Five-year risk of incident disease following a diagnosis of chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) has a broad range of comorbidities. Due to a lack of longitudinal studies, it is not known whether these comorbidities cause CRS, are promoted by CRS, or share a systemic disease process with CRS. OBJECTIVE: The objective of this study was to determine the risk of incident disease within 5 years after a new diagnosis of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). METHODS: We conducted a case-control study nested within the longitudinal cohort of primary care patients in the Geisinger Clinic using electronic health record data. We evaluated incident disease over 5 years in newly diagnosed CRSwNP and CRSsNP cases compared to controls using multivariable Cox regression models. RESULTS: CRSsNP (n = 3612) cases were at greater risk (HR, 95% confidence interval) than controls for incidence of: upper airway diseases, including adenotonsillitis (3.29, 2.41-4.50); lower aerodigestive tract diseases, including asthma (2.69, 2.14-3.38); epithelial conditions, including atopic dermatitis (2.75, 1.23-6.16); and hypertension (1.38, 1.19-1.61). CRSwNP (n = 241) cases were at greater risk for obesity than controls (1.74, 1.08-2.80), but CRSwNP was not associated with other diseases. CONCLUSION: The risk of other diseases associated with CRS adds to the burden of an already highly burdensome condition, and suggests either that CRS promotes onset of other diseases or is an indicator of systemic disease processes. Different patterns of association with diseases by CRS phenotype may be due to CRSwNP sample size limitations or reflect a different pattern of disease onset by phenotype. These findings have implications for screening guidelines and care of CRS patients.

Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases.

The increasing emphasis on open reduction in the management of orbital fractures has led to an extensive debate as to which approach provides adequate exposure for these fractures. This retrospective study compares the exposure provided and the rate of complications between transconjunctival and subciliary incisions for orbital rim and floor fractures. The charts of 55 patients with orbital fractures, treated with open reduction and internal fixation, were reviewed. A total of 30 subciliary and 30 transconjunctival incisions had been performed, and the adequacy of exposure as well as intraoperative and postoperative complication rates were compared. The authors found a higher rate of complications with the subciliary approach and, therefore, advocate the use of a transconjunctival incision for the management of orbital fractures.

Effect of irradiation on guinea pig ABR thresholds.

A significant number of patients undergo irradiation to the temporal bone for malignancies. Conflicting reports exist regarding the effects of irradiation on hearing thresholds. Although radiation-induced otitis media and osteoradionecrosis of the ossicles with resultant conductive hearing loss are well-documented, there is disagreement regarding the effect of irradiation on sensorineural hearing. Previous animal models, relying only on behavioral tests and reflex thresholds, have failed to reveal consistent threshold shifts after irradiation. However, with the advent of auditory brainstem response (ABR) testing, a reliable objective measurement of hearing in animals is available. Hearing thresholds were determined bilaterally by ABR testing in 21 albino guinea pigs. The left temporal bones of sixteen animals were then irradiated with a total dose ranging from 5750 to 7000 cGy over 7 weeks. The right ears of these animals, plus both ears of five nonirradiated guinea pigs, served as controls. Follow-up threshold ABRs were obtained immediately post-irradiation (RT), and at 6 and 12 months post-RT. Average thresholds in all groups increased over time: 60 dB in the control group; 53 dB in the control ears of the irradiated animals; and 46 dB in the irradiated ears. There were no statistically significant increases in ABR thresholds for irradiated ears vs. control ears. At the 6-month followup, hearing was actually better in the irradiated ears than the control ears and this difference between ears was significantly greater than the difference at baseline (p < 0.026). Overall, there was no evidence that irradiation produces changes in ABR thresholds.

Absence of a tachycardic response to intraperitoneal hemorrhage.

Five cases of intraperitoneal hemorrhage associated with hypotension and the lack of a tachycardic response are presented. All patients were young, previously healthy women without a history of myocardial disease. None of our patients fits into the category of "irreversible shock." Although relative bradycardia associated with hypotension is often considered a preterminal event, each of our patients recovered after laparotomy. In hypovolemic shock due to intraperitoneal bleeding, the lack of a tachycardic response may occur earlier and perhaps more often than has been suggested, and may delay definitive treatment by confusing the clinical picture. Orthostatic vital signs may be helpful in distinguishing those with true hypovolemia.