Functional endoscopic sinus surgery and allergy.

The principles of functional endoscopic surgery require adequate sinus ventilation and drainage to avoid chronic disease states. The techniques employed by Messerklinger, Stammberger, and Kennedy have been demonstrated to be safe and effective. Careful evaluation of patients preoperatively with a careful allergy history and at least screening allergy tests, either intradermal or radioallergosorbent, is essential. Once the diagnosis of allergic rhinitis is established, the onset of therapy should precede surgical intervention to aid in appropriate surgical patient selection and to obtain the maximal symptomatic and functional relief postoperatively.     

Preoperative disease severity at sites of subsequent skull base defects after endoscopic sinus surgery

BACKGROUND: Skull base (SB) injury is a known complication of endoscopic sinus surgery (ESS). Risk factors for SB injury include poor visualization, low-lying SB, and SB asymmetry. Anecdotal evidence indicates that many SB defects occur in areas with minimal mucosal disease adjacent to the SB. We evaluated preoperative computed tomography (CT) scans to determine the degree of mucosal disease present at the site of subsequent SB defects caused by ESS. METHODS: Retrospective review of patients with SB injury as a result of ESS. Preoperative and postoperative CT films were reviewed for extent of overall sinus disease and disease at the site of the subsequent SB defect and presence of risk factors for SB injury. RESULTS: Preoperative and postoperative CT scans were obtained for 22 patients with 23 defects, who underwent 21 primary and 1 revision ESS. Fifteen (65%) patients had no disease, 2 (9%) patients had minimal disease, and 6 (26%) patients had complete opacification at the site of subsequent SB injury. SB defects occurred in the ethmoid roof (15 patients, 65%), lateral lamella (5 patients, 22%), cribriform plate (2 patients, 9%), and sphenoid sinus (1 patient, 4%). Risk factors for SB injury were only identified in 6 patients. CONCLUSION: SB injuries resulting from ESS occurred in SB regions with minimal or no mucosal disease in over two-thirds of cases. Explanations for this may include thinner bone and mucosa in areas without chronic disease that is easier to injure and less resistance to dissection in minimally diseased areas. Caution should always be exercised in ESS, but especially in minimally diseased areas.     

Paranasal sinus disease could be a reason for unsuccessful immunotherapy of inhalant allergy in children

PurposeThe aim of this study was to evaluate the role of paranasal sinuses condition assessed in computed tomography on inhalant allergen desensitization effects.Materials & methodsRetrospective analysis of medical records of children undergoing allergen immunotherapy in outpatient otolaryngology clinic of University Children Hospital in Lublin was performed. Control group consisted of children who underwent allergen immunotherapy and obtained satisfying effects; study group consisted of children who did not experience significant improvement after desensitization therapy.ResultsComputed tomography of nose cavity and paranasal sinuses exposed numerous pathologic changes affecting both, control and study group. Blockage of ostiomeatal complex was twice more common in children who did not respond adequately to desensitization therapy. In our study group, radiological findings suggesting rhinosinusitis were found in 73% of patients, while retention cysts in maxillary sinuses were discovered in 27% of patients.ConclusionsPathological findings in paranasal sinuses in computed tomography may arise from uncontrolled allergic rhinitis. If chirurgical management is indicated, allergen immunotherapy should be postponed until total recovery from operational procedure and repeated.     

The role of allergy in the severity of nasal polyposis

BACKGROUND: Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited information about the impact of allergy on the severity of nasal polyposis. The goal of this study was to evaluate the role of allergy in the severity of nasal polyposis. METHODS: Polyp sizes, computed tomography (CT) scores, skin-prick test results, blood total eosinophil count, serum levels of total immunoglobulin E, symptom scores, and recurrences were analyzed in 83 patients with nasal polyposis. The results were compared between allergic and nonallergic patients with nasal polyposis. RESULTS: No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p > 0.05). In allergic patients, only the serum total eosinophil count correlated strongly with the results of CT (p = 0.005) but not with other parameters (p > 0.05). CONCLUSIONS: The results of this study show that, although patients with nasal polyposis frequently have allergies, the presence of allergy does not correlate with polyp size, symptom scores or rate of recurrence.     

鼻及鼻窦疾病的CT诊断价值

目的 认识鼻及鼻窦疾病的ＣＴ诊断价值。方法 本文对９６例慢性鼻炎、鼻窦炎,鼻及鼻窦肿瘤进行ＣＴ检查,并结合病理检查结果对其进行分析。结果 发现ＣＴ能清晰地显示鼻窦解剖结构,包括窦口－鼻道复合体及前后筛房,筛房与眼眶之间关系及后筛与蝶窦颅底间的关系。对鼻窦内组织情况也能清晰显示,用ＣＴ对慢性增生性鼻窦炎进行分期,有利于手术前制定手术方案和评估预后。对慢性鼻窦炎、上颌窦囊肿、筛窦炎的诊断准确率分别为９     

Anosmia and nasal sinus disease

Smell loss associated with nasal sinus disease can be a frustrating condition for patients and their physicians. A better understanding of the causes and pathophysiology of olfactory dysfunction can provide a framework from which the physician can plan appropriate treatment and counsel patients as to probable outcomes. This article reviews the pathophysiology of smell loss and the diagnostic paradigms and treatment approaches for the more common causes of anosmia.     

慢性鼻-鼻窦炎患者主观症状与客观检查的相关性研究

目的：探讨慢性鼻-鼻窦炎（CRS）患者主观症状与客观检查的相关性。方法：采用视觉类比法（VAS）对75例CRS患者的全身不适感以及鼻塞、头昏或头痛、面部疼痛或胀满感、嗅觉障碍、鼻分泌物或后鼻漏5个单个症状进行评分;对鼻窦CT和鼻内镜检查这两项客观检查结果分别采用Lund-Mackay法和Lanza—Kennedy法进行评分;分析上述指标间的相关性。结果：①Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分正相关（r=0．88,P〈0．01）;②嗅觉障碍VAS评分与Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分正相关（r值分别为0．57和0．53,均P〈0．01）;鼻塞、头昏或头痛、面部疼痛或胀满、鼻分泌物或后鼻漏以及患者全身不适感症状VAS评分与Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分无显著相关性（均P〉0．05）;5个单个症状VAS评分之和与Lund-Mackay CT评分正相关（r=0．26,P〈0．05）,但与Lanza—Kennedy鼻内镜检查评分不相关（P〉0．05）。结论：CRS患者的主观症状同客观检查间无显著相关性,对CRS患者进行病情评估和治疗方式选择时必须结合主观症状和客观检查。     

Correlation between nasal polyposis and perennial allergy exemplified by house dust mite and house dust allergy

A total of 139 patients with nasal polyps were investigated by a standardized history, intradermal skin test and nasal challenge to house dust mite allergy. The aim of the study was to assess the disputed role of perennial allergy in patients with nasal polyps using allergens to the house dust mite as an example. Using our diagnostic criteria we found allergy to house dust mite in 28% of all cases. We found this diagnosis in 44.8% of patients aged 10-39. We recommend, especially in this age group, an allergy test, if necessary with the appropriate therapy. Test correlations are illustrated in 174 patients who have been examined by the above methods. Good reproducibility was found by the nasal challenge, which led to the right diagnosis in 92%, compared with 81% by a standardized history. Therefore, it can be considered to be the key to the diagnosis of allergy.     

Correlation between cephalometric data and severity of sleep apnea

IntroductionObstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome.ObjectiveTo correlate cephalometric data with the apnea-hypopnea sleep index.MethodsWe performed a retrospective and cross-sectional study that analyzed the cephalometric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012.ResultsNinety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index.ConclusionCephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation with the apnea-hypopnea index.     

鼻内镜术后上颌窦异常引流与黏膜炎症状态

目的观察上颌窦自然引流状态及引流的关键部位，探讨鼻内镜术后上颌窦的引流与窦腔炎症的关系，为鼻内镜手术上颌窦自然窦口的处理提供参考。方法用美蓝作为示踪剂，观察15例上颌窦无明显炎症或炎症较轻受检者上颌窦自然引流状态及引流的关键部位。另选择89例慢性鼻窦炎不伴鼻息肉患者鼻内镜术后6个月，且上颌窦黏膜恢复良好的患者，观察其上颌窦引流状态及方式，并继续随访至12个月，内镜下评估黏膜的炎症情况，分析鼻内镜术后上颌窦引流方式与黏膜炎症状态的关系。结果上颌窦自然窦口引流的关键部位在自然窦口的后下，近钩突尾端的附着处。引流物出上颌窦向后下走行，最终流向鼻咽部。传统鼻内镜手术后，引流方式相对正常者15例，占16．9％；74例（83．1％）患者上颌窦的引流状态及引流方式发生了明显改变。其中包括反向引流6例、多相引流31例、引流不能20例、“蓄水池”样改变9例以及黏膜失用8例。术后12个月33．7％的患者再次发生炎症反应，以黏膜失用炎症的发生率（100％）最高，其次是引流不能及反向引流（各占50％）。结论上颌窦自然窦口的后下近钩突尾端附着处是上颌窦引流的关键部位；鼻内镜术后，上颌窦自然引流关键部位的损伤甚至瘢痕形成，可以导致上颌窦的异常引流，过度开放上颌窦窦口，有可能加重上颌窦黏膜的损伤；上颌窦的异常引流状态及方式与黏膜炎症的发生率密切相关。     

Isolated sphenoid sinus disease

Forty-three cases of isolated sphenoid sinus disease were reviewed. In 33 cases, headache was a presenting symptom. Seven of 29 cases of inflammatory disease and nine of 13 patients with tumors of the sinus presented with cranial nerve findings. When nonspecific visual disturbances were eliminated, two of 29 cases of inflammation and eight of 13 cases of tumors of the sphenoid sinus had cranial nerve deficits. Ten of 12 CT scans performed on patients with tumors of the sinus demonstrated bony erosion or perisinus extensions. This was not found in any of the 27 scans of patients with inflammatory disease. A thorough cranial nerve examination and a CT scan should be performed early in patients who present with vague and unusual headaches.     

孤立性蝶窦占位性病变的诊断与治疗

进一步认识孤立性窦占位性病变,提高对其诊断和治疗水平。方法在鼻内窥镜下摘除蝶窦囊肿２０例,行蝶窦探查术６例,经鼻外径路摘除囊肿３例,前颅底径路病变切除＋视神经减压术１例。结果２４例随０．５－４年无复发,１例术后不久囊肿复发,１例术后１年复发再次手术后随访１年无复发,１例正在放疗中３例失访。     

Isolated sphenoid sinus disease

Disease of the sphenoid sinus is often vague and nonspecific in its clinical presentation. Therefore, the otolaryngologist must maintain a high index of suspicion when evaluating patients who present with such nonspecific symptoms. A thorough understanding of the radiologic characteristics of sphenoid sinus disease is essential in the proper evaluation and management of these patients.     

鼻窦炎内镜手术操作与术后复发

目的：探讨内镜鼻窦手术操作与鼻窦炎术后复发的关系。方法：对2001～2005年随访的因手术操作不当造成复发的病例进行回顾性分析。结果：因手术操作不当造成复发的原因有鼻中隔高位偏曲未矫正、鼻丘及额隐窝部病变处理不彻底、筛窦开放不完全、中鼻甲处理不当、钩突残留、上颌窦口狭窄闭锁、上颌窦内息肉未摘除干净、鼻腔黏膜粘连,下鼻甲明显肥厚术中未同期手术等。结论：熟悉内镜鼻窦手术的应用解剖,熟练手术操作技巧,特别是对几个容易引起复发部位的处理要得当。     

Septal deviation and chronic sinus disease

The introduction of computerized tomography in the identification of sinonasal pathology and associated anatomic variants has contributed to a greater understanding of the factors leading to ostiomeatal complex (OMC) obstruction and chronic sinus disease. The OMC and paranasal sinus regions were prospectively evaluated in 150 consecutive patients as a function of the degree of nasal septal deviation and compared with matched controls. These data were correlated with paranasal sinus disease, lateral nasal wall findings, and middle turbinate abnormalities. An increased incidence and severity of bilateral chronic sinus disease was present with increasing septal deviations (p < 0.05). Similarly, patients with increasing nasal septum deviations were noted to have a higher incidence of OMC obstruction (p < 0.05). Ostiomeatal complex obstruction in the direction of septal angulation was associated with nasal septal deformity; however, contralateral OMC obstruction was associated with middle turbinate and lateral nasal wall abnormalities (p < 0.05). The evaluation of the degree of septal angulation has helped better understand the factors contributing to chronic sinus disease and OMC obstruction.     

上颌窦气化与牙源性上颌窦炎的相关性分析

目的 探讨上颌窦气化与牙源性上颌窦炎发病的关系.方法 回顾性分析牙源性上颌窦炎患者鼻窦CT中双侧牙槽突骨质厚度、牙槽突气化深度,冠状位上颌窦高度及矢状位对角线长度,观察牙源性上颌窦炎患者双侧上颌窦气化程度的差异.结果 牙源性上颌窦炎患者患侧上颌骨牙槽突厚度:(5.67±1.79)mm,健侧上颌骨牙槽突厚度:(7.88±...     

Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery

CONCLUSION: Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). OBJECTIVES: To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. PATIENTS AND METHODS: This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. RESULTS: Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.