Disease-Specific Vs Non-Specific Questionnaires on Septoplasty Outcomes.

Introduction: Validated questionnaires are a valuable tool in medical practice. The role of septoplasty in improving patients' non-nasal symptoms and their quality of life is still controversial. The aim of this study was to determine the differences in outcome after septoplasty measured by a disease-specific questionnaire vs a general QoL questionnaire. Materials and Methods: A total of 50 patients underwent septoplasty and completed the SNOT-22 and the SF-36v2 questionnaires preoperatively and at 6 months post-op. Pre-op, post-op and variation for each domain in both questionnaires were calculated and compared with a measure of self-reported health transition (Question 2 of SF-36v2) and with the Minimal important difference (MID) for our sample. Results: SNOT-22 scores significantly improved for each specific question and for the total score. SF-36v2 showed a significant improvement in scores for mental domains (Mental Health, Role Emotional, and Vitality) but less so for the physical domains. MID for our sample was 4.2 points. Patients with variations greater than 4.2 in SNOT-22 total score (74%) revealed significantly better variations in Physical Function, General Health, Social Function and Vitality. Conclusions: Validated questionnaires are a fundamental tool for assessing outcomes of commonly performed surgeries in ENT. Disease-specific questionnaire showed improvement in scores for the majority of patients. The general QoL showed improvement only in Mental Domains. This may suggest that the impact of septoplasty in patient's general health might not be significant.

Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches / Enfermedad inmunomediada del oído interno: diagnóstico y enfoques terapéuticos

Introduction: Immune Mediated Inner Ear Disease (IMIED) is a rare form of sensorineural bilateral hearing loss, usually progressing in weeks to months and responsive to immunosuppressive treatment. Despite recent advances, there is no consensus on diagnosis and optimal treatment. Methods: A review of articles on IMIED from the last 10 years was conducted using PubMed(R) database. Results: IMIED is a rare disease, mostly affecting middle aged women. It may be a primary ear disease or secondary to autoimmune systemic disease. A dual immune response (both cellular and humoral) seems to be involved. Cochlin may be the inner ear protein targeted in this disease. Distinction from other (core common) forms of neurosensory hearing loss is a challenge. Physical examination is mandatory for exclusion of other causes of hearing loss; audiometry identifies characteristic hearing curves. Laboratory and imaging studies are controversial since no diagnostic marker is available. Conclusion: Despite recent research, IMIED diagnosis remains exclusive. Steroids are the mainstay treatment; other therapies need further investigation. For refractory cases, cochlear implantation is an option and with good relative outcome

Introducción: La enfermedad inmunomediada del oído interno (EIMOI) es una forma rara de pérdida auditiva bilateral sensorineural, que progresa generalmente en semanas a meses y responde al tratamiento inmunosupresor. A pesar de los recientes avances, no hay consenso sobre el diagnóstico y el tratamiento óptimo. Métodos: Se realizó una revisión de artículos sobre la EAOI de los últimos 10 años utilizando la base de datos PubMed(R). Resultados: La EIMOI es una enfermedad rara que afecta principalmente a las mujeres de 2 a 50 años de edad. Puede ser una enfermedad del oído primaria o secundaria a una enfermedad sistémica autoinmune. Parece estar involucrada una respuesta inmune dual (tanto celular como humoral). La coclina parece ser la proteína del oído interno diana en esta enfermedad. La distinción de otras formas de pérdida de audición neurosensorial es un desafío. El examen físico es obligatorio para la exclusión de otras causas de pérdida de la audición; la audiometría identifica curvas características de pérdida de audición. Los estudios de laboratorio y de imágenes son controvertidos, ya que no hay marcador diagnóstico disponible. Conclusión: A pesar de la investigación reciente, el diagnóstico de la EAOI sigue siendo de exclusión. Los esteroides siguen siendo el pilar del tratamiento; otras terapéuticas necesitan más investigación. Para los casos refractarios, la implantación coclear es una opción con buen resultado relativo

Stridor as initial presentation of rolandic epilepsy.

The authors present the case of a 5-year-old girl referred to our institution due to several episodes of nocturnal stridor with ocular retroversion and parental notion of apnea. She has been previously submitted to adenotonsillectomy. Due to symptoms worsening she was referred to our hospital. Here, a nasal fiberoptic endoscopy evaluation was conducted and a diagnosis of laryngomalacia was done. The was submitted to CO2 laser ariepiglotoplasty with symptom improvement after surgery. During a follow-up appointment, parents reported self-limited clonic facial movements at sleep onset. The electroencephalogram (EEG) was compatible with benign childhood epileptiform discharges.

Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches.

INTRODUCTION: Immune Mediated Inner Ear Disease (IMIED) is a rare form of sensorineural bilateral hearing loss, usually progressing in weeks to months and responsive to immunosuppressive treatment. Despite recent advances, there is no consensus on diagnosis and optimal treatment. METHODS: A review of articles on IMIED from the last 10 years was conducted using PubMed® database. RESULTS: IMIED is a rare disease, mostly affecting middle aged women. It may be a primary ear disease or secondary to autoimmune systemic disease. A dual immune response (both cellular and humoral) seems to be involved. Cochlin may be the inner ear protein targeted in this disease. Distinction from other (core common) forms of neurosensory hearing loss is a challenge. Physical examination is mandatory for exclusion of other causes of hearing loss; audiometry identifies characteristic hearing curves. Laboratory and imaging studies are controversial since no diagnostic marker is available. CONCLUSION: Despite recent research, IMIED diagnosis remains exclusive. Steroids are the mainstay treatment; other therapies need further investigation. For refractory cases, cochlear implantation is an option and with good relative outcome.

Septoplasty with or without postoperative nasal packing? Prospective study.

UNLABELLED: Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

Septoplastia com ou sem tamponamento pós-operatório? Estudo prospectivo / Septoplasty with or without postoperative nasal packing? Prospective study

O tamponamento nasal anterior é efetuado num grande número de cirurgias nasais, nomeadamente na septoplastia. Contudo, não é um procedimento inócuo pelo que o seu benefício tem vindo a ser questionado. OBJETIVO: Avaliar a necessidade do tamponamento nasal anterior e a qualidade de vida nos doentes submetidos à septoplastia. MÉTODO: Doentes submetidos à septoplastia, com ou sem turbinoplastia inferior, foram randomizados para a colocação ou não de tamponamento nasal anterior no pós-operatório. Foram registados e comparados os dados relativos ao pós-operatório (dor, hemorragia). A qualidade de vida foi avaliada no pré e pós-operatório. Estudo prospetivo randomizado. RESULTADOS: Foram incluídos 73 doentes (37 tamponados e 36 não tamponados) com seguimento mínimo de 3 meses. Nos doentes tamponados, a dor nasal e as cefaleias no pós-operatório imediato foram superiores. Destes doentes, 75,7% referiram dor moderada/intensa no destamponamento. Nos doentes não tamponados, a hemorragia foi mais frequente, mas apenas um doente necessitou tamponamento. Houve melhoria da qualidade de vida em todos os doentes. CONCLUSÃO: A septoplastia melhora a qualidade de vida do doente com desvio do septo e obstrução nasal. O uso por rotina do tamponamento nasal anterior deve ser questionado por não apresentar benefício comprovado.

Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

Respiratory adenomatoid hamartoma must be suspected on CT-scan enlargement of the olfactory clefts.

OBJECTIVE: To demonstrate that Respiratory Epithelial Adenomatoid Hamartoma (REAH) of the nose, a recently individualized benign tumour, is characterized by a significant widening of the CT-scan width of the olfactory clefts. PATIENTS AND METHODS: Retrospective study comparing, in the axial and coronal planes, the CT-scan maximum width of the olfactory clefts, i.e. the maximum distance between both turbinal ethmoidal walls, of 15 REAH patients, 36 Nasal Polyposis (NPS) and 49 normal individuals. RESULTS: In axial and coronal planes, respectively, the medians of the olfactory clefts width were of 12.2 mm and 12.1 mm for REAH, and 5.6 mm and 5.4 mm for NPS, compared to 4.5 mm and 4.2 mm for normal individuals (both p < 0.0001). Total nasal width (i.e. the distance between both medial orbital walls) was not found to be different between groups in both planes. The median ratios "olfactory cleft width/total nasal width" were, for the axial and coronal planes respectively, of 53.1% and 44.7 for REAH, and 23.5% and 22.9% for NPS, compared to 19.2% and 19.1% for normal controls (both p < or = 0.001). CONCLUSION: Compared to normal and nasal polyposis CT-scans, REAH significantly enlarges the olfactory clefts width. Bilateral REAH represent a genuine differential diagnosis of Nasal Polyposis; the CT-scan appears as a major clue to differentiate the two diseases. Endoscopic surgery of REAH definitely confirms their origin in the olfactory cleft, and opens a new field of endoscopic surgery of the olfactory cleft.