Acoustic rhinometry to evaluate plastic surgery results of the nasal septum.

UNLABELLED: Acoustic rhinometry to evaluate plastic surgery results of the nasal septum. OBJECTIVE: In this study, acoustic rhinometry was used in the preoperative and postoperative evaluation of 16 patients undergoing surgery for nasal obstruction. METHODOLOGY: The parameters evaluated prior to and subsequent to the operation were the diameter of the nasal cavity at its narrowest point, and the total volume of the nasal cavity. RESULTS: This method accurately showed changes in the dimensions of the nasal cavity following surgery. As shown by acoustic rhinometry, the change in the mean minimal cross-sectional area of the nasal cavity was 67%. Similarly, the augmentation of the mean total volume of the nasal cavity was 24.15%. The change in the dimensions of the nasal cavity paralleled the improvement in clinical symptoms. CONCLUSION: Acoustic rhinometry can accurately measure the dimensions of the nasal cavity, especially at the front part. It can also be used to assess the efficiency of treatment in cases of nasal obstruction, especially plastic surgery of the nasal septum.

Decannulation in children after long-term tracheostomy.

Various approaches and techniques are used in discontinuing tracheostomy in children. The variability in the use of resources is considerable. The objective of the study was to assess decannulation in children attending our ENT department. A retrospective analysis was carried out of the medical records of patients who had had both a tracheostomy (n=7) and a decannulation (n=6) from 1998 to 2003. Tracheostomies placed at a mean age of 4.2 months were discontinued on average 26.4 months later. All the children underwent airway endoscopy in the operating room in preparation for decannulation. They had downsizing, then capping of the tracheostomy as a functional trial. One child failed decannulation and another needed a second trial for successful decannulation. The individualization of tracheostomy decannulation is necessary in children.

Thymic cyst in the differential diagnosis of paediatric cervical masses.

Thymic cyst in the differential diagnosis of paediatric cervical masses. Cervical ectopic thymic tissue is rarely reported. However, it should be included in the differential diagnosis of neck masses, especially in children. We present a case of a 7-year-old male with a soft, asymptomatic right-sided cervical mass. The patient underwent complete excision of a 3 x 4 cm cyst, which was derived from a mass of soft tissue and was in close relation with the carotid sheath. Histological examination of the specimen showed a thymic cyst. The child's post-operative course was unremarkable and follow-up appointment six months later showed complete recovery. The embryological development, clinical presentation and management of ectopic thymic lesions are discussed together with a brief review of the literature.

Sensorineural hearing loss in children with thalassemia major in Northern Greece.

Eighty eight (88) beta-thalassemic patients undergoing regular transfusion- chelation therapy with desferrioxamine (DFO) were studied for ENT problems from 1988 to 1993, as DFO has been implicated for auditory neurotoxicity. The mean age of the patients was 9.66 +/- 3.1 years, their pre-transfusion haemoglobin level was 9 +/- 2 g/dl, serum ferritin level was 2065 +/- 898 ng/ml and the daily DFO dose was 50.7 +/- 9.5 mg/kg for 5 days/week. The ENT study included, ENT examination, pure tone audiometry, speech audiometry, tympanometry, tone decay test and ABR. During this 6-year study 24/88 (27%) patients developed bilateral or ipsilateral sensorineural hearing loss in high tone frequencies, sometimes exceeding 80 dB, which was attributed to DFO toxicity. Therefore, a reduction or temporary withdrawal of DFO followed. After this intervention 12/24 patients recovered almost completely, 7/24 remained stable and 5/24 presented aggravation of their hearing loss. This study confirms the DFO induced auditory neurotoxicity and the necessity of periodical audiology control of beta-thalassemic patients for prompt diagnosis and management of this complication.

Our experience in open rhinoplasty.

AIM: The last decade the external approach has gained enormous popularity in rhinoplastic surgery and it is a relatively new technique in Greece for the correction of functional and aesthetic problems of the nose. We introduce our experience in open rhinoplasty, we describe the operative technique, its advantages. MATERIAL-METHODS: In a period of two years (2003-2005), 98 patients underwent open rhinoplasty in our department. In 42 of them, breathing problems were existed in combination with nasal deformities. Eighty seven patients underwent septo/rhinoplasty under general anesthesia and the other 11 under local anesthesia. RESULTS: The postoperative course was uneventful, painless and without postoperative bleeding in all patients. Postoperative photo documentation was performed in all of them after 1, 3, 6, and 12 months. Only two patients needed to undergo revision surgery (the first patient due to "polly beak" deformity and the second one due to postoperative nasal valve stenosis). The scar of broken columella incision was invisible in all patents some weeks postoperatively. CONCLUSION: In open approach in Rhinoplasty, as provides a full exposure of the osseocartilaginous vault, it is much more easier to perform all the modern rhinoplasty techniques with sutures, biological and non biological materials, to modify the nasal tip deformities and asymmetries and to gain an aesthetic result balanced with the other facial components. Its disadvantages are minimal, that's why it becomes every day more popular all over the world.

External septal reconstruction with the use of polydioxanone foil: our experience.

We present our experience and results after using polydioxanone (PDS) foil in septal reconstruction. In a period of 2 years, 12 patients who were admitted in our department with severe septal deviation and breathing problems underwent septoplasty under general anaesthesia. The nasal septum was approached via an external approach. In all patients, after resecting and exposing the septum, the removable piece after being divided into straight pieces, was sutured onto an appropriate sized PDS foil and reimplanted together between the mucoperichondrium flaps. Sutures were placed to fixate the "new septum" to the nasal dorsum and to the anterior nasal spine. The immediate postoperative course was unremarkable and in a follow-up appointment 6 months and 1 year postoperatively, one complication occurred, with septum subluxation noted in one patient. Use of PDS foil in septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal dorsal septum border with the upper lateral cartilages and at the nasal spine is essential.

Hearing loss in children with sickle cell disease.

Hearing loss in children with sickle cell disease. Sickle cell anemia (S/S) has been associated with a high incidence of hearing loss mostly of the sensorineural type (SNHL). Twenty-four patients with sickle cell disease (13 female and 11 male; 22 patients belonging to the S/beta(+)-Thal and 2 to the S/S phenotype) with a mean age of 12.5 +/- 3.6 years and hemoglobin (Hb) levels range 6.5-11 g/dl underwent ENT examination, pure tone audiometry, speech audiometry, tympanometry, auditory reflex evaluation, tone decay test and brain auditory evoked potentials (BAEP) in order to evaluate the presence, type and degree of hearing loss. Only one patient (4.6%) who also sustained an infarct of the middle cerebral artery, demonstrated a unilateral SNHL in high tone frequencies exceeding 70 dB, as well as a prolonged III-V interpeak latency at the same side. No abnormalities were detected in the control group. These findings suggest a low incidence of SNHL in Greek SCD patients probably due to different hematological and clinical profile (S/beta(+)-Thal).

Tracheotomy in neonates.

The particularities and complications of tracheotomy in neonates, as well as postoperative care and follow-up are presented. During the five year period from 1991-1996, 12 urgent tracheotomies were performed on 12 neonates in the Hippokration Hospital of Thessaloniki, 7 boys and 5 girls, ranging from 1 to 25 days. All these infants presented severe respiratory failure due to upper airway obstruction. Endotracheal intubation was attempted on all of them with no success, and urgent tracheotomy was recommended by the neonatologists. Three out of the twelve neonates died (the first during the procedure, the second just after the procedure and the third one week later) while the remaining nine were relieved from respiratory distress. Tracheotomy is a procedure of major importance for the survival and further development of young patients.

Subglottic hemangioma treated with interferon alpha 2A.

Infantile subglottic hemagioma is a rare vascular malformation involving the subglottic larynx and although present from birth, symptoms will not be noted until later in infancy (due to tendency to enlarge). Typically presents with a progressive crouplike illness that begins a few weeks after birth and the infant develops inspiratory stridor, which becomes expiratory as the obstruction increases. Although benign lesions which involute spontaneously, they may demand the attention of an ENT surgeon to maintain a secure airway. We report a case of a 3-month-old female patient (full term, normal delivery) who was referred to us for investigation of respiratory distress. Endoscopic examination revealed a hemangioma at the left lateral wall of the subglottic larynx while the rest of the airway was normal. The infant was treated with a combination of steroids (dexamethazone 0.5 mg x 3 per os) and interferon A-2a (650.000 IU subcutaneously, every other day, for 12 months) and had fast improvement of her symptoms. Repeated endoscopy 3 months after the diagnosis reveal impressive remission of the subglottic hemangioma. Throughout the years, a variety of treatments have been proposed and utilised for subglottic hemangioma. Interfron 2-alpha, drug acting by interference with angiogenesis, is very effective in treating subglottic hemangiomas without the need for tracheostomy. Its side effects are generally not serious. As congenital subglottic hemangiomas have tendency towards spontaneous regression, conservative treatment seems more appropriate compared to more aggressive treatment that carry substantial risks of long term complications.

Long term audiological evaluation of beta-thalassemic patients.

OBJECTIVE: The objective of this study was to identify the incidence and to monitor the progression of hearing loss in children and young adults with beta-thalassemia major. METHODS: One hundred and four (104) patients aged 6-35 years (mean 17,2 years) participated in the study. All patients were on a regular transfusion-chelation program maintaining a mean hemoglobin level of 9.5 gr/dl. Subjects were receiving desferrioxamine (DFO) chelation treatment with a mean daily dose of 50-60 mg/kg, 5-6 days a week during the first six years of the study, which was then reduced to 40-50 mg/kg for the following eight years. Patients were followed for 8-14 years. RESULTS: Overall, 21 out of 104 patients (20.2%) presented with high frequency sensorineural hearing loss (SNHL), either unilateral or bilateral. No ototoxic factor, other than DFO, was present in any of the patients. Patients with SNHL presented with relatively lower serum ferritin levels than those with normal hearing, however, no statistically significant difference was observed. Subjects with SNHL were submitted to DFO reduction or temporary withdrawal. Following intervention, 7 out of 21 affected patients recovered, 10 remained stable and 4 demonstrated aggravation. CONCLUSION: The findings are indicative of DFO's contributing role in the development of hearing impairment. Regular audiologic evaluation is imperative in all thalassemic patients so that early changes may be recognized and treatment may be judiciously adjusted in order to prevent or reverse hearing impairment.