Obstructive sinonasal granuloma: a rare complication of systemic sarcoidosis.

Sarcoidosis is a granulomatous disorder which presents with pulmonary involvement in >90% of cases. Sinonasal involvement is rare, occurring in 1% of all patients with sarcoidosis. It typically presents in the setting of active pulmonary disease. Here, we present a rare case of sinonasal sarcoidosis (SNS) in a patient with latent pulmonary sarcoidosis. The patient presented to our clinic with several years of nasal obstruction, rhinorrhea and cough unresponsive to medical management. Eventually, radiographic imaging was performed, revealing a large obstructive mass in the left nasal cavity. The mass was resected, and pathology demonstrated epithelioid granulomas, consistent with sarcoidosis. The patient was subsequently placed on systemic therapy with improvement in her symptoms. In summary, SNS is a rare clinical entity that infrequently presents in patients without active pulmonary involvement. Clinicians should have a low threshold to obtain imaging in patients with sarcoidosis who present with sinonasal complaints.

Reliability of Home Sleep Apnea Testing for Diagnosing Obstructive Sleep Apnea in Patients With Spontaneous Cerebrospinal Fluid Leaks.

STUDY OBJECTIVES:  To establish the prevalence of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks and demonstrate the reliability of home sleep apnea testing (HSAT) to screen for OSA in this population. METHODS: A literature review was performed to assess data on OSA prevalence in sCSF leaks. An institutional retrospective review was performed of 20 patients with sCSF leaks who met inclusion criteria. Patients without prior sleep studies were prospectively administered sleep studies, either HSAT or polysomnogram (PSG). RESULTS: Twenty patients met the inclusion criteria. Two patients had prior sleep studies while 18 patients obtained prospective sleep studies following diagnosis and prior to management of sCSF leaks. Nineteen patients (95%) had evidence of mild or greater OSA. CONCLUSIONS:  This study re-demonstrates the high prevalence of OSA in patients with sCSF leaks, consistent with current literature, and investigates the reliability of HSAT for diagnosis of OSA in this population.

Determining the utility of standard hospital microbiology testing: Comparing standard microbiology cultures with DNA sequence analysis in patients with chronic sinusitis.

OBJECTIVE: To demonstrate DNA sequencing analysis (DNAsa) of sinus cultures in patients with CRS is a reliable method of detecting pathogens in polymicrobial CRS infections. METHODS: After obtaining Institutional Review Board approval for this prospective cohort study, we selected a random sample of 50 patients with CRS at Medstar Georgetown University Hospital between September 2016 and March 2017. We defined CRS as a history of rhinosinusitis refractory to maximal medical therapy and prior endoscopic sinus surgery. Patients demonstrating active purulence in a sinus cavity were prospectively selected to undergo standard hospital cultures (SHC) and DNAsa cultures. Organisms identified in both methods were compared for each patient. RESULTS: Specimens were obtained from 29 female and 16 male patients with a mean age of 50 years. A total of 45 cultures were included in our final analysis; five cultures were excluded after inappropriate laboratory processing. Results from these patients were compared and analyzed. Cohen's weighted kappa analysis showed agreement between the two testing methods in identifying predominant microorganisms. DNAsa detected 31.9% more microorganisms compared to SHC (P < 0.05). When multiple microorganisms were detected, DNAsa yielded more positive results compared to SHC (P < 0.05). CONCLUSIONS: DNAsa detects all microorganisms identified by SHC as well as predominant microorganisms not detected by SHC. Thus molecular pathogen identification may be more reliable for identifying multiple microorganisms as compared to standard culture techniques that identify only one or two microorganisms. In recalcitrant cases of CRS, DNAsa may provide better guidance in selection of appropriate antimicrobial treatment.

Oral Psoriasis of the Tongue: A Case Report.

Psoriasis is a common dermatological disease, but oral psoriasis is rarely reported in the literature. Its diagnosis has been a contentious issue among physicians. Its presence in the absence of skin lesions is not completely accepted by all physicians, and diagnosis is complicated by the fact that there are no defined criteria. We present a case report of oral psoriasis in a man who did not have skin lesions concurrently but did have a previous history of dermal psoriasis. Additionally, we discuss the history, typical presentation, and current treatments of oral psoriasis.

Initial clinical experience with balloon dilation in revision frontal sinus surgery.

OBJECTIVES: The purpose of this study was to determine whether balloon dilation is effective in revision frontal sinus surgery. METHODS: We retrospectively reviewed all patients who had previously undergone endoscopic frontal sinus surgery and had persistent sinusitis. All patients then underwent balloon dilation of the frontal ostium. Outcome measurements included endoscopic patency of the frontal ostium, Lund-Mackay scores, culture-positive postoperative infections, and subjective persistence of symptoms. RESULTS: Twenty-four frontal ostia and recesses were dilated in 13 patients. The mean follow-up was 13 months (range, 7 to 19 months). During follow-up, 21 of 24 ostia (86%) remained patent and 3 required additional procedures. Postoperative computed tomography scans were performed an average of 12 months after dilation (range, 6 to 18 months) in 9 patients (17 sinuses). The average Lund-Mackay score was 1.35 before dilation and 0.87 at follow-up (p = 0.0076), with 41% of sinuses (7 of 17) displaying radiographic improvement. The average number of postoperative infections was 2.07 (range, 0 to 7). Frontal headaches persisted in 38% of patients (5 of 13) at follow-up. CONCLUSIONS: Balloon dilation of the frontal ostia has a posttreatment patency rate comparable to those of other endoscopic revision techniques. Although it may not fully address the frontal sinus disease of all patients, it is a less invasive technique that may be helpful for some patients.

Topical antibiotic therapy of chronic rhinosinusitis.

Many different treatment options for chronic rhinosinusitis (CRS) exist, but questions remain regarding the best options. Although oral and intravenous antimicrobial therapies have traditionally been prescribed to manage CRS, topical administration of these agents has gained increasing popularity over the past few years. Topical antimicrobial agents are preferable because of their ability to localize delivery to the sinonasal mucosa and minimize the systemic effects seen with oral agents. This quality is especially important in treatment of biofilms, where higher concentrations of antibiotics are usually required. This article gives a brief overview of CRS and provides a summary of recent studies using topical agents for treatment of bacterial and fungal sinusitis.

The role of anti-IgE immunoglobulin therapy in nasal polyposis: a pilot study.

BACKGROUND: Although the etiology of nasal polyposis (NP) remains unknown, emerging evidence showing elevated local IgE levels and eosinophilic infiltration suggests an allergic etiology. Given this evidence, this pilot study examined whether anti-IgE therapy is efficacious in the treatment of NP. METHODS: Data were retrospectively collected on two groups of patients with atopic asthma and NP who underwent endoscopic sinus surgery (ESS), including a control group (n=4) and an anti-IgE treatment group (n=4), who received the anti-IgE agent, omalizumab, postoperatively. Both groups were evaluated by sinus computed tomography (CT) and nasal endoscopic examination, and comparisons were made between the groups with respect to differences in the recurrence of NP after ESS. RESULTS: Collectively, the subjects showed a direct relationship between NP severity and pretreatment total serum IgE levels. Preoperatively, there were no differences between the groups with regard to their total serum IgE levels, sinus CT scores, and endoscopically determined NP scores. Relative to corresponding preoperative values, there was no significant improvement in the sinus CT scores in either treatment group postoperatively. In contrast, relative to preoperative values, the nasal polyp scores significantly improved in the anti-IgE group, whereas the control group showed no significant improvement. CONCLUSION: This pilot study provides new evidence establishing that (1) endoscopic NP severity directly correlates to total serum IgE levels and (2) inclusion of anti-IgE therapy in the postpolypectomy management of atopic asthmatic individuals may reduce the severity of NP recurrence.