Personal experience in transnasal endoscopic resection of the olfactory groove meningiomas. What can an otolaryngologist offer to a neurosurgeon?

Olfactory groove meningioma is a demanding therapeutic problem involving two medical specialties, otolaryngology and neurosurgery. The use of transnasal endoscopic (TNE) approach to the tumour has been proved effective in many publications. Three patients with meningiomas localized in olfactory groove were treated in 2011 and 2012 by the otolaryngologist-neurosurgeon team using TNE approach and neuronavigation. The diagnosis was based on MR and CT images. In all patients after tumour removal an endoscopic anterior cranial fossa floor reconstruction was performed using homogeneous cartilage or titanium mesh and Hadad-Bassagasteguy flap. During postoperative period in all patients lumbar drainage was used. There were no cerebrospinal fluid leakage episodes. No recurrence was observed in 22, 12 and 8 months of follow-up, respectively. The authors describe otolaryngological and neurosurgical aspects of TNE approach to anterior cranial fossa with special regard to possible radical resection (according to Simpson) and reconstruction of the bony postoperative defect. TNE is a feasible operative method in olfactory groove meningioma management due to good tumour visibility, lack of brain traction, limited neurovascular structure manipulation and acceptable risk of neurological deficiencies when compared to open approach. Cosmetic aspect and short hospitalization is also of great importance.     

Is it necessary to differentiate tinnitus from auditory hallucination in schizophrenic patients?

Although the definitions of subjective tinnitus and auditory hallucination are very similar, the origins and underlying causes of each symptom clearly differ. This study examined whether the differentiation of tinnitus from auditory hallucination is necessary for the proper management of these symptoms in schizophrenic patients. We investigated the characteristics of auditory hallucinations in 15 schizophrenic patients, and measured their pure-tone hearing levels and auditory brainstem responses (ABR). The average hearing level was 20.6 +/- 16.2 dB, with a mild decrease at high frequencies. We classified the patients into three groups: pure hallucination, tinnitus, and hallucination plus tinnitus. Eight patients (53.3 per cent) complained of pure hallucination and only one of them had a mild hearing loss. Hearing deficits were observed in six of seven tinnitus patients. Abnormal findings of ABR were found only in the pure hallucination group. The results suggest that tinnitus should be differentiated from auditory hallucination in the evaluation of schizophrenic patients.     

Is day stay adenotonsillectomy safe in children with mild to moderate obstructive sleep apnoea? A retrospective review of 100 patients

Objective

This study explored the perioperative course of 100 children with polysomnogram (PSG) proven mild to moderate OSA to evaluate if day stay adenotonsillectomy is safe.

Methods

A retrospective chart review of patients who had undergone tonsillectomy with or without adenoidectomy following an overnight PSG at The Children's Hospital at Westmead Sleep Laboratory. 263 records were reviewed. Patients with apnoea hypopnea index (AHI) ≥1 and <15/h and/or a final sleep study report of mild to moderate OSA were included. Exclusion criteria were age <3 years, weight <10 kg, or any significant co-morbidities or other surgery that would preclude day stay surgery. Demographic, PSG and post-operative data was analyzed.

Results

No major respiratory complications occurred. No patient required an unplanned medical review for respiratory concerns, or admission to a high care facility. Eleven children left recovery with oxygen prescribed. One child had a desaturation to 88% in recovery, and one child had laryngospasm. The nine other children required oxygen to maintain saturation >90%.Supplemental oxygen was prescribed to 7 patients on the ward. Of these, three patients received supplemental oxygen beyond 6 h. The other 97 patients had an uncomplicated post-operative course and would have been suitable for day-stay surgery. Increasing severity of OSA grade on pre-operative PSG was significantly associated with post-operative supplemental oxygen use (p = 0.003; Cochrane-Armitage test for trend).

Conclusions

Children who are otherwise well with mild to moderate OSA have a sufficiently low risk of respiratory complications following adenotonsillectomy to permit day-stay surgery in the setting of appropriate facilities with careful post-operative monitoring for the first 6 h to identify a small sub-group who require overnight observations.