肿瘤表现为略高密度软组织肿块,呈不规则结节状,匍行性生长,骨质改变以骨质破坏多见。15例患者进行随访,5例患者再次复发。结论：鼻腔及副鼻窦内翻性乳头状瘤的CT表现具有一定的特点,CT除能够对其进行较准确诊断外,还可明确判断肿瘤的解剖位置及其与邻近解剖结构的毗临关系。     

Endoscopic approach to posterior epistaxis

Management of epistaxis is directly related to the site of the bleeding. The introduction of multi-angled rigid nasal endoscopes has refined the diagnostic capabilities of various conditions affecting nose and sinuses. The posterior epistaxis presents significant greater problems as bleeding is severe and treated with conventional packing can lead to increased morbidity and life-threatening complications. The precise location of a bleeding point with an endoscope has revolutionized the management of these difficult emergencies.     

A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest–posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0–3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (η_p² η_p² = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.     

Sinography in management of decubitus ulcers

Draining sinuses are considered a major complication of decubitus ulcers in spinal cord injury patients. Of 144 such patients with decubitus ulcers admitted in 1975 and 1976, 15 had draining sinuses. Twenty-one sinograms were obtained in the process of their evaluation prior to treatment. In 6 patients, sinography resulted in unexpected findings such as excessive depth of the sinus tract, abscess formation, undermining of previous graft, and extension into neighboring joints, affecting both the management of the decubitus ulcers and the surgical approach. It is concluded that sinography should become an integral part of management of decubitus ulcers with draining sinuses.     

多层螺旋CT在鼻骨骨折中的诊断价值

目的：探讨多层螺旋CT（Multi-slice spiral CT,MSCT）在鼻骨骨折的临床诊断价值。材料与方法：60例鼻外伤病人均行MSCT容积扫描后行多种后处理图象重建并与X线片进行分析比较。结果：X线片60例患者中诊断鼻骨骨折者28例,8例可疑骨折,其余未见明显骨折。60例患者行MSCT容积扫描后行多种后处理图象重建后显示鼻骨骨折56例,其中单侧鼻骨骨折33例,双侧鼻骨骨折23例,伴上颌骨额突骨折40例,伴泪骨骨折8例,伴鼻中隔骨折15例,骨折伴鼻额缝分离13例,鼻骨间缝分离移位18例,并发眶壁骨折12例,伴鼻颌缝分离移位38例,上颌窦壁骨折5例。4例MSCT检查未见异常。结论：MSCT容积扫描检查鼻骨骨折明显优于常规CT和X线平片。MSCT检查能准确地显示鼻骨及周围各骨结构,对鼻骨骨折的类型、部位及其伴发改变显示全面、准确,是当前诊断鼻骨骨折的一种可靠、安全、有效的检查方法,为临床选择治疗方案和法医学鉴定提供可靠依据。     

Imaging of sinonasal anatomy and inflammatory disorders

The widespread acceptance of functional endoscopic sinus surgery (FESS) underscores the importance of understanding the relevant anatomy of the paranasal sinuses as a means of providing a roadmap to the otorhinolaryngologist prior to surgery. The radiologist can address important imaging issues for the ear, nose, and throat (ENT) surgeon before FESS is undertaken. There are two main questions that the radiologist should address: 1. Are there anatomic features on the computed tomography (CT) scan that predispose the patient to impaired mucociliary clearance? 2. Are there anatomic features that pose a surgical hazard?     

骨瓣成形术治疗横窦骑跨性硬膜外血肿

目的：探讨骨瓣成形术治疗横窦骑跨性硬膜外血肿的疗效。方法：分析骨瓣成形术治疗的36例横窦骑跨性硬膜外血肿的临床资料：全部病例术前经CT确诊，行骨瓣成形术清除横窦骑跨性硬膜外血肿。单侧血肿（20mL者采用旁正中切口，单侧血肿≥20mL者采用枕后马蹄形切口或枕下倒钩形切口，双侧血肿采用正中切口。结果；术后复查CT横窦减压效果良好。按格拉斯哥预后评分术后恢复良好29例，重度残疾2例，中度残疾3例，植物生存1例，死亡1例。结论：骨瓣成形术清除横窦骑跨性硬膜外血肿安全且能更好地避免横窦受压，骨瓣复位符合解剖复位原则，可作为治疗横窦骑跨性硬膜外血肿较理想的方法。     

侵袭型霉菌性鼻窦炎的CT诊断与临床

目的 探讨侵袭性霉菌性鼻窦炎CT表现及诊断价值。方法 回顾性分析32例经手术病理证实的侵袭型霉菌性鼻窦炎CT及临床表现，提出诊断和鉴别诊断要点。结果 侵袭型霉菌性鼻窦炎主要CT表现有：病变多为单侧性，对侧鼻窦正常；病变多位于上颌窦或以上颌窦为主，可累及其他鼻窦；病变窦腔密度增高，不均匀，内有小团状，砂粒状、条状高密度钙化影；有鼻窦壁骨质破坏。结论 CT检查是诊断侵袭型霉菌性鼻窦炎有价值的方法.     

鼻内镜在鼻窦真菌球治疗中的应用

目的探讨鼻窦真菌球的诊断及合理的手术方式。方法总结分析31例经病理诊断为鼻窦真菌球患者的病史、临床表现、鼻窦CT、窦腔内病变的特点和鼻内镜手术后的疗效。结果31例经鼻内镜手术患者治愈28例，好转3例，无复发。结论鼻窦真菌球并非少见，鼻窦CT和鼻内镜检查是诊断的主要依据，最终确诊还需病理学检查，鼻内镜下病灶清除术及充分引流是治疗的首选术式。     

Efficacy of noninvasive hemolaserotherapy in patients with bronchial asthma and concomitant rhinosinusitis

AIM: To study efficacy of low-intensive infrared laser radiation impact on the tympanic membrane in patients with bronchial asthma (BA) and concomitant rhinosinusitis (RS). MATERIAL AND METHODS: 78 patients with moderate BA of a mixed type and concomitant chronic RS were divided into 3 groups: group 1 patients received medication plus infrared laser radiation of the tympanic membrane and paranasal sinuses; group 2 patients were exposed to supravenous laser radiation (0.63 mcm); group 3 received pharmacotherapy alone. The effect of the treatment was assessed by spirometry, peakflowmetry and paranasal sinuses findings. RESULTS: The highest response was achieved in group 1 which manifested with positive changes in clinical, device and spirometric data on BA and x-ray data on RS courses. The least effective treatment was observed in group 3. CONCLUSION: Use of infrared laser radiation of the tympanic membrane and paranasal sinuses projection in the treatment of BA patients with RS is effective, nontoxic and easy to use both in hospitals and outpatient departments.