Platelet counts and adenoid hypertrophy: a neglected relationship.

BACKGROUND: The increase in resistance of the respiratory nasal caused by adenoid hypertrophy can condition changes in pulmonary ventilation and translate into a risk of cardiopulmonary diseases. The mean platelet volume is a marker of platelet function, associated with indicators of platelet activity - a greater volume indicates the presence of larger platelets and greater hemostatic reactivity, associated with a propensity for thrombosis. METHODS: Retrospective study of 200 patients who presented to the otolaryngology outpatient clinic of our hospital, divided in two group-s : chAil dren with adenoid hypertrophy, B - children without adenoid hypertrophy. The age, hemoglobin levels, platelet counts were compared between the two groups. RESULTS: The Mean Platelet Volume levels in patients with Adenoid Hypertrophy were significantly higher than those in the control group (p<0.001). White blood cells, hemoglobin, and platelet levels were not significantly different between the 2 groups (P > 0.05). CONCLUSIONS: Adenoid hypertrophy is associated with higher mean platelet volume in children. Measurement of mean platelet volume and platelet count can be considered as quick, safe, and reliable guide for the assessment of clinical consequences of adenoid hypertrophy.

Middle Vault Changes After Humpectomy by Spare Roof Technique Versus Component Dorsal Hump Reduction.

Objectives: To compare the effect of two different humpectomy techniques in the internal nasal valve (INV) angle in human anatomic specimens. Methods: Seven human anatomic specimens (14 heminoses) were included. A strip of subdorsal septal cartilage was removed and, in each nose, the right side of the middle roof lied intact over and was sutured to the septal cartilage (spare roof technique [SRT]), whereas in the left side the upper lateral cartilage was folded and sutured to the septal cartilage (component dorsal hump reduction [CDHR]). The INV angle was measured pre- and postoperatively. Results: Mean age of the specimens was 69.86 (60-80) years. Five were female. CDHR resulted in a mean change of +1.71 ± 3.12° (p = 0.197), +0.62 ± 6.89° (p = 0.817) and +6.97 ± 6.84° (p = 0.036) after resection of 2, 4, and 6 mm of septal cartilage, respectively. SRT resulted in a mean change of +1.27 ± 2.37° (p = 0.207), +6.89 ± 1.19° (p < 0.001), and +12.55 ± 1.79° (p < 0.001) after resection of 2, 4, and 6 mm of septal cartilage, respectively. In SRT, the amount of septal cartilage resection presented a significant correlation with change in INV angle (r = 0.813, p < 0.001). Conclusions: In this human anatomic study, SRT significantly increased INV angle.

Presbylarynx: Does Body Muscle Mass Correlate With Vocal Atrophy? A Prospective Case Control Study.

OBJECTIVE: To analyze the potential association between body muscle mass and presbylarynx. METHODS: Study performed on subjects referred to the otorhinolaryngology department in a tertiary center between January and September 2019 . Based on endoscopic findings of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Data regarding gender, body composition, self-assessment of vocal complaints, and functional assessment were collected. STUDY DESIGN: Case control, prospective, observational and cross-sectional. RESULTS: The study population included a total of 115 Caucasian subjects (43 males; 72 females). Presbylarynx was identified in 43 patients (37, 39%) with no statistically predilection by gender (P = .668). The mean age of the patients with presbylarynx was slightly higher, but differences between groups were not statistically significant (P = .072). Results showed an association between functional impairment (score 4 of Katz Index and score 5 of Functional Ambulation Classification) and presence of presbylarynx (P < .001). Additionally, a positive association between the absence of presbylarynx and sport activity was also observed (P < .001). The mean value of muscle mass between presbylarynx and no presbylarynx groups was statistically different (P < .01), with a lower mean for subjects with presbylarynx. CONCLUSION: This case control prospective study confirms that the general age-related degeneration of body muscle mass might play an important role in the course of presbylarynx. In the future, preventing strategies based on regular sport activities and improvements on functional status can play an important role in the management of aging voice. LEVEL OF EVIDENCE: 2b Laryngoscope, 131:E226-E230, 2021.

Spare Roof Technique: A New Technique for Hump Removal-The Step-by-Step Guide.

Humpectomy is one of the most common steps in reduction rhinoplasty among Caucasian patients. The most widespread procedures to address hump removal are both the "en bloc humpectomy" (with reconstruction of the middle third with spreader grafts) and the "split hump technique" (with confection of spreader flaps). The spare roof technique, for rhinoplasty reduction, has been developed over the past 4 years. In this technique, the upper lateral cartilages are completely preserved-even the hidden part under the caudal aspect of the nasal bones. It consists of five main steps: step 1, the upper lateral cartilages are released from the dorsal aspect of the nasal septum; step 2, a 1-mm strip of the dorsal septum is taken in each movement as required; step 3, ostectomy of the caudal aspect of nasal bones, keeping the upper lateral cartilages intact and releasing the "lateral" (left and right) pyriform aperture ligament; step 4, classic medial and lateral osteotomies (closing the open bony roof); and step 5, suturing the upper lateral cartilages to the dorsal septum and thus avoiding the natural spring effect. The outcomes of the first 100 patients have been validated by a prospective, interventional, and longitudinal study performed on patients undergoing primary rhinoplasty by means of the spare roof technique. This study confirms that the spare roof technique significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in Caucasian and Mediterranean patients with a dorsal hump seeking rhinoplasty.

Dorsal Hump Reduction Based on the New Ethmoidal Point Classification: A Clinical and Radiological Study of the Keystone Area in 138 Patients.

BACKGROUND: Hump resection often requires reorganization of the keystone area. OBJECTIVES: The authors sought to describe the importance of the point where the perpendicular plate of ethmoid joins the septal cartilage (SC) and the nasal bones (NB) (Ethmoidal point [E-point]) for hump resection surgical planning. METHODS: Measurements from mid-sagittal slices in nasal computed tomography scans taken in adult Caucasian patients between January 2015 and December 2018 were compared between patients seeking primary rhinoplasty due to a nasal hump and patients not seeking rhinoplasty (control group). Patients with previous nasal surgery or trauma, genetic or congenital facial disorders, and high septal deviation were excluded. The length of overlap between NB and SC was compared between the 2 groups. The location of the E-point in relation to the beginning of the nasal hump in the cephalocaudal direction was documented in the patients seeking rhinoplasty. RESULTS: The study population included 138 patients, 69 seeking and 69 not seeking rhinoplasty (96 females). The mean age was 32.9 years (range, 18-55 years). The length of overlap between NB and SC was similar between both groups (11.7 ±â€…3.3 vs 10.8 ±â€…3.3; P = 0.235). The E-point was located before the beginning of the nasal hump in 97% (67/69) of nasal hump patients, and it could be found a mean distance of 2.3 (±2.3) mm cephalic to the latter. CONCLUSIONS: As a rule, the perpendicular plate of the ethmoid does not contribute to the nasal hump; therefore, only in exceptional cases should this be addressed while performing dorsal reduction.

On ciprofloxacin concentration in chronic rhinosinusitis / Acerca de la concentración de ciprofloxacino en la rinosinusitis crónica

Objective: Considering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic. Methods: Prospective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD). Results: The oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis (AU)

Objetivo: Considerando todas las evidencias de que la rinosinusitis crónica sin poliposis nasal (RSCsPN) y la rinosinusitis crónica con poliposis nasal (RSCcPN) son entidades distintas, el objetivo de este estudio fue comparar las concentraciones obtenidas en el plasma y en la mucosa nasal con ciprofloxacino oral y tópico nasal en pacientes con y sin pólipos nasales, sin evaluar la efectividad del uso del antibiótico. Métodos: Estudio clínico prospectivo con asignación aleatoria. La población se componía de pacientes con rinosinusitis crónica propuestos para cirugía endonasal, mayores de 18 años. Se desarrolló entre enero de 2010 y diciembre de 2014. Se administró una dosis única preoperatoria de ciprofloxacino (oral o tópico nasal, en aerosol, gel o gotas) y se recogieron muestras de plasma y mucosa nasal (cornetes, etmoides y seno maxilar) antes de la cirugía. La concentración de ciprofloxacino en el plasma y en la mucosa se ensayó mediante cromatografía líquida de alto rendimiento con detección de fluorescencia. Resultados: El ciprofloxacino oral logró las concentraciones mucosas más altas pero tuvo una expresión plasmática significativa en todos los pacientes. Ninguna de las formulaciones tópicas ha generado niveles plasmáticos de ciprofloxacino medibles. Entre las formulaciones tópicas, el gel fue el que presentó mejores resultados mucosos, a pesar de la existencia de poliposis (AU)

On ciprofloxacin concentration in chronic rhinosinusitis.

OBJECTIVE: Considering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic. METHODS: Prospective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD). RESULTS: The oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis.