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Prevention of chronicity of disease and minimising its impact with individualized treatment is a fundamental tenet of precision medicine. A review of the literature has been undertaken to explore how this may apply to chronic rhinosinusitis (CRS). Prevention may be thought of across 3 main domains. Primary prevention of CRS focuses on the avoidance of exposure to environmental factors associated with increased incidence of disease. This includes avoidance of tobacco smoke and occupational toxins. Although allergic rhinitis, respiratory infections and gastro-oesophageal reflux have been shown to be risk factors, there is no evidence as yet that treatment of these conditions is associated with reduced incidence of CRS. Secondary prevention of CRS is concerned with detecting a disease in its earliest stages, intervening to achieve disease and symptom control and preventing future exacerbations. Evidence based guidelines facilitate early diagnosis and appropriate use of medical and surgical interventions. In the future the use of endotypes to direct optimal is like to allow more clinically and cost-effective use of current and emerging treatments, such as monoclonal antibodies. Tertiary prevention aims to minimise the impact of an ongoing illness or injury that has lasting effects. Anxiety and depression have been shown to be associated with symptom amplification and may require treatment. The role of disease-related factors such as the role of the microbiome and osteo-neogenesis in the development of chronicity, and the development of severe combined upper airway disease needs further research.
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Rinite/prevenção & controle , Sinusite/prevenção & controle , Doença Crônica , Humanos , Prevenção Primária , Fatores de Risco , Prevenção SecundáriaRESUMO
OBJECTIVE: The aim of the study was to perform a systematic review of existing evidence on the role of local anaesthetic nerve block (LAB) in patients undergoing endoscopic sinus surgery (ESS). DESIGN: The databases searched were the Cochrane Register of Controlled Trials, MEDLINE and Embase using the Ovid portal (1946-2017). RESULTS: Seven randomised controlled trials were included. Due to considerable heterogeneity of data, only two studies were pooled into meta-analysis which demonstrated a statistically significantly better surgical field quality during ESS in the LAB group compared with the control group (MD -0.86; 95% CI -2.24, 0.51; P = .009). No adverse events related to LAB toxicity were reported. CONCLUSIONS: Sphenopalatine ganglion LAB with adrenaline carries relatively low risk of morbidity, but may improve the quality of the surgical field in terms of bleeding. However, there are limitations of the study due to heterogeneity of methods, quality and size of the studies. Well-conducted large RCTs are needed using standardised inclusion criteria, balanced baseline characteristics of cohorts, and validated subjective and objective outcome measures.
Assuntos
Anestésicos Locais/uso terapêutico , Endoscopia , Bloqueio Nervoso , Rinite/cirurgia , Sinusite/cirurgia , HumanosRESUMO
PURPOSE: Plastic surgery on the eyelids for the purpose of aesthetic or functional correction requires precise knowledge of lid anatomy. Changes in the tarsal curvature of the upper eyelid relative to line of vision are important, particularly when a surgical correction of paralytic lagophthalmos is undertaken. We used a computer-based image-processing algorithm to establish a relationship between changes in the curvature of the tarsus relative to the line of vision. MATERIAL AND METHODS: A dynamic, ultrasound examination of the upper eyelids of 100 participants (100 eyes) was performed transpalpebrally using a 7.5 MHz scanner with the patient looking straight ahead, away from and towards the midline of the body. A computer-aided examination of the upper eyelid tarsus was then performed, followed by the calculation of the radius of curvature of the tarsus relative to the line of vision in each position. RESULTS: Using regression of a Taylor polynomial, the shape of the tarsus was mapped by a quadratic function, and the change in tarsal curvature relative to line of sight could be demonstrated. CONCLUSION: With objective evidence of change in the tarsal curvature relative to the line of sight, this may influence the treatment of pathological changes in the upper eyelid.
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OBJECTIVES: In Germany there is no uniform practice regarding the histological examination of removed tissue after an adenoidectomy. In addition, the unique benefits of routine histological examination of adenoid tissue cannot be ascertained from current literature due to varying opinion and evidence. METHODS: This study was approved by the Medical Association and Ethics Committee in Cottbus, Brandenburg, Germany. We evaluated the pre- and intra-operative examination findings (direct and indirect epipharyngoscopy, digital palpation, intraoperative macroscopic assessment and examination of removed tissue) and the histopathological findings of excised adenoid tissue. A statistical analysis of obtained results was undertaken thereafter. RESULTS: It was found that in all young patients included in the study, the histological results invariably represented lymphoepithelial hypertrophic mucosa with a varying inflammatory response, matching a clinical picture of adenoid vegetation and in keeping with the pre- and intraoperative investigations and findings. CONCLUSION: The characteristic history of adenoid vegetation in combination with a classic pre- and intraoperative clinical examination and an inconspicuous macroscopic examination of removed tissue, renders routine histopathological workup dispensable. On suspicion of deviant pathology a histopathological examination is recommended and should be undertaken.
Assuntos
Adenoidectomia , Tonsila Faríngea/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia , Lactente , Masculino , Cuidados Pós-Operatórios , Estudos Retrospectivos , Adulto JovemRESUMO
Invasive aspergillosis originating from the paranasal sinuses is a rare disease that is associated with high mortality rates. We report on a 77-year-old patient with myelodysplastic syndrome and progressive left-sided proptosis persisting for 5 days. Antibiotic therapy and endonasal orbital decompression yielded insufficient improvement. Only upon application of complementary antifungal therapy was remission observed. Rapid diagnosis and treatment are essential in order to prevent life-threatening complications.
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Aspergilose/induzido quimicamente , Aspergilose/diagnóstico , Infecções Oculares Fúngicas/induzido quimicamente , Infecções Oculares Fúngicas/diagnóstico , Imunossupressores/efeitos adversos , Idoso , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Diagnóstico Diferencial , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Masculino , Doenças Raras , Resultado do TratamentoRESUMO
Carcinomas of the nose and paranasal sinuses are rare solid head and neck tumours. With an incidence of 1-1.5/100,000 per year, they account for only 3% of all malignancies in the head and neck region. Sinonasal carcinomas are often adenocarcinomas. Hardwood dust is one possible triggering agent, although the latency period may extend to decades. Central nervous system complications arising from solid tumours of the head can be explained in terms of the close anatomical relationship between the two areas. However, leptomeningeal spread is rare. To our knowledge, this is the first report demonstrating cranial nerve deficits due to a leptomeningeal carcinomatosis as the primary manifestation of an adenocarcinoma of the paranasal sinus and the nasal cavity.
Assuntos
Adenocarcinoma/complicações , Doenças dos Nervos Cranianos/etiologia , Carcinomatose Meníngea/complicações , Neoplasias Primárias Múltiplas/complicações , Neoplasias Nasais/complicações , Adenocarcinoma/diagnóstico , Idoso , Humanos , Masculino , Carcinomatose Meníngea/diagnóstico , Cavidade Nasal , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Nasais/diagnóstico , Seios ParanasaisAssuntos
Tonsila Faríngea/cirurgia , Endoscopia/métodos , Perda Auditiva Condutiva/fisiopatologia , Perda Auditiva Condutiva/cirurgia , Doenças do Prematuro/genética , Doenças do Prematuro/fisiopatologia , Ventilação da Orelha Média/métodos , Obstrução Nasal/fisiopatologia , Obstrução Nasal/cirurgia , Paracentese/métodos , Rigidez Muscular Espasmódica/genética , Rigidez Muscular Espasmódica/fisiopatologia , Testes de Impedância Acústica , Pré-Escolar , Terapia Combinada , Comportamento Cooperativo , Eletrocoagulação , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/genética , Humanos , Doenças do Prematuro/diagnóstico , Comunicação Interdisciplinar , Masculino , Obstrução Nasal/diagnóstico , Obstrução Nasal/genética , Equipe de Assistência ao Paciente , Posicionamento do Paciente , Rigidez Muscular Espasmódica/diagnósticoRESUMO
INTRODUCTION: There is still disagreement concerning the significance of sinus x-ray prior to septoplasty: according to the previous guidelines for Diagnostic and Therapy of the German Society for Oto-Rhino-Laryngology and head and neck surgery in 1996, a sinus x-ray prior to septoplasty was seen as "necessary." According to the guidelines from 2010, a suitable radiology imaging is just "optional." In the present study, we analyzed the significance of a sinus x-ray to exclude a chronic sinusitis prior to septoplasty. PATIENTS AND METHODS: A total of 96 patients were included in this study. All were admitted to the hospital by an ENT specialist for septoplasty with conchotomy. The preoperatively performed sinus x-ray was evaluated with regard to an already existing sinusitis. These results were correlated with the patients' anamnesis and the nasal endoscopic view. RESULTS: A sinus x-ray (occipitomental) was obtained in all 96 patients. No pathological result was observed in 82 patients, while 14 patients showed pathology in the paranasal sinus. After a detailed appraisal of the sinus x-ray with pathology, 7 patients with pathological findings in the paranasal sinus remained. In the other 7 patients, the statement was false positive. In only 3 patients was a CT image obtained, which resulted in modification of the surgical procedure. CONCLUSION: Our findings show that a routinely performed sinus x-ray is not necessary prior to septoplasty. If there is reasonable suspicion for pathology in the paranasal sinus, radiological imaging is necessary, whereby a CT scan should be performed.
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Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Rinoplastia/estatística & dados numéricos , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sinusite/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVES: The Eustachian tube is responsible for ventilation, protection and drainage of the middle ear. Dysfunction of the Eustachian tube can lead to impairments ranging from inadequate pressure equalisation in the middle ear and pneumatised mastoid process to cholesteatoma. Conventional surgical interventions for chronic tube dysfunction have not brought resounding clinical success. However, the 'Bielefelder Balloon dilatation' constitutes a new and, judging from early results, very effective treatment for chronic tube dysfunction. Proof of the efficacy of the surgical procedures is provided by objective clinical factors, but for quality assurance, the assessment of the subjective quality of life of patients must also be taken into account. To measure health-related quality of life, standardised questionnaires are used which have been tested for reliability, validity and sensitivity. METHODS: A total of 30 patients were included in the study. The patient survey was conducted retrospectively, and validation of patient satisfaction was carried out with the Glasgow Benefit Inventory (GBI). RESULTS: GBI analysis revealed significant improvements in the total score as well as in general and physical health. CONCLUSIONS: The Bielefelder Balloon dilatation is a new and safe treatment for chronic tube dysfunction, which had a significant positive influence on the postoperative quality of life of our patient cohort.
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Tuba Auditiva/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Procedimentos Cirúrgicos Otológicos/normas , Satisfação do Paciente , Recuperação de Função Fisiológica , Adulto , Idoso , Cateteres de Demora , Doença Crônica , Coleta de Dados , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Osteonecrosis of the mandible is a well-known and dreaded complication after the administration of bisphosphonates. Only a few cases of bisphosphonate-associated osteonecrosis of the external ear canal have been described. Especially after long-lasting bisphosphonate therapy, for example in patients with multiple myeloma, an ulceration of the floor of the bony external auditory canal should be treated surgically and be distinguished from radioosteonecrosis, malignant external otitis, or carcinoma of the external ear.
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Difosfonatos/efeitos adversos , Meato Acústico Externo/patologia , Otopatias/induzido quimicamente , Otopatias/diagnóstico , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico , Adulto , Conservadores da Densidade Óssea/efeitos adversos , Meato Acústico Externo/cirurgia , Otopatias/cirurgia , Humanos , Masculino , Osteonecrose/cirurgia , Resultado do TratamentoRESUMO
Progressive growth of a thrombosed aneurysm in the venous neck vessels represents an important differential diagnosis in solitary cervical swelling. We report the case of a 72-year-old woman with a 4-month history of left cervical, supraclavicular swelling. CT showed a cystic tumour with a maximum diameter of 4.8 cm at the left jugulobrachial venous arch. Surgical removal revealed a firm elastic tumour, which arose from the subclavian vein. Histological analysis showed a thrombosed venous vessel.
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Aneurisma/diagnóstico , Aneurisma/cirurgia , Veia Subclávia/cirurgia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/cirurgia , Trombose Venosa/diagnóstico , Trombose Venosa/cirurgia , Idoso , Aneurisma/etiologia , Feminino , Humanos , Veia Subclávia/patologia , Resultado do Tratamento , Neoplasias Vasculares/complicações , Trombose Venosa/etiologiaRESUMO
Stapedotomy with implantation of an alloplastic prosthesis is a well-established therapy for the treatment of otosclerosis. Since the middle of 2008, a new Nitinol prosthesis with memory function and superelastic properties has been available which is expected to make fixation on the long process of the incus much easier. The advantage of this prosthesis is that heat-induced wire crimping is no longer necessary and damage to the incus caused by heat is avoided. Since May 2008, laser-assisted stapedotomy with implantation of a Nitinol prosthesis was performed in 21 patients suffering from otosclerosis. The prostheses used for all patients had a size of 4.5 mm × 0.4 mm. The patient collective consisted of 14 women and 7 men with a mean age of 53.4 years. Pre- and postoperatively, an ENT examination was carried out followed by an audiological evaluation of the hearing result. In addition, the properties of the prosthesis ("proper fitt", "handling", and "overall rating") were evaluated intraoperatively by means of a test protocol. The Nitinol prosthesis was implanted successfully in all 21 patients. The mean air-bone gap for the frequencies from 0.5 to 4 kHz was 9.83 dB postoperatively. Intraoperatively, the fit of the prosthesis was rated as "good to very good", the handling as "good" and the overall rating of the system was "good to very good". Our patient collective showed good postoperative hearing results. Due to simple intraoperative handling, especially placing the Nitinol prosthesis in position, the critical work step of crimping is no longer necessary.
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INTRODUCTION: The antibiotic und antitumoral effect of Mitomycin C (MMC), a derivative of Streptomyces caespitosus, has been known since 1956. Besides its use as an adjunction in the treatment of breast, lung and prostate cancer, or as a second-line cytostatic drug for head and neck squamous cell carcinoma (HNSCC), since 1963, MMC has also been successfully used in the suppression of post-operative scar formation, particularly in the field of ophthalmology. This is due to its modulation of fibroblast activity, which enables decreased scarring and fibrosis. In this résumé, we wish to recapitulate our long years of experience in the topical application of Mitomycin C in the treatment of scar formation and stenosis in head and neck organs. PATIENTS AND METHODS: A retrospective analysis on the basis of clinical disease courses and findings (image documentation, questionnaires, pulmonary function tests) covering an examination period of 10 years, was performed on 40 patients with stenosising lesions and a mean age of 54 years. The fields of application included laryngeal, tracheal, oesophageal stenosis and stenosis of the external ear canal and the choane. RESULTS: After combined application of MMC and surgical intervention in cases of recurrent stenosising processes in head and neck organs, especially the larynx and the trachea, a sustained improvement was achieved in the pre-operative stenosis level as well as in the pre-operative, severely limited, forced inspiratory volume in 1 second (F1V1). CONCLUSION: The topical application of MMC appears to be an effective adjunction as a concept of treatment for stenosising, scar-forming lesions. This topical application, however, is not a substitute for correct diagnosis and appropriate surgical treatment. It must be regarded as a purely adjunctive manoeuvre. During the 10 years in which it was used, the clinical findings confirmed an enhancement in the containment of complex cases without the occurrence of any complications.
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Obstrução das Vias Respiratórias/tratamento farmacológico , Antibióticos Antineoplásicos/administração & dosagem , Cicatriz/tratamento farmacológico , Mitomicina/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/cirurgia , Antibióticos Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Cicatriz/diagnóstico , Cicatriz/cirurgia , Terapia Combinada , Feminino , Humanos , Capacidade Inspiratória/efeitos dos fármacos , Laringoscopia , Laringoestenose/diagnóstico , Laringoestenose/tratamento farmacológico , Laringoestenose/cirurgia , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Mitomicina/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Retratamento , Estudos Retrospectivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/tratamento farmacológico , Estenose Traqueal/cirurgiaRESUMO
INTRODUCTION: A large variety of prostheses are available for stapes surgery. The newly designed Soft-CliP Piston is an alloplastic prosthesis used in patients with Otosclerosis which has been available since May 2007. With the new design, an intra- and postoperative damage of the ossicle chain should be minimized. PATIENTS AND METHODS: A Laser-Stapedotomy was performed in 11 patients with a mean age of 45.7 years. Soft-CliP pistons with a shaft diameter of 0.4 mm and a length of 4.5 mm were used. An accurate examination and an exact audiometric testing were performed pre- and postoperative. RESULTS: The average observed air-bone-gap in the frequencies from 0.5 to 4 kHz was postoperatively in 2.9% of the patients greater than 20 dB, in 5.7% between 15-20 dB, in 14.3% between 10-15 dB and less than 10 dB in 77.1% of the patients. Despite the new design of the prostheses it wasn't possible to slit the prosthesis onto the incus in two cases, and in one case there wasn't the needed size available. CONCLUSION: A critical point in every stapes surgery, the prosthesis fixation onto the incus, is facilitated by the novel Soft-CliP Piston. Crimping is not needed anymore. Very good hearing results are achieved postoperatively, comparable to other Titanium Prostheses. However the surgeon needs adequate experience to insert the Soft-CliP Piston. Long-term results in a larger group of patients are needed and pending.