The value and safety of specific nasal provocation in the diagnosis of allergic rhinitis in mild persistent asthma under inhaled steroid therapy.

Although specific nasal provocation is an objective diagnostic test for allergic rhinitis, it can also increase the lower airway responsiveness in asthmatic patients. Our goal was to determine the value and safety of specific nasal provocation test for the diagnosis of allergic rhinitis in mild persistent asthmatic patients under low-dose inhaled steroid therapy. The study was performed on 32 mild persistent, stable, mite-sensitive allergic asthmatics (group 1), 9 mild persistent nonallergic asthmatics (group 2) and 9 healthy non-smokers (group 3). Nasal symptoms were noted, paranasal sinus computerized tomography (PNCT) and rhinoscopic evaluations were performed. Cases with pathologic-anatomic changes in PNCT and rhinoscopy were excluded. Symptom scoring, flow-volume, peak expiratory flow (PEF), serum and nasal lavage eosinophil cationic protein (ECP) and nasal lavage eosinophil counts were performed before mite specific nasal provocation test and at the 0th, 4th and 24th hours following the test. No adverse effects were observed in all diagnostic procedures. Total diagnostic value of nasal symptoms were found to be at 92%, while being 70% for rhinoscopy and 88% for specific nasal provocation test respectively in the diagnosis of allergic rhinitis in group 1. Statistically significant differences were found between basal nasal lavage eosinophil values (p < 0.001) and ECP levels (p < 0.05) when group 1 was compared with both group 2 and group 3. In the remaining measured values between three groups, no statistically significant differences were found. Specific nasal provocation test is a safe method for mild house dust mite allergic asthma cases under low-dose inhaled steroid therapy, but history of rhinitis might be sufficient for the diagnosis of allergic rhinitis.

[Lipoma of the cerebellopontine angle: two cases report and review of literature]. / Serebellopontin köse lipomasi: Iki olgu sunumu ve literatürün degerlendirilmesi.

Here we report two cases with cerebellopontine angle lipoma. Cerebellopontine angle lipomas previously reported in the literature were reviewed. The review of the literature revealed the condition is more prevalent in women. The median tumor size was 10.26 (range: 1 to 26) mm. It was noted that these tumors are most frequently associated with hearing loss (56%) and tinnitus (40%), while 9% demonstrate no symptoms. Fifty-six percent of these patients had been operated, however complete resection had been accomplished in only 36% of patients. In our cases, the tumor sizes were 7 x 4 and 5 x 3 mm. Tinnitus and ear fullness were major complaints in both cases. One case had hearing loss and vertigo in addition to these complaints. Surgery was not performed for these cases. The patients have been followed up using same approach without any complication. Histopathological diagnosis is rarely necessary with the widespread use of magnetic resonance imaging. Because of the potential for significant morbidity with resection of these lesions, conservative follow-up is the best approach for cerebellopontine angle lipoma.

Isolated sphenoid sinusitis presenting with unilateral VIth nerve palsy.

Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis and the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. In this paper, we report a case of isolated sphenoid sinusitis in a 12-year-old girl who was presented with unilateral VIth nerve palsy. She was initially treated with parenteral antibiotherapy, the abducens nerve palsy recovered but as sphenoiditis persisted she underwent an endoscopic sphenoidotomy. We discuss the clinical features, the diagnostic tools, and the treatment options for this entity.

[Orbital decompression by endoscopic transnasal and transantral approach in thyroid-associated ophthalmopathy]. / Tiroit oftalmopatisinde transantral ve endoskopik transnazal yolla orbital dekompresyon.

OBJECTIVES: We evaluated the results of orbital decompression in patients with Graves' disease. PATIENTS AND METHODS: Orbital decompression was performed by endoscopic transnasal medial wall approach and transantral inferior wall approach in 18 eyes of 12 patients (8 males, 4 females; mean age 41 years; range 24 to 65 years). The degree of exophthalmos was evaluated with the use of the Hertel exophthalmometer preoperatively, and postoperatively in the 24th hour, first and third months. RESULTS: At the end of the third month, exophthalmos decreased by a mean of 4.4 mm (range 3 to 7 mm). Visual acuity and field defects improved considerably in all patients. Complications occurred in three cases (25%) including diplopia, displacement of one eye inferiorly, and maxillary sinusitis caused by the encroachment of the adipose tissue upon the ostium, respectively. CONCLUSION: With the increasing ease of surgical procedures and enhanced experience on the part of surgeons, successful treatment of exophthalmos has become possible with decreased complication rates.