Effect of adjunctive sodium hyaluronate versus surfactant nasal irrigation on mucociliary clearance in allergic rhinitis: a single-blind, randomised, controlled study.

OBJECTIVE: To investigate the effects of nasal irrigation with sodium hyaluronate and surfactant solutions on mucociliary clearance time in patients with mild persistent allergic rhinitis. METHODS: A total of 120 patients diagnosed with mild persistent allergic rhinitis were enrolled in this prospective study. The patients were allocated randomly to the surfactant, sodium hyaluronate or isotonic saline (as a control) nasal irrigation group. The mucociliary clearance times and improvements in mucociliary clearance times were compared. RESULTS: Improvements in mean mucociliary clearance time were significantly greater in the surfactant and sodium hyaluronate groups than in the control group (p < 0.01). The mean post-treatment mucociliary clearance time of the surfactant group was significantly lower than that of the control (p < 0.001) and sodium hyaluronate groups (p = 0.03). CONCLUSION: Surfactant and sodium hyaluronate nasal irrigation solutions may both be used as adjunctive treatments for allergic rhinitis. Surfactant nasal irrigation resulted in better mucociliary clearance times.

Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign.

BACKGROUND: A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve. METHODS AND RESULTS: In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed. CONCLUSION: Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

OBJECTIVES: To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. DESIGN AND SETTING: Multicentre retrospective study in eight tertiary referral hospitals over 17 years. PARTICIPANTS: Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. MAIN OUTCOME MEASURES: Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. RESULTS: In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. CONCLUSIONS: We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery.

Evaluation of endometrial echotexture and cervical cytology in cows during and after treatment of endometritis.

OBJECTIVE: The aim of this study was to evaluate changes in the endometrium by using echotexture parameters during and after treatment of endometritis with intrauterine administration of an intrauterine antiseptic solution (Lotagen®, 3% metacresolsulphonic acid and formaldehyde) in cows which became pregnant after treatment. MATERIAL AND METHODS: According to the severity of endometritis 21 cows were divided into three groups: E1 (slight, n = 7), E2 (moderate, n = 8), E3 (severe, n = 6). The control group (C, n = 11) consisted of cows without endometritis that did not receive an intrauterine medication. A software (Bs200 Pro®) was used to evaluate echotexture parameters Contrast (CON), Gradient (GR), Homogeneity (HOM), Mean Gray Level (MGL) of images taken during the examinations at hours (h) 0, 1 and 6 and days (d) 2, 3, 5 and 10. RESULTS: At 0 h, GR was significantly lower in group E2 than in groups E1 and C (p < 0.05). There was an increase in GR values between 0 h and 10 d in group E2 and E3, but a decrease during the same time interval in group C (p < 0.05). In contrast, CON values of group E2 were lower (p < 0.05) at 0 h compared to other timepoints of examination and lower than in group C. HOM values were lower (p < 0.05) in groups E1, E2 and E3 than in group C on d 5 and d 10. HOM values were higher at 1 h compared to 6 h, d 2 and d 10 in group E3 (p < 0.05). By contrast to GR values, HOM values were higher in group C at 6 h and d 10 than they were in group E3. MGL values of group E2 were higher (p < 0.05) than in group C until d 10 and higher (p < 0.05) in group E3 than in group C at 6 h after treatment. In group E2 an increase of MGL values until d 2 was followed by a decrease (p < 0.05). CONCLUSION: Echotexture parameters determined by the evaluation of sonographic B-mode images reflect changes in the endometrium and could be used for the evaluation of the recovery period after treatment of endometritis.