鼻内镜手术治疗后鼻孔息肉

目的　研究鼻内镜手术治疗后鼻孔息肉的方法和疗效。方法　回顾2009年1月～2013年12月我科经鼻内镜手术治疗的后鼻孔息肉患者59例,并对后鼻孔息肉的临床特点、手术入路的选择以及疗效进行分析和讨论。结果所有患者后鼻孔息肉均起源于上颌窦,50例患者采用鼻内镜下经上颌窦口入路行息肉切除术,6例患者采用鼻内镜联合下鼻道上颌窦开窗入路行息肉切除术,3例患者采用经鼻内镜联合柯-陆氏入路上颌窦开窗行息肉切除术。3例患者术后复发接受2次手术,手术成功率95.4%。结论　根据息肉基底部的位置不同选择不同的手术入路,彻底切除息肉的基底部是避免后鼻孔息肉复发的关键。     

鼻内镜手术治疗后鼻孔息肉

目的探讨后鼻孔息肉的起源部位,分析鼻内镜下治疗后鼻孔息肉的疗效。方法回顾性分析1999～2006年间行鼻内镜手术的63例后鼻孔息肉患者的临床资料。结果59例上颌窦后鼻孔息肉,42例可在上颌窦内确切定位起源部位,其中起源于内上壁16例,后壁为9例,前壁为3例,下壁为3例,外侧壁为2例,上壁2例,前内壁为4例,前外侧壁1例,后上壁1例,外下壁1例;2例起源于鼻中隔;1例起源于蝶窦;1例起源于前组筛窦。所有病例均在鼻内镜下手术切除。术后随访6～30个月,4例复发,经二次手术治愈。5例并发鼻腔粘连,经松解后解除粘连。结论后鼻孔息肉多原发于上颌窦内侧壁。采用鼻内镜手术治疗安全、有效。术前明确后鼻孔息肉的起源部位对手术方式的选择至关重要。     

来源于后组筛窦的后鼻孔息肉的诊断和治疗

目的:探讨后组筛窦的后鼻孔息肉(CP)的临床特征、诊断以及鼻内镜下手术方法.方法:总结2002年1月～2007年6月收治的11例后组筛窦的CP患者的临床资料,分析其临床表现、鼻腔及鼻窦内病变情况、鼻内镜手术方法及注意要点以及临床疗效.结果:11例均在鼻内镜下完成手术.术中见11例CP根部均来自后组筛窦开口处.后组筛窦内3例(27.3%)伴有囊肿,5例(45.4%)窦内有明显息肉,3例(27.3%)表现为窦内黏膜水肿息肉样变.术中无明显并发症,术后随访6个月～3年,平均1.2年,无息肉复发者.结论:后组筛窦的CP多来自后筛窦口,可能由窦内囊肿演变而成.鼻内镜下切除息肉同时需开放后组筛窦清除窦内病变,彻底清除病变后不易复发.     

后鼻孔息肉的临床类型和诊断及鼻内镜手术

目的探讨后鼻孔息肉的临床类型、诊断及鼻内镜手术的方法和效果。方法总结1998年1月至2005年12月收治的34例后鼻孔息肉患者的临床资料，分析其发病方式、来源、临床表现、与鼻窦的关系以及鼻内镜手术技巧和疗效。结果①18例发病源于鼻窦囊肿或息肉，其中上颌窦17例，后筛窦1例；②5例发病分别源于鼻囟门或蝶筛隐窝、蝶窦口黏膜，同侧上颌窦或蝶窦积脓或黏膜水肿；③11例发病分别源于中鼻甲、钩突、嗅沟鼻中隔和筛泡前壁黏膜，邻近的鼻窦正常；④全部病例均行鼻内镜手术切除后鼻孔息肉及相应鼻窦开放，术后无复发。结论①建议诊断后鼻孔息肉应分为窦内型、鼻窦阻塞型和单纯型三种临床类型，遵循以临床类型为依据的手术原则，选择合理的术式和范围；②鼻内镜和鼻一鼻窦CT检查可以在术前明确后鼻孔息肉的诊断和临床类型；③鼻内镜手术治疗后鼻孔息肉准确、微创，彻底切除息肉蒂基部，防止复发。     

Stenting for bilateral congenital choanal atresia--a new technique

We describe a new nasal stent for the treatment of bilateral congenital choanal atresia. The stent is made up of reinforced endotracheal tube mounted on a portex carrier tube. It potentially causes less internal crusting and stent blockage and is secured without sutures. It remains patent for at least 4 weeks. We have used the stent successfully in six patients between 1998 and 2004 at Leeds General Infirmary and present the data collected retrospectively. The current practice in the UK for treatment and stenting for congenital choanal atresia was investigated by a prospective internet based questionnaire sent to 18 consultant paediatric otolaryngologists of whom 12 (67%) responded. Their experience and results are reported. The literature has been reviewed.     

Antenatal carbimazole and choanal atresia: a new embryopathy

Carbimazole embryopathy is a recently recognized and defined phenotype. Choanal atresia; gastrointestinal anomalies, particularly esophageal atresia; athelia or hypothelia; developmental delay; hearing loss; aplasia cutis; and dysmorphic facial features all can occur after exposure to the antithyroid drugs carbimazole or methimazole during gestation. Although full expression of this phenotype appears to be an uncommon sequelae of antenatal carbimazole exposure, infants with less overt manifestations may remain with the condition undiagnosed. It is clearly important when an infant with choanal atresia is assessed to take an adequate drug history and consider this embryopathy as a potential causative factor.     

A new hearing aid variant. Preliminary evaluation

An attempt was made to combine the advantages of a behind-the-ear (BTE) hearing aid (trouble-free use, powerful amplification, room for high-quality components, space for large energy source, use of extra equipment), with the advantages of the in-the-ear (ITE) hearing aid (improved intelligibility, improved directional hearing, improved signal/noise ratio). A BTE hearing aid was equipped with filters and provided with an external microphone. A first experiment, carried out in an anechoic chamber on KEMAR (Knowles Electronic Manikin for Acoustical Research), showed that directional variation of the frequency response of the hearing aid microphone was better in the new hearing aid than in the original BTE. A second experiment was carried out with a group of 6 normal-hearing persons concerning the frequency characteristic of sound transmission from twelve angles in the horizontal plane without a hearing aid, with a normal BTE aid, with the 'new aid', and with an ITE aid. The new instrument gave significantly better directional hearing than the original BTE aid. A clinical study will be started to verify and extend the experimental results obtained.     

Endoscopic endonasal emergency management of bilateral choanal atresia in new borns

The advent of the rigid paediatric nasal endoscope has revolutionized the management of congenital choanal atresia. This endoscopic endonasal approach is considered as a simple, safe and reliable procedure. Also, definitive surgery for choanal atresia has been quite a challenge especially regarding the fulfillment of two important objectives- complete removal of the atretic plate and assurance of wide long-term patency of the posterior nares. Several approaches to the posterior nares have been described in the past. These include: the transpalatal (English, 1981 and Owens,196S), transnasal (Singhl990 and Singh 1991), transseptal and transantral (Hall et al 1982 and Osquthorpe et al 1982) approaches. However, endoscopie endonasal surgery for choanal atresia is found to be better due to the simplicity of the surgery, better access and lesser morbidity. The objective of this presentation is to encourage the use of the rigid nasoendoscope in the management of cases of bilateral choanal atresia of the newborn.     

A new variant of posterior canal-benign paroxysmal positional vertigo-canalolithiasis

ObjectiveThe characteristics of typical posterior canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can) are well known. We found 10 patients with a new variant of P-BPPV-Can: Reverse (Rev)-P-BPPV-Can. The characteristics and pathophysiology of Rev-P-BPPV-Can are discussed.MethodsFor 4 years and 9 months, 10 patients with Rev-P-BPPV-Can (9 women and 1 man; mean age: 73 years) visited our clinic. Within the same period, 268 patients with unilateral typical P-BPPV-Can were treated. During the Dix–Hallpike and Epley maneuvers, nystagmus was recorded using an infrared charge-coupled device camera mounted on a pair of spectacles.ResultsThe patients exhibited entirely opposite direction of nystagmus from typical P-BPPV-Can in both the Dix–Hallpike head position and upright sitting position. The patients had typical characteristics of nystagmus due to canalolithiasis, such as latency, duration of <1 min, linear-torsional nystagmus, and fatigability. Rev-P-BPPV-Can appeared after the Epley maneuver for typical P-BPPV-Can; in other patients, Rev-P-BPPV-Can changed to typical P-BPPV-Can. The affected sides of Rev-P-BPPV-Can were decided by those of typical P-BPPV-Can.ConclusionCanalolithiasis in the non-ampullary distal portion of the posterior semicircular canal may be a potential pathophysiology of Rev-P-BPPV-Can. The Epley maneuver has little effect for treating Rev-P-BPPV-Can, but spontaneous transition to typical P-BPPV-Can or spontaneous recovery is expected.     

Hairy polyps: A new case presentation and a pathogenetic hypothesis

Hairy polyps are benign lesions found in the oropharynx or nasopharynx that are thought to be present at birth and can lead to upper airway obstruction in infants. Also known as naso‐oropharyngeal choristoma, they are increasingly viewed as aggregates of bigeminal tissue, likely from the first or second branchial arches, found in aberrant locations. They are benign lesions that are usually successfully treated by surgical excision. Here we present a rare case of a hairy polyp originating in the eustachian tube of a 7‐week‐old male, discuss our management of the patient, and put forth a new hypothesis as to the origin of these lesions. Laryngoscope, 129:2398–2402, 2019     

Nasal and paranasal sinus polyps - A suspected new etiological co-factor

Seventeen adult patients with nasal or paranasal sinus polyposis were studied in an attempt to determine whether there was any relationship between them and children with cystic fibrosis. The oyster gill cilia inhibition test, commonly used to detect the “C.F. factor” in the serum of cystic fibrosis patients (homozygous) and their parents (heterozygous), was applied to these 17 patients. Fourteen of the 17 patients had the “C.F. factor” in their serum. There would appear to be some relationship between cystic fibrosis and adult nasal and paranasal sinus polyposis; however, it is too early to draw any strong conclusions to this affect.     

A simple transnasal procedure for treating choanal atresia

Bilateral choanal atresia is a rare but life-threatening disorder. Prompt diagnosis and emergency treatment are necessary. Various transnasal tools as well as other techniques have been tried in the past: they have all been associated with complications. The authors report a treatment of a newborn with a simple and previously unreported procedure for dealing with bilateral choanal atresia. As described, the use of a simple hand-powered drill and bit offers an approach which is straightforward and free of complications. Efficacy of this procedure is documented by a 6-year follow-up period.