The value of bilateral simultaneous nasal spirometry in the assessment of patients undergoing septoplasty.

PROBLEM: There is no consensus regarding the best approach to select patients for septoplasty. Patient dissatisfaction after septoplasty implies that clinical examination alone is inadequate to detect a clinically relevant nasal septal deviation (NSD). Objective testing provides an in-depth analysis of nasal obstruction and its underlying anatomic causes but it is effort consuming, requires training and it is not widely available. AIM: We studied the role of bilateral simultaneous nasal spirometry (BSNS) in the preoperative selection of patients for septoplasty. PATIENTS, SUBJECTS AND METHODS: Thirty patients with nasal obstruction and NSD were assessed by subjective measures and BSNS before and after septoplasty. The decongested nasal partitioning ratio (NPR) was used as a measure of the degree of NSD. Thirty healthy controls were recruited for providing a normal range of NPR values. RESULTS: All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits had a significant reduction of NPR. Patients with unilateral symptoms and NPR beyond normal limits were also able to identify the more obstructed side preoperatively. For this group of patients, physicians were able to identify the convex side of NSD preoperatively. No correlation between subjective measures of nasal obstruction or airflow asymmetry and NPR was observed. CONCLUSION: BSNS is a rapid, easily interpretable, noninvasive technique, which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BSNS is not applicable in cases with a septal perforation or an S type septal deviation, it cannot detect an insufficient nasal valve and it does not substitute rhinomanometry or acoustic rhinometry.

Benign paroxysmal positional vertigo in the first acute attack of Ménière's disease.

A 69-year-old woman, with no history of vertigo attacks, presented with the classical triad of symptoms for Ménière's disease in the right ear (vertigo, tinnitus, fullness). Upon admission, the patient had a third-degree horizontal nystagmus beating to the right, after beating towards the left ear a few hours earlier. Audiometry confirmed a severe sensorineural hearing loss in the right ear, especially at low and high frequencies. The following day, the patient complained of short episodes of vertigo linked to head movement, and the Hallpike test was compatible with benign paroxysmal positional vertigo (BPPV) in the right ear. To our knowledge this is the first description of BPPV of the posterior semicircular canal manifesting during the first vertiginous attack of Ménière's disease in the same ear. It was possible that the hydropic distension or rupture damaged the otolithic apparatus, leading to the release of otoconia debris which migrated to the posterior semicircular canal where it resulted in BPPV.

An alternative manoeuvre for posterior canal BPPV treatment.

OBJECTIVES: The aim of this study is to evaluate the effectiveness of a new manoeuvre in the treatment of posterior canal benign paroxysmal positional vertigo (p-BPPV) based on the idea that highly accelerated endolymphatic flow may lead a mass of otoconia to collide with the walls of the posterior semicircular canal, resulting in its disintegration and/or in the expulsion of the free particles from the posterior semicircular canal. MATERIAL-METHODS: Our study group included 146 patients with a diagnosis of p-BPPV. All patients underwent the new manoeuvre, which consisted of several high-acceleration successive head movements in the horizontal plane performed by the same physician. The results of the study group were compared with those of a sham control group of 30 patients with p-BPPV undergoing placebo treatment. The patients of both groups were reviewed in a follow-up appointment 1 month and 1 year after the initial treatment. RESULTS: Complete resolution of symptoms immediately after the manoeuvre was observed in 92% of patients. At 1-month and 1-year follow-up assessment, all the patients in the study group reported complete relief from their symptoms compared with only 13% and 43% of control patients respectively. Recurrence of symptoms was reported in 12 patients (8%) from the study group, who responded successfully to one additional session. CONCLUSIONS: This study establishes the efficacy of the new manoeuvre in the short- and long-term management of p-BPPV. It is a quick office procedure, usually resolving this disorder with a single session, although there some limitations in patients with underlying cervical spine pathology.

Review of the genus Saropogon Loew, 1847 (Diptera: Asilidae) from Russia, Transcaucasia and Central Asia, with description of three new species.

Nine species of the genus Saropogon Loew, 1847 are reviewed. Saropogon aliyevi Sakhvon sp. nov. (Azerbaijan), S. astakhovi Sakhvon sp. nov. (Armenia) and S. tajikistanensis Sakhvon sp. nov. (Tajikistan) are described and illustrated. The distribution of some species is increased. Saropogon pittoproctus Loew, 1873 is recorded from Russia (Kalmykia) for the first time. Records of prey of some of the Saropogon species are presented. An identification key to males of the species is given.

Enhancement of antibiotic activity by phytocompounds of Turnera subulata.

The present study aimed to evaluate the antibacterial and modulatory activity of the Turnera subulate methyl extract in isolation or in combination with aminoglycoside antibiotics, using the microdilution method. The Turnera subulata methyl extract was used in isolation in the antibacterial assays and in combination with antibiotics in the modulation assays. All tests were performed in triplicates. The Turnera subulata methyl extract presented both antibacterial and antibiotic-modulatory effects in vitro, in isolation and in association with aminoglycosides. The extract activity depends on the bacterial strain and may be associated with the presence of tannins and flavonols. However, further studies are required to characterize the Turnera subulata potential for the development of new drugs against multiresistant bacteria.

Castleman's disease of the neck: report of a case and review of the literature.

OBJECTIVES: Castleman's disease is an uncommon disease of benign lymph node hyperplasia primarily affecting the mediastinum, with the head and neck region being the second most common site. CASE REPORT: A 27-year-old woman was admitted to our department due to a left lateral cervical mass. After a complete clinical and imaging examination, a neck dissection was performed, in which a mass, size 3.5 x 2.7 x 4.5 cm, was excised. The patient was diagnosed with Castleman's disease of the neck after histopathological examination. CONCLUSIONS: The diagnosis of Castleman's disease is always a clinical challenge, as the patient commonly presents with nonspecific signs and symptoms resembling other lymphatic diseases. Consequently, Castleman's disease should be in the differential diagnosis of congenital, inflammatory, or neoplastic cervical alterations. A review of literature, including histopathological characteristics, differential diagnosis, and treatment options is also presented.

Middle ear adenoma/carcinoid tumour: a case report and review of the literature.

UNLABELLED: Middle ear adenoma, a rare benign tumour with glandular and neuroendocrine differentiation, originates from the epithelial lining of the middle ear. CASE REPORT: We report a case of a 52-year-old woman, who presented with progressive hearing loss and fullness in the left ear for 3 months. Clinical examination revealed a mass in the left middle ear. Histological examination revealed tumour cells forming gland-like and cribriform structures, as well as compact groups. The nuclei were round and uniform, without atypia or mitotic activity. On immunohistochemical staining, the tumour cells were positive for epithelial (cytokeratins, epithelial membrane antigen) and neuroendocrine (neuron specific enolase, synaptophysin, chromogranin and pancreatic polypeptide) markers. CONCLUSION: Middle ear adenoma is a benign tumour that is treated by complete surgical removal. Follow-up of the patient is essential in order to detect possible recurrence. The immunohistochemical staining of the present case supports the suggestion that this tumour is best described by the term neuroendocrine adenoma of the middle ear.

Intra- and postoperative application of Mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS.

AIM: Obstruction of the osteomeatal complex is the commonest anatomic finding in revision endoscopic sinus surgery. This study assesses the efficacy of topical mitomycin C in the middle meatus, intra- and postoperatively in the prevention of adhesion formation and restenosis of the maxillary sinus antrostomy. MATERIALS AND METHODS: At the end of endoscopic surgery for chronic rhinosinusitis and four weeks postoperatively 30 patients received a pledget soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatus for 5 minutes while a pledget soaked in saline was placed in the contralateral side. Patients were assessed at least 6 months postoperatively by a blinded observer for the presence of synechiae and antrostomy stenosis. Medical records were reviewed for episodes of recurrent sinusitis. RESULTS: Adhesions were observed in 8 patients. All adhesions rated as moderate to severe (4 patients) were observed in the control side (p = 0.043). Restenosis was observed in 2 sides treated with mitomycin C and in 9 control sides (p = 0.032). Recurrent symptoms of sinusitis occurred in three patients on the saline side. CONCLUSION: Mitomycin C is safe and effective in the prevention of severe adhesions and antrostomy stenosis when applied twice, during surgery and the early postoperative period.

Ectopic Warthin's tumour presenting as a neck mass.

INTRODUCTION: Warthin's tumour usually involves the parotid gland. However, it can also arise from ectopic salivary tissue in the para-parotid and latero-cervical lymph nodes. CASE REPORT: We present the case of a 60-year-old man with a 3-month history of a smooth, mobile mass on the right side of the neck. Computed tomography (CT) scanning (coronal, axial and sagittal sections) showed a cystic lesion in the right upper neck without connection to the major salivary glands (8 x 4 x 3 cm). Complete surgical excision with a transverse neck incision was performed. Histological findings of the specimen revealed Warthin's tumour. CONCLUSION: This neoplasm should be included in the differential diagnosis of cystic lesions of the neck. Although rare, it has potential for malignant transformation. Coronal and sagittal CT scans are necessary to accurately localize the tumour and to differentiate the diagnosis from earring lesions of the parotid tail.

Review of the genus Heteropogon Loew, 1847 (Diptera: Asilidae) from Russia and Central Asia, with description of two new species.

Nine species of genus Heteropogon Loew, 1847 are reviewed. Heteropogon ater Sakhvon sp. nov. (Kazakhstan, Tajikistan) and H. hiemalis Sakhvon sp. nov. (Turkmenistan) are described and illustrated. A new synonymy is proposed for Heteropogon filicornis (Loew, 1871) = Cyrtopogon leleji Lehr, 1998, syn. nov. The status of Heteropogon lugubris mesasiaticus Lehr, 1970 is upgraded to species level that of mesasiaticus. The distribution of some species is increased. A key to males of the species is given.

[Estimating the prognosis of peripheral facial paralysis: is the minimal nerve excitability test still up to date?]. / Prognoseabschätzung der peripheren Fazialisparese: Ist der Minimal-Nerve-Excitability-Test noch zeitgemäss?

BACKGROUND: In this retrospective study, we assessed the long-term prognostic value of the minimal nerve excitability test (NET) by comparing the results it yielded with the House-Brackmann (HB) index in patients with the most common types of facial paralysis, Bell's palsy and traumatic facial palsy. PATIENTS AND METHODS: Three hundred and fifty patients aged 9-85 years (mean age 42.4 years; 156 male and 194 female), all of whom were treated initially with the same steroid therapy, entered on study. Patients in whom decompression surgery had been performed were excluded so as to avoid falsely optimistic prognoses. The 350 study patients were divided into two groups: group 1 was made up of 250 with Bell's palsy and group 2, of 100 with nonpenetrating traumatic facial palsy following temporal bone fracture. The NET was conducted repeatedly in all patients for 3 weeks from the start of day 3 of treatment, the value recorded on day 14 being used in the evaluation. For each patient, the result of the NET was recorded as 'normal', 'diminished' or 'without response' according to the difference between the two sides of the face. The final HB grading was determined after 1 year to check for the agreement between the electrical prognosis and the clinical outcome and thus the reliability of the prognosis indicated by the NET. RESULTS: The results indicate that a normal NET forecast a satisfactory outcome that could be classed as HB I-II in almost all the patients in both groups. Among patients who had no response on NET, 85% of those with Bell's palsy and 90% of those with traumatic facial palsy failed to recover nerve function. Diminished nerve excitability proved to be a sign of a relatively favourable prognosis: 74% of patients in each group recovered normal facial function. CONCLUSION: The NET is a method of investigation that is easily applied and can make a positive contribution to the assessment of prognosis in Bell's palsy and in traumatic facial palsy, reflecting the functional state of the facial nerve reliably in most of cases.

Far-advanced otosclerosis and cochlear implantation.

PROBLEMS/OBJECTIVES: To report the radiographic and surgical findings, speech perception performance, and complications of cochlear implantation for patients who were affected by far-advanced otosclerosis. METHODOLOGY: Five patients, 2 males and 3 females, with a family history of otosclerosis and who previously underwent stapedectomy to improve hearing were included in this study. CT scans of all ears were graded according to Rotteveel's grading system. All patients underwent cochlear implantation according to standard procedures. A control group of 10 non-otosclerotic postlingual implanted adults matched for age was used. RESULTS: On CT scanning, one patient had solely fenestral disease (type 1), 3 patients had localized retrofenestral disease (type 2), and 1 had diffuse retrofenestral disease with loss of the normal architecture of the cochlea (type 3). In all otosclerotic patients, the electrode array was fully inserted. However, in two patients (type 2 and 3) a thickened otic capsule was present and required more drilling than normal. One patient (type 3) experienced postoperatively facial nerve stimulation with normal fitting parameters. Otosclerotic patients showed excellent speech perception after implantation and obtained similar results to those achieved by the non-otosclerotic patients. CONCLUSIONS: Patients suffering from far-advanced otosclerosis may benefit from cochlear implantation and achieve speech performance scores comparable to non-otosclerotic implantees. Regarding surgery and facial nerve stimulation, attention should be taken to these cases in which the extension of otosclerosis is more severe on CT scanning (type 2 and mainly 3). Postoperative facial nerve stimulation can be managed successfully by resetting the current levels for comfort level.

Sinonasal hemangiopericytoma of the middle turbinate: a case report and brief review of the literature.

Hemangiopericytomas (HPCs) are rare vascular neoplasms that arise from the pericytes of Zimmerman. They account for 2-3% of all soft tissue sarcomas in humans and they occur mainly in the musculoskeletal system. 15 to 30% of all HPCs occur in the head and neck region. Only 5% are located in the sinonasal region, where they display a more benign behaviour than in other parts of the body. We will describe a case of a right-sided HPC, in the posterior third of the middle turbinate. We will also discuss the epidemiology, the macro- and microscopical characteristics, the clinical and pathological findings and the treatment of this particular neoplasia.

Ossicular necrosis following head injury.

PROBLEMS/OBJECTIVES: The aim of this study is to report on ossicular necrosis in the middle ear occurring shortly after head injury. METHODOLOGY: Our sample included 3 males and 2 females aged 9 to 37 years who complained of unilateral hearing loss after a head trauma that had occurred 3 to 6 months previously. The tympanic membranes were intact, and a CT-scan did not show fracture of the temporal bone. Audiometry showed a unilateral conductive hearing loss in all cases. RESULTS: On tympanotomy exploration, 4 of the 5 patients had a necrosis of the lenticular process of the incus and one patient had a necrosis of the posterior and anterior crura of the stapes. Additionally, the incus was displaced at the incudomalleolar joint towards the promontory in two patients. The long process of the incus was surgically aligned and adjusted to the head of the stapes through interposition of either temporal fascia or a bone chip. At the 2-year-postoperative follow-up, the pure tone audiometry showed that the preoperative air-bone gap was almost closed with a mean of 11.8 dB. CONCLUSIONS: It is possible that the head injury resulted in ossicular displacement in the middle ear with disturbance of the local vascular supply. Due to the tenuous blood supply to the lenticular and long processes of the incus, this portion of the ossicular chain, including the stapes suprastructure, may become more vulnerable to an ischemic process and subsequent necrosis shortly after the head trauma.

Subclavian steal syndrome: neurotological manifestations.

The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. In this case, the subclavian artery steals reverse-flow blood from the vertebrobasilar artery circulation to supply the arm during exertion, resulting in vertebrobasilar insufficiency. As the vertebrobasilar arterial system feeds both the peripheral and central auditory and vestibular systems, in subclavian steal syndrome, neurotological symptoms are expected because of the vertebrobasilar insufficiency. In this report, we describe three patients suffering from subclavian steal syndrome, who presented with isolated dizziness, recurrent vertigo, hearing loss and tinnitus. In two of the three cases, a positional nystagmus was detected, which was vertical in two. Abnormal saccades were documented in one, and the auditory brainstem responses were pathological in all three patients; the caloric response was reduced in only one case. Upon magnetic resonance imaging, ischaemic lesions were observed in two patients, in the brainstem and in the hemispheres, respectively. These findings suggest that the central auditory and vestibular system is more likely to be involved in the pathogenesis of neurotological symptoms in subclavian steal syndrome. Patiehts complaining of numbness of the upper arm and isolated neurotological symptoms should be thoroughly examined for subclavian steal syndrome. Furthermore, regular follow-up must be undertaken in order to prevent other neurological deficits in the vertebrobasilar arterial territory.

Chondrosarcoma of the larynx: a case presentation.

The chondrosarcoma of the larynx is an exceptionally rare tumour. It appears mainly in white men in their 7th decade. The most significant clinical manifestation is hoarseness accompanied at times by stridor. It involves mainly the cricoid cartilage and the treatment of choice is surgical excision. A case of a large tumour of the cricoid cartilage is described. The diagnostic work-up consisted of two minor operations for biopsies and an MRI scan prior to the patient being treated with total laryngectomy.

Endonasal endoscopic repair of cerebrospinal fluid leaks versus craniotomy: comparison of the outcomes.

BACKGROUND: Cerebrospinal fluid (CSF) leaks have been traditionally managed via craniotomy with an intradural repair. The endonasal endoscopic approach represents a minimally invasive alternative. This study aimed to compare the outcomes of the two methods. CASE SERIES: This is a prospective case series of 18 consecutive patients who underwent endonasal repair of a CSF leak. Thirteen variables were evaluated during the study, including age, gender, body mass index, site of the defect, CSF leak etiology, days of hospitalization, use of lumbar drainage, the success of repair, complications, recurrence, duration, and cost of surgery as well as patient satisfaction. The outcomes were compared with a historical cohort of 25 patients treated for CSF leaks with a craniotomy. Though we found no significant difference in the success of the repair, the endoscopic group had a significantly shorter duration of the procedure and hospitalization, a lower rate of complications, lower cost, and higher patient satisfaction. CONCLUSION: The presented data further solidify the endoscopic approach as the preferred method to address CSF leaks located in the anterior and middle skull base in cases not associated with complex intracranial pathology. Hippokratia 2016, 20(4): 299-302.

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.

Morphological study of development and functional activity of palatine tonsils in embryonic age.

Palatine tonsils play an important role in the development of the immune system, being the first organ in the lymph system which analyses and reacts to antigenic stimulation. In this study, the peritonsillar area of Waldeyer's ring was investigated in 88 normal human embryos which were examined histologically and immunohistochemically. The progressive development of palatine tonsils during embryonic life is discussed. The first appearance of tonsils is in about the 14th-15th week followed by a parallel development of B- and T-cell regions which accounts for the high incidence of non mucosa-associated lymphoid tissue lymphomas among all tonsillar lymphomas and the higher incidence of T-cell-lymphomas, in comparison to the mucosa-associated lymphoid tissue of the digestive system. The way in which the human body develops the palatine tonsils quickly and prepares them to react to the first antigenic stimulation, are discussed.