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1.
Background
Stapedectomy and, more recently, stapedotomy have been widely accepted as the primary surgical techniques to improve conductive hearing in patients suffering from otosclerosis. Unsuccessful outcomes are infrequent, but revision surgery may become necessary. We have analyzed the value of computed tomography (CT) scanning following unsuccessful stapes surgery.Patients and methods
In a total of 37 CT scans, the depth of insertion, angle between prosthesis and footplate, location of prosthesis within the oval niche, visibility of the prosthesis, dehiscence of the superior semicircular canal, and extent of otospongiotic foci were evaluated and compared with the audiometric results.Results
There was no significant correlation between CT parameters and audiologic results, except for patients with cochlear otosclerosis or lateral dislocation of the piston. One previously unknown dehiscence of the superior semicircular canal was diagnosed. Otospongiotic foci were seen in 13 ears (35%).Conclusion
Displacements of the stapes piston and rare causes for an insufficient result, such as a dehiscence of the superior semicircular canal, can be diagnosed accurately by CT. However, correlation between the audiologic results and the findings on CT scans was possible in only a few cases. Nevertheless, CT scans provide additional information for surgical planning in revision stapes surgery and may become increasingly important to reduce unanticipated intraoperative risks; they may even guide the surgeon not to perform unnecessary revision surgeries. 相似文献2.
Background
Against the background of constantly intensifying economic pressure in the healthcare sector, in the future confirmation of subjective and economic benefit of different forms of therapy will be the criterion applied by the health insurance companies to decide whether to reimburse the costs they involve. The aim of this study was to provide confirmation that patients with chronic rhinosinusitis (CRS) do benefit from functional endonasal sinus surgery (FESS).Patients and methods
One year after undergoing FESS for the treatment of CRS, 82 patients completed various questionnaires. The Glasgow Benefit Inventory (GBI) was used, as it is a validated instrument for the assessment of benefit. In addition, the patients were asked to complete questionnaires relating to pre- and postoperative use of resources (use of antibiotics, visits to their doctors and time unfit for work) and also to give an overall rating of their satisfaction with the outcome, the difference in their symptoms after FESS and the likelihood that they would recommend this treatment to friends or relatives.Results
Three out of four GBI scales [total score (+22.6), general benefit (+26.8), physical functioning (+23.7)] indicated that patients experienced significant benefit. The frequency of visiting their doctors, their intake of antibiotics and the amount of time off work were all significantly reduced. The vast majority of patients were satisfied with the overall result and the level of symptom relief achieved and would recommend FESS to friends and relatives.Conclusion
The vast majority of these patients with CRS experienced FESS as highly beneficial. A significant reduction of resource usage was reported after the operation. 相似文献3.
Øystein Eskeland Kjell Arild Danielsen Fredrik Dahl Katrin Fridrich Vivian Cecilie Orszagh Gregor Bachmann-Harildstad Espen Burum-Auensen 《BMC ear, nose, and throat disorders》2017,17(1):15
Background
Chronic rhinosinusitis display a variety of different phenotypes. The symptoms of disease are characterised by various signs and symptoms such as nasal congestion, nasal discharge, pressure sensation in the face and reduced or complete loss of smell.In a patient population undergoing functional endoscopic sinonasal surgery (FESS) for chronic rhinosinusitis, we wanted to investigate the clinical features and explore if the presence of biofilm, nasal polyps or other disease characteristic could serve as predictor for the symptomatic load. A patient group undergoing septoplasty without disease of the sinuses was included as control.Methods
The Sinonasal outcome test (SNOT-20), EPOS visual analogue scale (VAS) and the Lund-Mackey CT score (LM CT score) were used to examine 23 patients with chronic rhinosinusitis without nasal polyps (CRSsNP), 30 patient with nasal polyps (CRSwNP) and 22 patients with septal deviation. Tissue samples were collected prospectively during surgery. The cohort has previously been examined for the presence of biofilm.Results
Patients with CRSsNP and CRSwNP had significantly higher degree of symptoms compared to the septoplasty group (SNOT-20 scores of 39.8, 43.6 and 29.9, respectively, p?=?0.034). There were no significant differences in the total SNOT-20 or VAS symptoms scores between the CRSsNP and CRSwNP subgroups. However patients with nasal polyps showed significantly higher scores of symptoms related to sinonasal discomfort such as cough, runny nose and need to blow nose (p?=?0.011, p?=?0.046, p?=?0.001 respectively). Patients with nasal polyps showed a significantly higher LM CT score compared to patients without polyps (12.06 versus 8.00, p?=?0.001). The presence of biofilm did not impact the degree of symptoms.Conclusion
The presence of nasal polyp formations in CRS patients was associated with a higher symptomatic airway load as compared to patients without polyps. These findings suggest that nasal polyps could be an indicator of more substantial sinonasal disease. The presence of biofilm did not impact the degree of symptoms, however, as biofilm seem to be a common feature of chronic rhinosinusitis (89% in this cohort), it is more likely to be involved in the development of the CRS, rather than being a surrogate marker for increased symptomatic load.4.
Introduction
Videoendoscopic endonasal-transsphenoidal pituitary surgery is a modern minimally invasive surgical technique, which requires interdisciplinary cooperation between ENT and neurosurgery.Patients and methods
Between December 2006 and July 2008, 25 patients (13 male, 12 female, average age 55 years old) suffering from pituitary adenomas were operated on with the abovementioned method. All operations were done four-handed with the ENT surgeon carrying out the sphenoidectomy and the neurosurgeon the adenomectomy. An optoelectronic system (Vector Vision ®) was used for navigation using CT and MRI scans that were fused together.Results
Of the patients 21 suffered from a macroadenoma and 3 from a microadenoma. Primary surgery was carried out on 22 patients and 3 underwent recurrence surgery. The adenoma could be resected without any intraoperative complications in all cases. In five cases postoperative liquorrhoea occurred, which in one case was combined with a pneumocephalus due to strong nose blowing and revision surgery was required in three cases. Oculomotor nerve palsy due to neuroborreliosis was observed in one case on the third postoperative day, which receded completely under antibiotics within 1 week. Navigation worked well in all cases, thus there was no need for a C-bow. Additional functional endoscopic sinus surgery (FESS) was necessary in one case due to nasal polyposis. The endoscopic panorama view was advantageous because of the possibility to view the operation cavity. The changeover from microscopic to endoscopic techniques was performed due to the interdisciplinary approach without an intensive learning phase.Conclusions
The newly developed videoendoscopic endonasal pituitary surgery as an interdisciplinary operation between neurosurgery and rhinosurgery by means of modern navigation systems proved to be an excellent method. 相似文献5.
Background
Orbital complications following functional endoscopic sinus surgery (FESS) are fortunately rare. They are usually easily and rapidly recognizable.Case presentation
We present an unusual case of a forty-five year old woman who underwent routine FESS and was not packed nasally after the procedure. Six hours later she started bleeding and nasal packs were inserted. She soon developed unilateral periorbital bruising and within hours her condition had worsened so much that the viability of the eye was thrown into question. She underwent medial and lateral canthotomies and made an uneventful post-operative recovery.Conclusion
This rare case demonstrates that late, brisk post-operative bleeding can occur after FESS with potentially catastrophic consequences. Clinicians should be aware that discharging patients after FESS too early may lead to medico-legal problems. 相似文献6.
Vasileios Papanikolaou Mohammad H Khan Ivan J Keogh 《BMC ear, nose, and throat disorders》2010,10(1):1-7
Background
The evaluation of patients presenting with audiovestibular symptoms usually includes MRI of the internal auditory meatus, the cerebellopontine angle and the brain. A significant percentage of these scans will present unexpected, incidental findings, which could have important clinical significance.Objective
To determine the frequency and clinical significance of incidental findings on MRI scans of patients with audiovestibular symptoms.Materials and methods
A retrospective analysis of 200 serial MRI scans.Results
Gender distribution: equal. Age range: 17-82 years. One-hundred and four scans (52%) were normal and 1 scan (0.5%) demonstrated a unilateral vestibular schwannoma. Ninety-five scans (47.5%) demonstrated incidental findings. Sixty-six of these (33%) were considered of ishaemic origin and did not require further action. Five (2.5%) scans demonstrated significant findings which warranted appropriate referral; Two Gliomas (1%), 2 cases of extensive White Matter Lesions (1%), 1 lipoma (0.5%). The remaining scans demonstrated various other findings.Conclusion
Investigation of patients with audiovestibular symptoms with MRI scans revealed incidental findings in a significant percentage (47.5%). The majority of these findings were benign warranting no further action and only 2.5% required further referral. It is the responsibility of the referring Otolaryngologist to be aware of these findings, to be able to assess their significance, to inform the patient and if needed to refer for further evaluation. 相似文献7.
Background
Balloon sinuplasty (functional endoscopic dilation surgery, FEDS) has become established as a safe therapeutic procedure for treatment of chronic rhinosinusitis. Our goal was to assess the effect on quality of life (QoL) using validated tools and identify predictive factors.Materials and methods
A consecutive cohort of 14 patients was evaluated using the disease-specific QoL questionnaire Sino-Nasal Outcome Test 20 (SNOT-20). The measured postoperative changes were then correlated to the results of preoperative CT scan analyses performed according to Lund.Results
Both the overall SNOT-20 scores and those corresponding to subsections regarding primary nasal symptoms (PNS) and secondary rhinogenic symptoms (SRS) showed a highly significant improvement (p?<?0.01). Changes in PNS but not in SRS correlated with the CT scan analyses (p?<?0.05). Eighty five percent of patients said that they would choose to undergo FEDS again.Conclusions
FEDS is an effective technique that can alleviate symptoms and improve QoL. Patient selection should not be based on CT data alone but a CT scan can be used to determine whether or not the FEDS technique is applicable to the individual patient. 相似文献8.
Background
The efficacy and tolerability of a homeopathic combination remedy for the treatment of acute rhinosinusitis was investigated.Patients and methods
A total of 144 patients with acute rhinosinusitis were treated in a randomized, double-blind study either with a homeopathic remedy (n=72) or placebo (n=72). At the control examinations after 7, 14 and 21 days, five sinusitis-typical symptoms were measured with scores from 0 (absent) to 4 (very strong). The change of sum score of the sinusitis-typical symptoms (max. 20 points) during the treatment served as the primary efficacy criterion.Results
In the homeopathic treatment group, the average sum score dropped from initially 12.1±1.6 to 5.9±2.0 points after 7 days. In the placebo group it decreased from 11.7±1.6 to 11.0±2.9 points (p<0.0001). The homeopathic treatment resulted in freedom from complaints in 90.3% of the patients and improvement in a further 8.3%, whereas in the placebo group, the complaints remained unchanged or became worse in 88.9% of the patients. Only one adverse event occurred in one patient from the placebo group.Conclusion
The homeopathic product allows an effective and tolerable treatment of acute rhinosinusitis. 相似文献9.
Eichhorn KW Tingelhoff K Wagner I Westphal R Rilk M Kunkel ME Wahl FM Bootz F 《HNO》2008,56(8):789-794
Background
To relieve the surgeon during functional endoscopic endonasal sinus surgery (FESS), the endoscope should be guided by autonomous robot assistance. The surgeon will thus have two hands free for suctioning and manipulation during FESS.Patients/methods
With a force/torque sensor mounted on the endoscope, we measured forces in six degrees of freedom in five cadaver heads and in 20 actual endoscopic sinus procedures. On the cadaver heads we performed complete endoscopic endonasal dissection of all paranasal sinuses. All forces at the endoscope were monitored continuously.Results
The mean forces occurring at the endoscope were 3.2 N. There were only slight differences between the in vivo and ex vivo data. We measured peak forces up to 25.2 N. In 95% of all cases, forces were lower than 7 N.Conclusion
Forces up to 7 N are sufficient for endoscopic guidance during FESS. Peak forces are distinctive for endoscopic guidance by humans and could be optimised by sensor-based intraoperative robot guidance. Higher forces are required for surgical endoscopy of the frontal and maxillary sinuses compared with the ethmoid sinuses. 相似文献10.
11.
Background
The prevalence of chronic polypous rhinosinusitis is high at 1–2%. In the present study, the predisposing factors for this condition, the clinical symptomatology, results of surgical interventions, significance of computed tomography diagnosis, as well as histology and post-operative therapy with steroids were investigated.Methods and results
A 15% stratified sample, made up of 194 post-paranasal sinus surgery patients of 5 surgical years was investigated. Above all, the eosinophil dominated type led to the formation of polyps. In the diagnosis of chronic polypous rhinosinusitis computed tomography is only sufficiently sensitive for the ethmoid bone. The complication rate was, with 4.6%, in the lower range of comparable pre-examinations. In addition, the 18% relapse rate in the patient population, of whom 49% had already been operated on once or several times, corresponds to a good result when compared at an international level.Conclusions
These data confirm that surgical experience and a consistent post-surgical treatment can reduce the relapse frequency of chronic polypous rhinosinusitis. This is indicated by the on average late occurrence of a relapse. 相似文献12.
Background
Inflammatory processes play a central role in the pathogenesis of chronic rhinosinusitis (CRS), however, the impact of apoptosis in CRS in unclear. The aim of this study was a comparison of caspase 3 activity, a key enzyme in the apoptosis cascade, in samples of nasal tissue from patients with different types of rhinosinusitis.Material and methods
Immunohistochemical analyses were carried out to detect caspase 3 in samples of nasal tissue from patients with CRS and nasal polyps (NP), allergic rhinitis (AR), rhinitis medicamentosa (RM) and atrophic rhinitis.Results
Evidence of increased apoptosis was found in the epithelium, submucosal glands and blood vessels in NP samples. Samples of RM showed strong caspase 3 activity in the endothelial cells and the lamina muscularis of blood vessels. In atrophic rhinitis the epithelium and subepithelial glands showed increased caspase 3 activity. In samples of patients with allergic rhinitis caspase 3 activity could not be detected.Conclusions
Activated apoptosis seems to play an important role in the pathogenesis of different types of rhinosinusitis. Further investigations on the induction of caspase 3 are necessary for the development of new therapeutic strategies to influence the regulation of apoptosis. 相似文献13.
Aims
To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS.Methods
A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund–MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed.Results
Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P < 0.01). CRS patients with and without biofilms had similar preoperative Lund–MacKay CT and Johansson endoscopic scores (P > 0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P > 0.05).Conclusions
The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS. 相似文献14.
Strauss G Koulechov K Röttger S Bahner J Trantakis C Hofer M Korb W Burgert O Meixensberger J Manzey D Dietz A Lüth T 《HNO》2006,54(12):947-957
Background
The aim of this study was to evaluate the Navibase navigation system for ear, nose, and throat (ENT) surgery. A new methodology for evaluating surgical and human factors is developed.Patients and methods
The evaluation is based on 102 ENT surgical applications, including 89 cases of functional endoscopic sinus surgery (FESS). The evaluation of surgical and human factors was performed by seven ENT surgeons. To evaluate surgical performance, level of quality (LOQ) in the 89 cases of FESS was determined, comparing the surgeon’s own impressions with those of the navigation system on a scale from 0 to 100 and further comparing them with clinical results. Intraoperative changes in surgical strategy were documented. The human factors of total confidence (trust), situation awareness, skill set requirement and workload shift were recorded as level of reliance (LOR).Results
The maximum deviation amounted to 1.93 mm. Averaging the quality of information resulted in an LOQ of 63.59. Every second application of the navigation system (47.9%) led to a change in surgical strategy. Total confidence showed a positive evaluation of 3.35 points in LOR.Conclusion
Application-relevant information relevant to the application beyond only technical details permits comparison with other assisting systems. 相似文献15.
Background
For the functional outcome after cochlear implant surgery, the electrode position is of essential importance. Therefore, radiological techniques to localize the electrode within the cochlea are becoming increasingly important. In our study, we used multi-slice computed tomography (CT) to find radiological criteria to allocate the electrode within the cochlea.Methods
Ten Nucleus 24 RCA electrodes were implanted into isolated human temporal bones using an extended cochleostomy and the Advance Off-Stylet technique. Five electrodes were implanted into the scala tympani and five into the scala vestibuli. After implantation, the temporal bones were blinded to the radiologist, and 64-slice CT scans were performed and analysed.Results and conclusions
In all 10 cases, the surgical positioning of the electrode was equal to the radiological analysis of the CT scans. Radiological criteria were found that permit correct identification of the electrode within the cochlea. We think that this technique is sufficient for most questions concerning quality control and is widely available. 相似文献16.
Background
Segmental tracheal resection is considered to be the standard treatment of tracheal stenoses.Materials/Methods
During the time period 1985–2002, segmental tracheal resection with a primary end-to-end anastomosis was performed in 117 patients with a cervical or upper thoracal stenosis of the trachea. The age distribution of the patients was between 7 and 77 years. Of the patients with a benign tracheal stenosis, sufficient data for a retrospective analysis were available in 101 patients. The length of the resected tracheal segments varied between 2 and 6 cm which required mobilisation of the trachea and the larynx and, if necessary, incision of the pulmonary ligament.Results
In 5 patients a permanent damage of the recurrent laryngeal nerve was seen, of which 4 had undergone revision surgery and 10 months after surgery 93% presented with a large and stable tracheal lumen without any relevant restenosis. Due to a restenosis of 70–80% causing dyspnea at rest, 3% of the 101 patients had to undergo revision surgery. In 4% a mild and asymptomatic restenosis of 30–40% was seen which did not require any further treatment.Conclusion
These results demonstrate that segmental tracheal resection can safely and effectively remove stenotic tracheal segments of up to 6 cm and is therefore the treatment of choice. 相似文献17.
Strauss G Schaller S Zaminer B Heininger S Hofer M Manzey D Meixensberger J Dietz A Lüth TC 《HNO》2011,59(5):470-479
Problem
The goal of this work is the extension of instrument navigation with a collision warning function. With the help of an additional distance display and warning system the performance of surgical navigation systems should be improved.Material and Methods
The collision warning system (DCS) is an extension of an optoelectric navigation system (NPU, Karl Storz GmbH&;Co.KG, Tuttlingen, Germany). The measurement of situation awareness was performed on phantom models of functional endoscopic surgery of the paranasal sinuses (FESS; Phacon, Leipzig). Altogether 450 measurement pairs for the analysis of surgical accuracy to the risk structure (frontal skull base, lamina papyracea, internal carotid artery) were available. To examine the influence on the clinical process, a prospective analysis of intraoperative complications was carried out. Of the 104 FESS patients, two groups, one of 56 patients with only navigation (NAV) and one of 48 patients (NAV+DCS), were examined. Efficiency was evaluated on the basis of times for system preparation and intraoperative application.Results
A significant increase in the assumed and actual distance values between instrument tip and risk structure using the collision warning system was seen at 76%. The complication rate was more favorable for the NAV+DCS group. The time needed for preparation of the navigation system with the application of the collision warning system increased on average by 48%, or 1.2?min. However, the relation between preparation time and utilization time was approximately the same at 53.5% in the NAV group and 57.4% in the NAV+DCS group.Conclusions
This work supports the clinical use and efficiency of a collision warning system as an addition to well-known instrument navigation in endo- and transnasal surgery. The segmenting algorithm is suitable for clinical requirements. 相似文献18.
Jate Lumyongsatien Waralak Yangsakul Chaweewan Bunnag Claire Hopkins Pongsakorn Tantilipikorn 《BMC ear, nose, and throat disorders》2017,17(1):14
Background
Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients’ health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis.Methods
Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach’s α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients.Results
The Thai version of SNOT-22 showed good reliability according to high value of Cronbach’s α coefficient (r?=?0.929) and intraclass correlation coefficient (r?=?0.935). It also showed good validity by its ability to differential the patients with chronic rhinosinusitis from normal (p?<?0.001), and different severity of symptoms (p?<?0.05). In addition, the SNOT-22 Thai version also showed good responsiveness when compared between pre-operative and post-operative scores (p?<?0.001) and also well-performed in effect size calculation (1.37).Conclusion
We demonstrated that Thai -version of SNOT-22 has good reliability and validity, suitable for evaluation of chronic rhinosinusitis symptoms together with severity of the disease and response to treatment.Trial registration
Thai clinical trials registry TCTR20170320003. Date of registration 20/03/2017 (retrospectively registered).19.
Background
No validated German instrument for measuring health-related quality of life (QOL) in patients with chronic rhinosinusitis (CRS) has been available to date.Methods
The Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) is a translated and adapted version of SNOT-20. To validate this instrument, we evaluated its reliability, validity and sensitivity. SNOT-20 GAV was completed by 163, 123, and 82 patients at the initial visit and at 3 months and 1 year after treatment commencement, respectively.Results
Cronbach’s ? indicated good internal consistency. Test-retest scores in 38 patients were highly correlated. Discrimination validity was demonstrated by a comparison with healthy controls. Sensitivity to change showed medium to large effects.Conclusions
SNOT-20 GAV is the first reliable, validated and sensitive German instrument for measuring health-related QOL in patients with CRS. 相似文献20.
Dr. Dr. R. Seeberger W. Kater M. Schulte-Geers O.C. Thiele R. Davids C.H. Hofele K. Freier 《HNO》2010,58(8):806-811