mySinusitisCoach: patient empowerment in chronic rhinosinusitis using mobile technology.

Mobile health technology is emerging to take a prominent position in the management of chronic diseases. These technologies aim at enhancing patient empowerment via education and self-management. To date, of all the different apps available for patients with sinus disease, none were developed by medical experts dealing with chronic rhinosinusitis (CRS). The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) has undertaken a multi-stakeholder approach for designing, developing and implementing a tool to support CRS patients in monitoring their symptoms and to provide patients with a digital support platform containing reliable medical information about their disease and treatment options. mySinusitisCoach has been developed by medical experts dealing with CRS in close collaboration with patients, primary care physicians and community pharmacists, meeting the needs of both patients and health care providers. From a research perspective, the generation of real life data will help to validate clinical studies, patient stratification and improve understanding of the socio-economic impact of CRS, thereby paving the way for better treatment strategies.

Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea.

OBJECTIVES: The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN: Prospective study. SETTING: Multicentre study. PARTICIPANTS: Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES: Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS: 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS: Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.

Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement.

Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.

The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty.

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4 days). However, 1 week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

Rhinology Future Debates, an EUFOREA Report.

The first Rhinology Future Debates was held in Brussels in December 2016, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases). The purpose of these debates is to bring novel developments in the field of Rhinology to the attention of the medical, paramedical and patient community, in a highly credible and balanced context. For the first time in Rhinology, a peer to peer scientific exchange with key experts in the field of rhinology and key medical colleagues from leading industries let to a brainstorming and discussion event on a number of hot issues in Rhinology. Novel developments are presented by key experts from industry and/or key thought leaders in Rhinology, and then followed by a lively debate on the potential positioning of new developments in care pathways, the strengths and weaknesses of the novel development(s), and comparisons with existing and/or competing products, devices, and/or molecules. As all debates are recorded and distributed on-line with limited editing (www.rhinology-future.com), EUFOREA aims at maximizing the education of the target groups on novel developments, allowing a critical appraisal of the future and a more rapid implementation of promising novel tools, techniques and/or molecules in clinical practise in Europe. The next Rhinology Future debate will be held in Brussels in December 2017.

Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease.

BACKGROUND: Aspirin desensitization (AD) treatment at doses of up to 1300 mg/day improves outcomes in aspirin-exacerbated respiratory disease (AERD). The aim of this study was to investigate the efficacy of aspirin 300 mg/day in the treatment of patients with AERD. METHODS: The study included 40 patients diagnosed in our clinic as AERD that were desensitized and treated with aspirin 300 mg/day between December 2005 and December 2012. Changes from the baseline status were analyzed at 1 year and at 3 years of follow-up. RESULTS: Of the 40 patients included, 24 (60%) were female and median (interquartile range [IQR]) age was 45 (40-51) years. Median (IQR) duration of AD was 31.5 (10.5-48.5) months. In total, 29 patients continued treatment for at least 1 year and 18 patients for at least 3 years. The annual rate of use of systemic corticosteroid regimens, episodes of sinusitis, and surgery was significantly lower both at 1 year (P = 0.002, P = 0.01, and P < 0.001, respectively) and at 3 years (P = 0.001, P = 0.03, and P = 0.002, respectively). Significant improvement was observed in the nasal congestion score (P = 0.01) and sense of smell score (P = 0.05) at 1 year and in the postnasal drainage score (P = 0.01) at 3 years. CONCLUSION: Daily treatment with aspirin 300 mg had beneficial effects in patients with AERD, especially for the control of upper airway disease.

Juvenile nasopharyngeal angiofibroma: a single centre's 11-year experience.

OBJECTIVE: This study aimed to present the clinical features and surgical outcomes of juvenile nasopharyngeal angiofibroma patients who were surgically treated. METHODS: The medical records of 48 male patients histologically confirmed as having juvenile nasopharyngeal angiofibroma, who underwent transnasal endoscopic surgery between 2005 and 2016, were retrospectively reviewed. RESULTS: The overall recurrence rate was 20.8 per cent; however, the recurrence rate differed significantly between patients diagnosed aged less than 14 years (34.7 per cent) and more than 14 years (8 per cent) (p < 0.05). Advanced-stage tumours (Radkowski stage of IIC or more, and Önerci stage of III or more) were more aggressive than earlier stage tumours (p < 0.05 and p < 0.01, respectively). Pre-operative embolisation significantly prolonged mean hospitalisation duration, but had no effect on intra-operative blood loss in patients with advanced-stage tumours (p < 0.001 and p = 0.09, respectively). CONCLUSION: The findings show that transnasal endoscopic surgery could be considered the treatment of choice for juvenile nasopharyngeal angiofibroma. Patients diagnosed when aged less than 14 years and those with advanced-stage tumours are at risk of recurrence, and should be monitored with extreme care.

nm23 Protein expression in larynx cancer and the relationship with metastasis.

The nm23 gene, which encodes nucleoside diphosphate (NDP) kinase, is proposed as a metastatic suppressor gene and has been demonstrated to correlate inversely with metastatic potential in several tumours. To elucidate the role of nm23 in larynx carcinomas, we examined using immunohistochemistry the expression of the nm23 protein in matched sets of primary tumours and metastatic lymph nodes. nm23 Protein was expressed in all the carcinomas as well as in non-neoplastic larynx mucosa. Overexpression of nm23 protein was found in the majority of primary tumours compared with corresponding normal mucosa, while decreased expression was associated with poor differentiation and distant metastasis and/or recurrence. No significant difference in age, sex and stage was found between primary tumours with high and low nm23 protein expression. These results suggest that decreased nm23 protein expression may play a role in metastasis and/or recurrence in larynx cancer and therefore could be used as a prognostic factor.

The effect of tonsillectomy and adenoidectomy on neutrophil chemotaxis.

Although tonsillectomy and adenoidectomy are common surgical procedures, the effects of these operations on the immune system have not been thoroughly determined. Our data on neutrophil chemotaxic functions in a group of 17 patients with chronic tonsillitis and adenoid hypertrophy show that chronic tonsillitis and adenoid hypertrophy impair neutrophil chemotaxic functions and that there is a subsequent normalization of these values following tonsillectomy and adenoidectomy.

Shortcomings of lateral sinus radiograph in the preoperative determination of the extent of endonasal endoscopic sinus surgery.

Lateral sinus radiograph is helpful in determining the distances between certain anatomic landmarks in preparation for endonasal endoscopic sinus surgery. However, some misleading factors limit the usefulness of this radiograph. In this study these distances were measured in 49 patients and compared with measurements obtained from another imaging modality, magnetic resonance imaging, which provides more accurate measurements. Results show a discrepancy in the measurements of distances between some of these landmarks that cannot be explained by the factor of magnification alone on the sinus radiographs. Statistical analysis of the results for women revealed a significant discrepancy between the distances from the nasal spine to the midfovea ethmoidalis, the sphenoethmoid junction, and the posterior sphenoid wall as measured on MR images and those as measured on lateral sinus radiographs (P < .05). For men the same was true for the distances from the nasal spine to the midfovea ethmoidalis and the posterior sphenoid wall (P < .05). It is concluded that there should be reservations in the surgical application of data provided by the lateral sinus radiograph before endoscopic sinus surgery.

Lymphoma with bilateral cavernous sinus involvement in early childhood.

A 4-year-old girl developed complete ophthalmoplegia with intact pupillary responses. Computed tomography and magnetic resonance imaging demonstrated a mass invading the cavernous and sphenoid sinuses and posterior ethmoidal cells. Biopsy revealed non-Hodgkin lymphoma. This patient is the youngest reported with malignant lymphoma of the cavernous sinus and the second reported with bilateral cavernous sinus involvement.

Submandibular hydatid cyst. A case report.

An unusual case of Echinococcus cysticus infection of the submandibular salivary gland is reported. A 41-year-old female patient was admitted with a progressively increasing swelling in the left submandibular region present for two years. There was no pulmonary or hepatic involvement. The site, and that there is no evidence of pulmonary or hepatic involvement is of interest in this patient. Definitive therapy required radical surgery.

Intranasal endoscopic silicone intubation for congenital obstruction of the nasolacrimal duct in children.

Aim of the present study was to determine the efficacy of intranasal endoscopic silicone intubation to treat congenital nasolacrimal duct obstruction in children who failed conventional lacrimal system probing. Silicone intubation with intranasal endoscopic visualization was performed in 18 eyes of 16 patients with an age range of 18-48 months (mean, 25 months) to treat congenital nasolacrimal duct obstruction. Out of 16 patients, ten had already undergone previous probings with failure, the other six were primary intubation cases without any previous probings. The tubes were left in place an average of 6 months. Follow-up ranged from 4 months to 2 years (mean, 12 months) following removal of the silicone tubing. Intranasal endoscopic silicone intubation is effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 18 months of age and, it is also recommended as the next step in the management of epiphora which fails to resolve after probing.

Unusual complication of temporomandibular joint surgery: cervicomediastinal abscess.

Cervicomediastinal abscess developed in a 14-year-old girl after temporomandibular joint surgery. No such complication could be found in the literature. The complications of temporomandibular joint surgery and the possible ways this abscess may have developed are discussed.

Trace elements in children with chronic and recurrent tonsillitis.

Trace elements are indispensable for life and play a very important role in the essential functions. According to some reports in the literature lower trace element levels increase the susceptibility to recurrent infections. Since there are no reports available in the English literature about the effects of trace elements on recurrent and chronic tonsillitis, 37 children with recurrent and chronic tonsillitis were evaluated for Zn, Cu and Mg levels. Serum levels of Zn in 6 patients were slightly lower than the normal limit. All the other serum levels of Zn, Cu and Mg were within the normal range. On the other hand, the mean serum level of Zn in the 37 patients was significantly lower than in a control group of 28 age and sex matched children. In contrast, the mean serum levels of Cu and Mg in the patients were significantly higher than in the control group. Whether this alteration in the trace element status causes or fosters recurrent and chronic tonsillitis is not clear.

Reappraisal of probing of the congenital obstruction of the nasolacrimal system: is nasal endoscopy essential?

OBJECTIVE: The rate of false passages during probing for congenital nasolacrimal system obstruction (CNLO) is a major limiting factor for a successful outcome. This shortcoming may be decreased with the use of a nasal endoscope during probing. This approach is particularly important in the probing training of ophthalmology residents. METHODS: An experienced pediatric ophthalmologist performed probings on 11 eyes, and a group of ophthalmology residents under his supervision performed probings on another 11 eyes for CNLO. Their claims of a successful or unsuccessful procedure were evaluated with nasal endoscopy by an ear--nose--throat (ENT) surgeon. The age range of the patients was 8-23 months. RESULTS: The ophthalmologist made two false passages, one of which he was aware, out of 11 eyes. The residents had five false passages, two of which were unclear to them, out of another 11 eyes. No false passages occurred in obstructions at the level of the Hasner valve. None of the successful probings required more than a 30 mm probe introduction into the nasolacrimal canal from the inferior punctum. CONCLUSION: It seems justified to have a nasal endoscopic evaluation, performed by an ENT surgeon, for probings during the training program of ophthalmology residents. Difficult cases with stenosis proximal to the inferior meatus, prior false passage experience on a particular case, and any indication for silicone tube implantation will benefit from the use of an endoscope during the procedure. In order to achieve the best results in CNLO, the collaborative teamwork of an ophthalmologist and an ENT specialist is necessary.

Conventional or endoscopic probing for congenital nasolacrimal duct obstruction.

PURPOSE: To compare conventional and endoscopic probing for congenital nasolacrimal duct obstruction in infants. METHODS: Conventional probing was performed in 22 eyes of 18 patients, age range 7-14 months (mean 11.4 months). Probing was done with intranasal endoscopic visualization in 18 eyes of 14 patients, age range 7-13 months (mean 11.2 months). All were primary probing cases. RESULTS: After conventional probing 2 of the 22 cases required reprobing. After endoscopic probing only 1 of the 18 cases required reprobing. CONCLUSIONS: In most cases of congenital nasolacrimal duct obstruction endoscopy is not required; however, in failed cases direct visualization of the inferior meatus with endoscopic guidance may be helpful.

Synovial sarcoma in the neck.

Synovial sarcomas are very uncommon and highly malignant tumours. This uncommon malignant tumour of mesenchymal origin may rarely present in the neck. Since 1954, nearly 80 cases of synovial sarcoma, located in the head and neck region have been reported. Synovial sarcoma is most prevalent in adolescents and young adults between 15 and 40 years of age. In this report we present a case of synovial sarcoma in the neck of a 10-year-old patient.

Lacrimal sac dacryolith: a study wit atomic absorption spectrophotometry and scanning electron microscopy.

Dacryoliths are uncommon causes of partial or complete obstruction of the nasolacrimal drainage apparatus. We report our findings of a dacryolith that we studied by culture, light microscopy, atomic absorption spectrophotometry, and scanning electron microscopy. Although no fungi were recovered by culturing, hyphae-like structures were observed. No inorganic material was detected by atomic absorption spectrophotometry. Scanning electron microscopy of ultrastructure showed the stone was composed of lobes and lobules built on an amorphous core material.

Audiologic and impedancemetric findings within thalassaemic patients.

The objective of this study is to investigate hearing losses in thalassaemic patients. This study was conducted on 34 thalassemic patients of which 27 of them had thalassaemia major and the remaining 7 had thalassaemia intermedia. Six (11.11%) of the 54 ears with thalassaemia major were found to have normal hearing. Thirty-two ears (59.26%) had conductive hearing loss, 8 ears (14.81%) had mixed type of hearing loss. Moreover, in this group, there was no ear which had pure sensorineural hearing loss. Of the majority of patients having thalassaemia major and thalassaemia intermedia, an air bone gap was found even though there was no negative pressure in the middle ear. In these patients a high degree of static compliance and normal shaped, stiff amplitude, normal pressure tympanograms were observed. Moreover, in most of these patients acoustic reflexes were not obtained. These findings are rather interesting since they show the pathological changes which may cause stiffness in the middle ear sound transmission system.