External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

To compare external and endoscopic dacryocystorhinostomy outcomes in patients with chronic dacryocystitis, a total of 103 patients with the complaint of epiphora and diagnosed as chronic dacryocystitis were included in the study. We performed external dacryocystorhinostomy on 55 patients under local anesthesia and endoscopic dacryocystorhinostomy on 48 patients under general anesthesia by means of drill and placed silicon stents to all the patients. The patients were examined endoscopically, at postoperative intervals of 1 week, first month, third month, sixth month and the first year. The patency of the tubes and nasolacrimal ducts were evaluated by irrigation and complaints of the patients were noted. Silicon stents were harvested at the sixth week postoperatively. Outcomes were classified as successful when epiphora diminished, no recurrent infection was noted and minimal or no reflux from the canaliculis during or after lacrimal irrigation was seen. A prospective endoscopic surgery group was compared to a prospective control group (external dacryocystorhinostomy). Full success was achieved in 69.9% of the patients with external dacryocystorhinostomy group whereas the full success rate of endoscopic dacryocystorhinostomy was 89.7%. Recently popularized endoscopic dacryocystorhinostomy is a safe and reliable procedure with high success rates.     

Endoscopic marsupialization of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts

A lacrimal sac mucocele is an uncommon disease usually treated by ophthalmologists. In rare cases, it is sometimes associated with a nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an otolaryngologist in diagnosis and management. Two cases of lacrimal sac mucoceles with nasolacrimal duct cysts are presented with a brief literature review. Both cases presented with intranasal cystic masses that caused nasal obstruction and were cured with endoscopic marsupialization of the cysts.     

Adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct: a case report

OBJECTIVES: To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. STUDY DESIGN: Retrospective review of the records of a case of adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 51-year-old man presented with a 10-year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex-pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment. CONCLUSIONS: Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex-pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.     

Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results

OBJECTIVE: Recurrent tracheoesophageal fistula (TEF) is a difficult problem in both diagnosis and management. Revision open repair with thoracotomy is challenging and has a significant associated morbidity. Because of the technical difficulty and the substantial morbidity, several authors have suggested and implemented endoscopic management. This paper reviews and describes the endoscopic techniques and management of recurrent TEF. METHODS: This retrospective study evaluates three patients who underwent endoscopic (bronchoscopic) management of recurrent TEF at Children's Memorial Hospital in Chicago, Illinois. Median follow-up is 48 months. A current literature review is presented with a synthesis of the data on techniques and results. RESULTS: Two of the three patients had successful bronchoscopic closure using fibrin adhesive. The mean number of procedures required was two. Including these patients, 62 patients with endoscopic closure of congenital TEF have been reported in the literature. The overall success rate is 60% with a mean of 2.1 procedures per patient. Of the obliterating agents described, tissue adhesive and fibrin adhesive have been employed most frequently with success rates of 48 and 55%, respectively. CONCLUSION: Endoscopic repair of recurrent TEF is an effective and safe alternative to second thoracotomy and open surgical repair. More than one endoscopic procedure is usually necessary for successful closure.     

Endoscopic dacryocystorhinostomy and retrograde nasolacrimal duct dilatation with cannulation: our experience

Endoscopic endonasal dacryocystorhinostomy [EDCR] is considered to be a superior alternative technique to the conventional external dacryocystorhinostomy [DCR], both in primary and secondary cases. It is of particular value in children and young adults as it avoids an external scar. Sixteen cases of chronic dacryo-cystitis were treated by the endoscopic technique, including 8 revision cases of failed external approach. In all cases except one, a patent nasolacrimal fistula was noted, with a success rate of 93.7%. The authors share their experience in EDCR and review the relevant literature.     

Ethmoid osteoma with frontal and orbital extension: Endoscopic removal and reconstruction

Conclusions

Endoscopy provides a safe and effective way of treating craniofacial bony benign lesions. This approach permits not only complete removal of the tumour, but also reconstruction of the bony boundaries as necessary.

Objective

Osteoma is a rare, osteogenic tumour that usually grows slowly and asymptomatically. It is the most frequent benign neoplasm of the nose and paranasal sinuses. Orbital extension is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debate persists regarding the optimal approach.

Material and methods

We report the case of a bulky fronto–ethmo–orbital osteoma that was treated using an endoscopic trans-nasal approach. The medial wall of the orbit was repaired by means of an implant of porous polyethylene endoscopically positioned using an “underlay” technique. The surgical technique is described and the reasons for the endoscopic choice are also discussed.

Results

Fifteen days after the operation the patient reported complete resolution of craniofacial pain. Nasoendoscopy showed complete integration of the polyethylene implant in the healing tissue 4 weeks after surgery. A CT scan performed 6 months postoperatively showed good ventilation of the sinonasal cavity and effective reconstruction of the medial orbital wall.     

Parapharyngeal and skull base yolk sac tumor: A case report with lessons in diagnosis and management

Yolk sac tumors are rare in the head and neck. A previously healthy 2-year-old female presented with a large parapharyngeal mass. Pathology was pathognomonic for yolk sac tumor, with glandular differentiation and focal mucin production, which has not been reported in a yolk sac tumor. She was treated aggressively with chemotherapy followed by endoscopic exploration with planned resection, but no viable tumor was encountered. Yolk sac tumors can be difficult to diagnose in the head and neck, but complete clinical response can be achieved. New endoscopic approaches to skull base tumors are applicable to the pediatric population with some technical modifications.     

Endoscopic microdebrider-assisted inferior turbinoplasty with and without posterior nasal neurectomy

Objective

Endoscopic microdebrider-assisted inferior turbinoplasty (EMAIT) has been recognized as an efficient surgical technique in the management of hypertrophied inferior turbinate. In an attempt to further increase surgical successful outcomes, posterior nasal neurectomy (PNN) was developed. The aim of this retrospective case–control study was to assess the position of PNN in the surgery of hypertrophied turbinate.

Methods

Seventy patients were assigned to the two treatment groups: Group A (EMAIT) and Group B (EMAIT and PNN). Subjective outcomes were represented by symptom score and quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire – RQLQ). Objective outcomes were nasal resistance, saccharin transit time and acoustic rhinometry parameters.

Results

The survey demonstrated that symptoms and objective parameters improved postoperatively in both groups, with no statistical significant differences in objective and subjective outcomes between the surgical groups.

Conclusion

The addition of PNN appears to offer no additional benefit in the subjective and objective outcome related with surgery of hypertrophied inferior turbinate. However, longer follow-up studies and larger number of patients are required in order to validate our results.     

Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study

ObjectiveIn the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.MethodsWe retrospectively reviewed the records of 96 patients with chronic rhinosinusitis (CRS). 48 patients undergoing endoscopic sinus surgery with surgical navigation (A group) and other 48 without navigation (B group). Data about percentage of complications, olfactory function (Visual Analogue Scale), Sino-nasal Outcomes Test (SNOT-22), Rhinosinusitis Quality of Life (RhinoQoL), recurrence (CT Lund–Mackay score), total nasal resistance (rhinomanometry) and duration of the intervention were collected and analyzed.ResultsA group evidenced a decrease of recurrence rate (p = 0.009), a reduction of total nasal resistance (p = 0.007), of frontal recess stenosis (p = 0.04) and of nasal symptomatology (p = 0.008). QoL had a better improvement in group A. Rate of other complications and olfactory function did not show statistically significant differences between the two groups. The average calibration time was approximately 11 min in the A group. Total time of surgical procedure does not evidenced statistically significant difference between the two groups (p > 0.05) but if it is considered only the time of the surgical intervention, the difference of duration is significant reduced statistically (p < 0.05) in CAN surgery.ConclusionComputer assisted navigation in ESS can be useful for the most experienced surgeons, especially in the frontal recess surgery, decreasing the recurrence rate and reducing the total nasal resistance.     

Sinonasal Disease and Olfactory Impairment in HIV Disease: Endoscopic Sinus Surgery and Outcome Measures

Objectives To investigate the effects of ESS (ESS) on olfactory impairment, disease‐specific symptoms, and general quality of well‐being In HIV+ patients with sinonasal disease. Study Design Study 1: Nasal cytology, rhinomanometry, nasal examination including endoscopy, disease‐specific sinonasal symptoms, olfactory threshold sensitivity, and odor identification testing were performed before and after ESS in HIV+ patients with sinonasal complaints. Study 2: Quality of well‐being was assessed before and after ESS in HIV+ patients with sinonasal complaints and controls. Results Significant olfactory sensitivity loss persisted for patients with chronic sinusitis after ESS, suggesting that the impairment in these patients may be due to viral disease rather than inflammation. Significant improvement in other disease‐specific symptom scores (nasal obstruction, nasal congestion, headache, sinus pain, etc.) and results of the general quality of well‐being assessment showed ESS to be beneficial in the extended health management of HIV illness. Conclusions The current study indicated both olfactory dysfunction and subjective negative symptoms in HIV+ patients with chronic sinusitis. Although olfactory dysfunction remained, ESS was successful in providing marked alleviation of symptomatology in HIV+ patients with chronic sinusitis. The results support ESS as an appropriate treatment option for HIV+ patients with chronic sinusitis.     

Endoscopic transnasal transethmosphenoidal approach for pituitary tumors: assessment of technique and postoperative findings of nasal and paranasal cavities

OBJECTIVE: Transnasal endoscopic surgery is the most common approach to removal of pituitary tumors. This study evaluated the transnasal transethmosphenoidal approach (TTES) in terms of its operative manipulability and the postoperative status of the paranasal cavities. METHODS: A total of 132 patients with pituitary tumors underwent surgery by one of the following three approaches: (1) bilateral TTES, in which the surgical procedures were performed via the bilateral paranasal cavities, (2) unilateral TTES, in which the procedures were performed via one side only, and (3) unilateral TTES and resection of the posterior portion in the nasal septum approach (RPS), which is a modification of approach (2) and enables performance of the procedures from both sides. RESULTS: The degree of freedom for the surgical procedures with each of the approaches decreased in the following order: bilateral TTES, unilateral TTES and RPS, and unilateral TTES. The postoperative CT images and endoscopic findings were good with each of the surgical approaches, but the incidences of olfactory disturbance and nasal dryness were significantly higher with the bilateral TTES compared with the unilateral TTES and RPS and the unilateral TTES. CONCLUSION: The unilateral TTES and RPS was for us most suitable approach of the three methods. In the case of advanced tumors, the bilateral TTES should be selected because it permits superior operative manipulability. Finally, the unilateral TTES is most appropriate for removal of tumors that are deviated to one side and localized within the sella.     

Microdrill stapedotomy for otosclerosis with small and large preoperative air-bone gap: a retrospective comparison of results

Abstract

Background: In otosclerosis mixed hearing loss is the most frequent symptom and arises when the focus involves the stapes footplate. Surgeons usually prefer to wait a minimum air-bone gap of 25 – 35?dB before surgery.

Objectives: To evaluate the outcome of microdrill stapedotomy for otosclerosis in patients with a preoperative air-bone gap (ABG) <25?dB versus patients with a preoperative gap ≥ 25?dB.

Material and methods: For this retrospective study, the outcomes and complications after microdrill stapedotomy were compared between adult patients with a preoperative small ABG (n?=?127, ABG <25?dB) and those with a large ABG (n?=?254, ABG ≥25?dB).

Results: The postoperative ABG was significantly smaller than the preoperative ABG (p?<?.05) in both groups; there were no differences in complications rates (severe sensorineural hearing loss, footplate fracture or early postoperative vertigo) between the two groups.

Conclusions: Our findings show that microdrill stapedotomy is safe and can be performed even in patients with a preoperative small ABG without increasing the risk of sensorineural hearing loss due to inner ear damage.     

Quality of life and cochlear implant: results in adults with postlingual hearing loss

Introduction

Considering the variability of results found in the clinical population using a cochlear implant, researchers in the area have been interested in the inclusion of quality of life measures to subjectively assess the benefits of the implantation.