内窥镜鼻窦手术术后的处理对其疗效的影响

分析术后处理对内窥镜鼻手术疗效的影响,寻找术后最佳处理方法,方法对５４例内窥镜术后患者作了内窥镜随访观察。结果在术后１年时,发现息肉复发７例,术腔有脓性分泌物８例,术腔粘连７例,术腔未完全上皮化１０例。结论恰当的术后处理,定期例题的鼻内窥镜随访是保证远期手术疗效的重要环节 。     

伯克纳在功能性内窥镜鼻窦手术后应用的疗效研究

目的探讨伯克纳在功能性内窥镜鼻窦手术后的疗效.方法随机将82例患者分组,对比应用伯克纳及未应用伯克纳的疗效.结果两组在术腔清洁时间,术后黏膜病变出现早晚等无明显差异,但应用伯克纳组术腔黏膜完全上皮化的时间明显早于未应用组.结论伯克纳难以缩短术腔清洁时间,也不能阻止或延缓息肉、囊泡、肉芽、黏连等病变的出现,但能促进黏膜上皮化,促进创面愈合,预防复发.     

内窥镜鼻窦手术术后的处理与疗效

目的 :探索提高内窥镜鼻窦手术疗效的术后处理方法。方法 :通过对 30 0例内窥镜鼻窦手术术后的定期随访和不同时期恰当的处理 ,分析其与疗效的关系。结果 :30 0例内窥镜鼻窦手术病人术后 1年有效率为 82 .3%。结论 :术后合理用药及恰当的术后处理和定期鼻内窥镜随访能提高手术疗效。     

鼻内镜下额窦口开放的远期疗效观察

目的 探讨鼻内镜下额窦口开放的远期疗效。方法 112例（204侧）慢性额窦炎患者鼻内镜下行额窦开放术。清理阻塞额窦口引流的病变组织，并开放额窦口直径〉7mm。结果 术后6个月、1年、2年额窦口开放良好率分别为91．2％（186／204）、87．3％（178／204）、86．3％（176／204），三者之间疗效比较无统计学意义（χ^2=2．45，P〉0．05）。狭窄和闭锁者再次手术成功率仅31．3％（5／16）。结论 准确寻找并开放额窦开口且保持引流通畅是手术成功的关键，钩突上端附着点是一个重要的参考标志，应彻底清理额隐窝并尽可能保留窦口周围的黏膜，正确开放后可获得满意疗效。     

An evaluation of the best head position for instillation of steroid nose drops

Steroid nose drops are used frequently to treat rhinosinusitis and nasal polyposis. The middle meatal area is of key importance in the pathophysiology of these conditions. This study assesses which of three head positions commonly used to instil nose drops resulted in the highest coverage of this area. Discomfort levels were also studied using a visual analogue scale for each position. Five volunteers were studied in: (i) head back (HB); (ii) head forward and down (HFD); and (iii) lying head back (LHB) positions. Betamethasone nose drops, dyed with fluorescein, were instilled into each nostril and the distribution was studied endoscopically. The middle meatus area distribution was highest in the LHB position (55.51%), followed by HFD (31.55%) and HB (6.87%) positions. Comparison of distribution between HB and LHB (P = 0.002) and between HB and HFD (P = 0.045) was statistically significant. The HFD position was most uncomfortable (mean discomfort score 8.8) whereas the HB (2.4) and LHB (2.6) were similar. The LHB would, therefore, appear to be the most suitable position for instillation of steroid nose drops.     

Topical steroid therapy using the Silverstein Microwick in sudden sensorineural hearing loss after failure of conventional treatment

CONCLUSIONS: Local administration of steroids to the inner ear through the round window route improves hearing in patients after failure of conventional therapy. OBJECTIVES: To determine if delivery of methylprednisolone to the round window can improve hearing after failure of conventional treatment for sudden sensorineural hearing loss (SSHL) administered for 10 days after the onset of the hearing loss. PATIENTS AND METHODS: A Silverstein microwick was placed in the round window niche under local anesthesia and endoscopic control, allowing self-administration of methylprednisolone twice a day for 3 weeks. Treated patients were compared to a control group composed of similar patients, treated with the same systemic regimen but who did not receive local therapy. RESULTS: Of the 12 patients enrolled in this nonrandomized prospective study, 8 patients showed an improvement of the pure tone average (PTA) and 4 remain stable. Of those who responded to perfusion, eight patients demonstrated a significant mean 24.5 +/- 12 dB improvement in PTA, and seven patients had a mean 17.5 +/- 18% improvement in discrimination, with five patients reaching 100% speech discrimination score (SDS). Patients in the control group did not show any improvement of the PTA.     

鼻内镜手术开放上颌窦口大小与术后疗效的探讨

目的探讨鼻内镜手术中扩大上颌窦口大小与术后疗效的关系。方法采用自身配对,研究120例双侧病变相近的、术中见双侧上颌窦窦口均有病变的I、II型慢性鼻窦炎鼻息肉患者,对比一侧窦口尽量扩大,另一侧常规扩大,术后不同时期鼻腔症状改善情况及窦口开放率。结果术中尽量扩大窦口一侧在不同时期其症状改善程度均优于常规扩大侧,随访6个月,窦口开放良好率为96.7%。结论鼻内镜手术中,对上颌窦窦口有病变者,尽量扩大窦口,有利于上颌窦通气引流,提高手术疗效。     

Catheter-based dilation of the sinus ostia: initial safety and feasibility analysis in a cadaver model

BACKGROUND: Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases. We speculated that catheter technology also might offer new treatment options for sinusitis patients. The purpose of this investigation was to explore the feasibility and safety of catheter-based technology to relieve sinus ostial obstruction. METHODS: Anatomic models and human cadaver specimens were used initially to design and iterate catheters to open sinus ostial drainage pathways. Thereafter, the safety of balloon-catheter dilation was evaluated in six human cadaver heads. CT scan obtained before and after catheter ostial dilation was analyzed for evidence of catheter-induced trauma. Dilated ostia also were examined by endoscopy and gross anatomic dissection for unwanted catheter-induced trauma. RESULTS: Catheters successfully dilated 31 of 31 ostia, including 9 maxillary, 11 sphenoid, and 11 frontal ostia/recesses. CT scan, endoscopy, and gross anatomic dissection revealed that such dilation did not cause trauma to surrounding structures such as the orbit or skull base. Mucosal trauma imparted by catheter dilation appeared to be less than that normally seen with standard endoscopic instruments. CONCLUSION: This initial study suggests that catheter technology can be used to dilate sinus ostia safely. Mucosal preservation and ease of use make catheters an attractive minimally invasive treatment strategy. Additional testing in patients is indicated to gain additional safety information and to explore the usefulness of catheter-based technology.