Two-year outcomes of radiofrequency device treatment of the nasal valve for nasal airway obstruction.

BACKGROUND: Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT). METHODOLOGY: Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥ 20 reduction in NOSE score or 1 reduction in severity class. RESULTS: The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was -41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in >=1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤ 25 at 2 years. CONCLUSIONS: TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

Extensive intracranial xanthoma associated with type II hyperlipidemia.

Xanthomas are associated with a spectrum of medical conditions, most commonly disorders of lipid storage and lipid metabolism. They occur primarily in the subcutaneous tissues, especially along the Achilles tendon and the extensor tendons of the hands. Intracranial xanthomas are extremely rare. We present a case of an extensive xanthoma of the temporal bone in a patient with hyperlipidemia.

Spontaneous resolution of dysgeusia.

BACKGROUND: Dysgeusia, distortion of taste perception, is a debilitating disorder that affects thousands of Americans. Presently, most forms of dysgeusia are considered to be untreatable, and no data are available for counseling patients on the probability of recovery. OBJECTIVE: To examine the probability of resolution of symptoms among patients with dysgeusia who were evaluated at the University of Pennsylvania Smell and Taste Center, Philadelphia, from January 1989 to December 1994. DESIGN: In this retrospective study, 117 patients with primary complaints of dysgeusia were initially identified from a population of 429 patients with smell and taste disorders who were seen during this period. PARTICIPANTS: Forty-eight patients agreed to participate. Each patient completed a telephone interview and a questionnaire that contained a dysgeusia severity rating scale, medical health questions, and the Beck Depression Inventory. RESULTS: Two thirds of the patients experienced spontaneous resolution of the dysgeusia, with the average duration being 10 months. A distinct relationship between the resolution of dysgeusia and depression was identified. CONCLUSION: These findings, along with the evidence that some dysgeusias are treatable, bode well for a disorder that was heretofore considered by many physicians as unrelenting.

Otolaryngological manifestations of Creutzfeldt-Jakob disease.

Creutzfeldt-Jakob disease (CJD) is one of the uniformly fatal spongiform encephalopathies that is characterized clinically by an unrelenting progression of myoclonus, dementia, and ataxia. Since many of these patients will develop cerebellar abnormalities, some may present to the otolaryngologist with dizziness. Hearing loss, however, to our knowledge, has not been reported. We describe a patient with CJD who presented with hearing loss and vague symptoms of imbalance, and whose disease progressed rapidly and fatally despite an extensive initial workup that was otherwise unrevealing. A review and discussion of the otolaryngological manifestations of CJD is presented. The otolaryngologist should be aware that CJD can present with otolaryngological manifestations, and with proper diagnosis extensive workups may be avoided.

New model for microsurgical training and skills maintenance.

PracticeRat (Sharpoint, Reading PA) is a system containing a simulation vein, artery and nerve, designed as an alternative to live animal use in microsurgical training. We find PracticeRat to be more expensive than living models. However, it does decrease animal usage and provides a very convenient opportunity to practice microsurgical techniques and procedures in a fairly realistic manner. Trainees can practice anytime, for any length of time, wherever microscopes are available. In this regard we find PracticeRat+ to be a useful addition to microsurgical training programs and an excellent tool for skills maintenance.