The treatment of polypous suppurative rhinosinusitis in the patients presenting with the severe and moderate aspirin triad

The present study inluded 22 patients presenting either with very severe or moderately severe aspirin triad 17 of whom suffered exacerbation of chronic polypous suppurative rhinosinusitis. The reference group comprised 10 patients with exacerbation of chronic polypous suppurative rhinosinusitis in the absence of concomitant bronchial asthma. The control group included 25 practically healthy subjects having neither chronic somatic diseases nor ENT organ pathology. Conventional otorhinolaryngological examination of the patients was supplemented by cytological studies of the secretion from maxillary sinuses (MS) and inranasal mucosa, measurement of viscosity and pH of MS secretion. It was shown that eosinophil count in the MS secretion was several-fold higher than that in the secretion from nasal cavity mucosa . Polypotomy in the nasal cavity was performed after the preoperative treatment of the patients using sparing procedures, such as laser irradiation and a radiofrequency loop. This approach allowed to reduce the probability of enhancement of bronchial resistance during surgery and in the immediate postoperative period; moreover, it made it possible to continue puncture therapy of patients experiencing exacerbation of the chronic inflammatory process in the maxillary sinuses.     

Level alterations of the 2f 1–f 2 distortion product due to hypoxia in the guinea pig depend on the stimulus frequency

Increased intracranial pressure (ICP) is known to affect the levels of distortion product otoacoustic emissions (DPOAEs) in a frequency-specific manner. DPOAEs might, therefore, be used for monitoring the ICP non-invasively. Hypoxia can also cause alterations of DPOAE levels, which can be distinguished from ICP-related changes only, when their characteristics, in particular frequency specificity, are known in detail. DPOAEs at f ₂ = 2, 4, 8, 12 and 16 kHz and oxygen saturation (SaO₂) were continuously monitored in nine spontaneously breathing guinea pigs, anaesthetized by i.m. administration of midazolam, medetomidin and fentanyl, during the respiration of a gas mixture of N₂O and O₂ containing either 30% O₂ or 13% O₂. Fourteen hypoxic intervals in eight animals were included into final data analysis. Characteristic hypoxic level alterations with a level decrease and a remarkable level destabilization during hypoxia, and a pronounced reversible level decrease after reoxygenation were observed at the frequencies of 4, 8 and 16 kHz. At 2 and 12 kHz, the only reproducible effect of hypoxia was an increased fluctuation of the DPOAE level, which was significantly less pronounced compared with the other frequencies (P < 0.05 for 12 vs. 16 and 8 kHz and for 2 vs. 16 kHz). DPOAE level alterations due to hypoxia depend on the frequency in guinea pigs. Studies in human are warranted to improve non-invasive ICP monitoring with DPOAE by the detection of hypoxia-related changes.     

Rupture of Reissner's membrane during acute endolymphatic hydrops in the guinea pig: a model for Ménière's disease?

Conclusion. The changes in cochlear function during a destructive acute endolymphatic hydrops were relatively small. This might be consistent with the hypothesis that an endolymphatic hydrops is a marker of disordered inner ear homeostasis rather than the cause of the clinical symptoms of Ménière's disease. Objective. Assessment of cochlear function during induction of a destructive acute endolymphatic hydrops. Materials and methods. During repetitive microinjections of 0.5 µl of artificial endolymph at a rate of 50 nl/s the 2f₁?f₂ and f₂?f₁ cochlear microphonics distortion products (CMDP) and 2f₁?f₂ distortion products otoacoustic emissions (DPOAE) were recorded in the guinea pig. Results. A ‘catastrophe’ occurred in the inner ear when 2.5–3.5 µl of artificial endolymph was injected. A rupture of Reissner's membrane was then found, most often in the apical turn of the cochlea. This rupture had only minor effects on the endocochlear potential, whereas it caused a marked decrease in 2f₁?f₂ DPOAE amplitude. The 2f₁?f₂ and f₂?f₁ CMDP amplitude increased during each injection prior to the rupture. After the rupture the f₂?f₁ CMDP amplitude decreased during each injection, possibly due to a shift of the cochlear transducer operating point position.     

Rupture of Reissner's membrane during acute endolymphatic hydrops in the guinea pig: a model for Ménière's disease?

CONCLUSION: The changes in cochlear function during a destructive acute endolymphatic hydrops were relatively small. This might be consistent with the hypothesis that an endolymphatic hydrops is a marker of disordered inner ear homeostasis rather than the cause of the clinical symptoms of Ménière's disease. OBJECTIVE: Assessment of cochlear function during induction of a destructive acute endolymphatic hydrops. MATERIALS AND METHODS: During repetitive microinjections of 0.5 microl of artificial endolymph at a rate of 50 nl/s the 2f1-f2 and f2-f1 cochlear microphonics distortion products (CMDP) and 2f1-f2 distortion products otoacoustic emissions (DPOAE) were recorded in the guinea pig. RESULTS: A 'catastrophe' occurred in the inner ear when 2.5-3.5 microl of artificial endolymph was injected. A rupture of Reissner's membrane was then found, most often in the apical turn of the cochlea. This rupture had only minor effects on the endocochlear potential, whereas it caused a marked decrease in 2f1-f2 DPOAE amplitude. The 2f1-f2 and f2-f1 CMDP amplitude increased during each injection prior to the rupture. After the rupture the f2-f1 CMDP amplitude decreased during each injection, possibly due to a shift of the cochlear transducer operating point position.     

Quality of life after gamma knife radiosurgery treatment in patients with a vestibular schwannoma: the patient’s perspective

This study evaluates the impact of gamma knife radiosurgery (GKRS) on the quality of life (QOL) of patients with a sporadic vestibular schwannoma (VS). This study pertains to 108 VS patients who had GKRS in the years 2003 through 2007. Two different QOL questionnaires were used: medical outcome study short form 36 (SF36) and Glasgow benefit inventory (GBI). Radiosurgery was performed using a Leksell 4C gamma knife. The results of the QOL questionnaires in relation to prospectively and retrospectively gathered data of the VS patients treated by GKRS. Eventually, 97 patients could be included in the study. Their mean tumor size was 17 mm (range 6–39 mm); the mean maximum dose on the tumor was 19.9 Gy (range 16–25.5 Gy) and the mean marginal dose on the tumor was 11.1 (range 9.3–12.5 Gy). SF36 scores showed results comparable to those for a normal Dutch population. GBI showed a marginal decline in QOL. No correlation was found between QOL and gender, age, tumor size, or radiation dose. Increased audiovestibular symptoms after GKRS were correlated with a decreased GBI score, and decreased symptoms were correlated with a higher QOL post-GKRS. In this study shows that GKRS for VS has little impact on the general QOL of the VS patient. However, there is a wide range in individual QOL results. Individual QOL was influenced by the audiovestibular symptoms. No predictive patient, tumor, or treatment factors for QOL outcome after GKRS could be determined. Comparison with microsurgery is difficult because of intra group variability.