Analysis of rhinomanometric data based upon a model of nasal airflow and logarithmic transformation of the data

Estimation of nasal airflow, flow asymmetry and nasal valve stiffness was performed using anterior rhinomanometry in a group of 12 normal subjects and a group of 12 patients suffering from nasal obstruction. The method, based upon a simplified mathematical model of nasal airflow and utilizing logarithmic transformation of inspiratory pressure and flow data, improved the sensitivity and specificity of rhinomanometry and gave a more comprehensive index of nasal function.     

Lateralizing the collapsed nasal valves simplified: 10-year survey of a simple concealed suture technique

Objective/Hypothesis:

A number of innovative surgical procedures have been devised to correct nasal obstruction resulting from the combined deformities of the internal and external nasal valves. Although successful, they can be complex and manipulative, requiring experience and expertise. We submit an alternative surgical procedure for the repair of isolated internal nasal valve collapse that is simple to execute in the office under local infiltration anesthesia and within the grasp of any otolaryngologist interested in its repair. The long‐term success and durability of the procedure have been tested and confirmed by a 10‐year survey of its effectiveness.

Study Design:

Retrospective review.

Results:

Fifty‐two (89.9%) of 58 respondents who underwent surgical repair for nasal valve collapse between 1999 and 2009 reported complete satisfaction with the improvement in their nasal airway that remained effective over time. Failures (10.1%) resulted from sutures coming loose from a variety of reasons that could be remedied quite easily.

Conclusions:

The simplified concealed suture lateralization of the collapsed internal nasal valve is highly successful and remains effective over many years with minimal complications and without any alteration in the nasal profile. Laryngoscope, 2011     

Wegener's granulomatosis: an analysis of 33 patients seen over a 10‐year period

Wegener's granulomatosis: an analysis of 33 patients seen over a 10‐year period This retrospective study examined 33 patients with Wegener's granuloma seen between 1990 and 1999 in the Ayrshire and Arran region of Scotland. There was an estimated annual incidence of 10/million/year. The diagnosis in this series was based on the presence of one or more of the following: a positive histology, a positive c‐ANCA or a typical clinical course. Twenty‐eight patients were diagnosed based on either a positive histology and/or c‐ANCA, whereas the remaining five were diagnosed based on the clinical course. c‐ANCA was positive in 79.3% but correlated poorly with disease activity. Nasal biopsies were positive in 40%, whereas 94% of renal biopsies were positive, thereby making nasal biopsies unreliable in the diagnosis. Significantly elevated levels of erythrocyte sedimentation rate (ESR) averaging 77 mm/h were found in 32 patients at diagnosis. This showed fluctuation with disease activity. Thirteen patients died, 12 within 5 years. The best prognostic indicator statistically was age.     

Wegener's granulomatosis of the orbit: a clinicopathological study of 15 patients

OBJECTIVES: Wegener's granulomatosis is a granulomatous and necrotizing vasculitis that classically involves the respiratory and renal systems. The goal of the study was to define clinical and pathological characteristics in a subgroup of patients with the changes of Wegener's granulomatosis involving the orbit. STUDY DESIGN: Retrospective study. METHODS: A database search identified 15 patients with the histological changes of Wegener's granulomatosis of the orbit presenting over a 23-year period. A review of the histological specimens, radiological studies, and patient charts was performed. Additional follow-up data were obtained through patient interviews. RESULTS: Of 15 patients (median age, 54 y) with Wegener's granulomatosis of the orbit identified, the disease was limited to the orbit in 12 patients; 3 patients had additional sinonasal involvement. All patients underwent various surgical procedures followed by medical treatment (cyclophosphamide and prednisone). Specimens showed characteristic histopathological features of Wegener's granulomatosis. Follow-up data were available for 12 patients with a median period of 5 years. In the group with only orbital involvement, none of the patients developed systemic progression of Wegener's granulomatosis. Only one patient had multiple local recurrences and later developed contralateral orbital Wegener's granulomatosis. CONCLUSIONS: Wegener's granulomatosis limited to the orbit is a localized form of the disease without systemic progression. Diagnostic surgical procedures followed by aggressive medical treatment results in good outcome, although local recurrence may occur.     

Reconstruction of the internal nasal valve: modified splay graft technique with endonasal approach

Objective/Hypothesis: The aim of this study was to determine the reliability and feasibility of modified splay graft technique in the surgical correction of internal nasal valve (INV) incompetence and nasal valve collapse. Study Design: Eleven patients operated with the diagnosis of INV incompetence were followed for 6 to 30 months after operation. Methods: Between 2004 and 2007, 11 patients with the complaint of shortness of breath, and in whom nasal valve incompetence was detected, and who were positive for Cottle and modified Cottle tests were operated. In the operation, splay graft was used endonasally with the technique we describe. Before and at least 6 months after the operation, patients were evaluated with acoustic rhinometry, linear symptom scale, and nasal obstruction symptom evaluation scale in addition to endoscopic examination, and the results were compared. Results: In 10 of 11 (90.9%) patients operated with modified splay graft technique, marked improvement was observed in INV region with endoscopic examination and acoustic rhinometry. In the evaluation made with linear symptom scale and nasal obstruction symptom evaluation scale, partial improvement was seen in nasal obstruction in one patient and marked improvement in 10 patients. No complications developed. Conclusions: Modified splay technique is an effective graft method that can be easily applied and has minimal complications and morbidity.     

Fish bones at the cricopharyngeus: a comparison of plain-film radiology and computed tomography

OBJECTIVES: To compare and contrast the use of plain film radiology and computed tomography (CT) scanning in the detection of fish bones at the level of the cricopharyngeus. STUDY DESIGN: Prospective study of 30 different fish bones placed at the level of the cricopharyngeus in a fresh human cadaver head and neck specimen and imaged using both plain films and CT scans. METHODS: Thirty different bones from 10 different local species of fish were selected and grouped as small, medium, or large in size. Both plain-film and CT images of the bones were reported by a radiologist as A, easily seen; B, seen on close inspection; or C, not seen. Results were analyzed using McNemar's test. RESULTS: CT scanning was superior to plain-film radiology in demonstrating the presence of fish bones at the level of the cricopharyngeus (P < .0001, McNemar's test, df = 1 when comparing report type A with B and C). CONCLUSION: The superior usefulness of CT scans in demonstrating the presence of fish bones lodged at the cricopharyngeus has been clearly shown in this study; therefore we advocated its use in selected cases.     

Computed tomography evaluation of the inner ear as a diagnostic,counselling and management strategy in patients with congenital sensorineural hearing impairment

The value of computed tomography (CT) of the petrous bone in the investigation of congenital sensorineural hearing impairment has been questioned. We have conducted a study to establish the usefulness of CT of the temporal bone in the evaluation and management of a consecutive series of unselected adolescent patients with congenital sensorineural hearing impairment of greater than 50 dB HL. Seventy-one patients (142 ears) were identified and images reviewed to establish the incidence of inner ear malformations. Fifteen ears were found to be abnormal in eight patients (seven bilateral and one unilateral abnormality). Three patients had Mondini abnormalities and one of these also had dilatation of the lateral semicircular canals. There were five patients with dilatation of the vestibular aqueduct. One patient had a unilateral dysplasia of the middle and external ear. A variety of incidental intracranial abnormalities were also discovered. We conclude that CT does have a valuable role in the management of SNHI.     

Assessing the efficacy of a modified crushing technique for the management of concha bullosa: a cone beam computer tomography study

IntroductionAlthough many surgical techniques exist to manage obstructive concha bullosa, there continues to be a drive to find the least invasive technique with the fewest complications and best results.ObjectivesThe purpose of this study is to describe and assess the short- and long-term efficacy of a modified crushing technique for concha bullosa management.MethodsPatients who met inclusion criteria underwent a detailed nasal examination and cone beam computed tomography imaging prior to and after septoplasty with crushing surgery for obstructive concha bullosa. Patients were divided into short- and long-term groups based on their followup period such that the short-term group had a mean followup of 15.14 months (range 6–22 months) and the long-term group had a mean followup of 56.66 (range 29–80) months.ResultsTwenty-four cases of obstructive concha bullosa were included in this study with 13 short-term and 11 long-term follow-ups. All patients showed a significantly decreased postoperative CB size (p < 0.001). There was no correlation between age and postoperative CB change in area (p = 0.39) and no significant difference in the amount of postoperative CB area reduction between the short-term and long-term groups (p = 0.35). No patients experienced bleeding, synechia, conchal destruction, or olfactory dysfunction on followup evaluations.ConclusionsOur modified crushing technique is a simple, effective, and lasting treatment option for concha bullosa. From our experience, there have been no complications and no instances of concha bullosa reformation during the follow-up period.     

Atypical haemangioma of the internal auditory meatus: a case report

Haemangiomas involving the internal auditory meatus (IAM) are rare and can mimic other frequent lesions of the IAM such as schwannomas by their clinical and imaging aspects. The case of a patient with an atypical IAM haemangioma fluctuating in size is reported to highlight this diagnostic possibility. A 36-year-old female presented with a sudden and recurrent left sensorineural hearing loss (SNHL). Three consecutive MRIs were performed in a 10-month period of preoperative observation. They showed a fluctuation of the tumour signal and size. The surgical removal was performed via a translabyrinthine approach. Pathological findings were consistent with the diagnosis of a heamangioma. MRI and CT findings suggested the diagnosis of IAM heamangioma, but the rapid variation in size and signal was misleading. This phenomenon may be due to haemorrhage or oedema, and can be accompanied by a deterioration of the hearing function. Early surgical resection is the treatment of choice and allows to confirm the diagnosis.