Severe granulomatous inflammatory response induced by injection of polyacrylamide gel into the facial tissue.

Facial soft tissue augmentation has been performed using different materials. We describe a woman who received polyacrylamide gel injections for cosmetic reasons and developed a severe granulomatous inflammation paranasally. Because the patient did not mention the cosmetic intervention, the diagnosis of polyacrylamide gel-induced granuloma was complicated. The distinctive histopathological findings led to the correct diagnosis despite sparse clinical information. Since complete surgical excision was not feasible, she was treated with repeated multiple local injections of triamcinolone acetonide. Polyacrylamide gel may have favorable properties for facial tissue augmentation, but a severe granulomatous inflammatory response induced by injection of polyacrylamide gel may occur. Before treatment with polyacrylamide gel injection this complication should be disclosed to the patient.

Metastatic calciumphosphate deposition in the membranous nasal septum in end-stage renal disease.

Metastatic calciumphosphate depositions are a well known complication of end-stage renal disease. Numerous localisations for metastatic calcification have been described. A patient with a sub-acute swelling of the membranous nasal septum, caused by calciumphosphate depositions is presented. This is the first report of this particular localisation of metastatic calcification in end-stage renal disease.

[Treatment of acute ethmoiditis according to a protocol based on clinical stage]. / Behandeling van acute etmoïditis volgens een protocol gebaseerd op het klinische stadium.

OBJECTIVE: To describe the results of application of a systematic treatment protocol, meant to reduce the risk of serious complications, when treating acute ethmoiditis. DESIGN: Prospective study. SETTING: Academic hospital of the 'Vrije Universiteit (VU)', Amsterdam, The Netherlands. METHOD: From January 1988 to March 1994, 25 children with acute ethmoiditis were admitted to the VU hospital. Eight of them had Chandler stage I, 8 stage II, 3 stage III, 3 stage IV and 3 stage V. The treatment protocol was stepwise, based on the Chandler stages and focused on intensive antibiotic treatment in combination with surgical drainage of the ethmoid complex and (or) the orbit. RESULTS: All children with ethmoiditis stages I-III were cured without rest symptoms. One patient with ethmoiditis stage IV and a pre-existent lymphatic leukaemia died of pulmonary complications of a massive fungal infection, 8 months after treatment. One patient with ethmoiditis stage V finally had permanent psychomotor retardation. CONCLUSION: The used treatment protocol offered the possibility to treat patients with acute ethmoiditis stepwise, depending on stage, with satisfying results. Especially the treatment result in patients with ethmoiditis stage V was good.

A new biochemical assay in the diagnostic management of nasal cerebrospinal fluid leakage.

A new method for the detection of cerebrospinal fluid (CSF) leakage is described, and is a refinement of the method originally reported by Oberascher and Arrer in 1986. Immuno-electrophoretic measurements are performed in a two-buffer system, making the test easier to do and providing qualitatively better images. Genetic variants of transferrin (which has a general population incidence of 2-4%) can be discriminated from false-positive test results in affected families. The test described is recommended as the method of choice for initial screening of suspected CSF leakage.

[Good results of endoscopic paranasal sinus surgery for chronic or recurrent sinusitis and for nasal polyps]. / Goede resultaten van endoscopische neusbijholtenchirurgie wegens chronische of recidiverende sinusitis en wegens polyposis nasi.

Endoscopic sinus surgery is being applied increasingly for chronic or recurrent sinusitis and nasal polyps. We investigated the results, which we classified as subjective results (i.e. the opinion of the patient) and objective results (i.e. the result as seen with nasal endoscopy). The subjective result was 'good' in 85% of 92 patients with chronic or recurrent sinusitis, the objective result in 77% of the treated sides, with a median follow-up of 46 months. In 90 patients with nasal polyps the percentages were 90% and 65% respectively, with a follow-up of 24 months. In 63% of 30 patients with chronic obstructive lung disease and nasal polyps the pulmonary function increased postoperatively (FEV1). In 4.2% of 1235 operated sides in 593 patients local complications were seen. These were mainly minor complications. Only in 0.3% serious complications as a orbital hematoma or a CSF leak were seen. Endoscopic sinus surgery has good results and little morbidity.

Difficulties with speech intelligibility in noise in spite of a normal pure-tone audiogram.

A group of 15 patients with complaints of having difficulties in understanding speech, especially in noisy surroundings in spite of (nearly) normal pure-tone audiograms, was subjected to a battery of speech-audiometric tests. The results showed that these subjects had a statistically significantly higher speech reception threshold (SRT) for sentences in noise than a reference group of 10 normal-hearing subjects. This difference was most clear for a fluctuating masking noise. In conditions with much reverberation, the patients also proved to be handicapped more than the control group. Binaural hearing gain was equal for both groups. The pathogenesis of the speech-hearing loss is not known, but assessment of the SRT in noise proves to be a valuable asset in objectifying these patients' complaints.

The effect of stapedectomy on speech intelligibility in noise.

Speech intelligibility in noise was tested pre- and postoperatively after 27 stapedectomy cases and 10 cases of reexploration after previous stapes surgery. We did not find a postoperative threshold shift (signal-to-noise ratio) for the intelligibility of sentences presented in noise. This finding corresponds well with the absence of postoperative high-frequency sensorineural loss in these patients. Using two types of prostheses we found a significant amelioration of speech intelligibility in quiet for the Schuknecht minihole prosthesis as compared to the House wire loop.

The effect of speechreading on the speech-reception threshold of sentences in noise.

The monaural speech-reception threshold of sentences in noise, here defined as the 50% correct-syllables threshold, was measured for a female speaker with and without speechreading via a video monitor. The additional visual information resulted in a 4.6-dB lower threshold for a group of 12 young subjects and in a 4.0-dB lower threshold for a group of 18 elderly subjects compared to auditory presentation alone.