Testing the Effectiveness of Computerized Cognitive Training on an At-Risk Student Population.

Core constructs such as working memory, task switching, and processing speed in cognitive psychology research have prominent predictive roles in K12 students' academic performance. Specifically, considerable empirical work shows that variability in such capabilities is linked to differences in numerous academic outcomes. Moreover, there is an increasing awareness and acceptance of the malleability of cognitive abilities. Thus, an emerging strand of research focuses on the use of computerized cognitive training to improve cognitive skills. This project addresses this issue with high-risk students attending community day schools. An in-school cognitive training program implemented (for 30 min per day) at each school site resulted in improvements for working memory, task switching, and processing speed after six total hours of participation. The current results provide evidence for the changeability of what were once thought to be static skills. Equally important, this study highlights the effectiveness of computerized cognitive training and critically extends intervention-based work to a student group that has received little attention. Implications of this work for cognitive research and educational support programs are discussed.

The Psychometric Structure of Executive Functions: A Satisfactory Measurement Model? An Examination Using Meta-Analysis and Network Modeling.

A long-standing debate among cognitive scientists has focused on describing the underlying nature of executive functions, which has important implications for both theoretical and applied research. Miyake et al.'s three-factor model has often been considered the gold-standard representation of executive functions and has driven much research in the field. More recently, however, there have been increasing concerns that the three-factor model does not adequately describe a highly complex construct such as executive functions. The current project presents two studies that examine the veracity of Miyake et al.'s model and propose a new approach (i.e., network modeling) for detecting the underlying nature of executive functions. The current results raise questions about the psychometric strength and adequacy of the three-factor model. Further, the studies presented here provide evidence that network modeling provides a better understanding of executive functions as it better captures (relative to latent variable modeling) the complexity of cognitive processes. Theoretical and applied implications are discussed.

Improving Cognitive Abilities in School-Age Children via Computerized Cognitive Training: Examining the Effect of Extended Training Duration.

Critical neuropsychological capabilities such as working memory, cognitive flexibility, and processing speed are foundational to many daily activities. For children, such skills are essential for school success. Thus, children who demonstrate weaknesses in these abilities may experience impaired academic performance; this is especially true for students identified with learning differences who often exhibit less developed cognitive abilities. The purpose of this project was to examine the efficacy of a cognitive training program implemented during the school day to improve abilities predictive of academic achievement. Ninety-five children completed two training activities that were counterbalanced across participants. Analyses of baseline working memory, cognitive flexibility, and processing speed performance relative to those following training showed a strong treatment effect. Moreover, there is notable evidence of greater intervention efficacy with extended engagement with the training program. Implications for neuropsychological research and practice are discussed.

The Modified Medial Maxillectomy as a Radical or Extended,-yet Still Functional,-Technique in Sinus Surgery.

BACKGROUND: Endoscopic sinus surgery with a middle meatal antrostomy is a common intervention in the treatment algorithm for maxillary sinus pathologies. However, this procedure has its origins in a time when simple ventilation of the sinus cavity was the primary (and only often) goal of surgery. In some patients, persistent mucociliary dysfunction occurs despite ventilatory surgery. Although the endoscopic modified medial maxillectomy (MMM) was originally described for tumour surgery, it provides a radical yet still functional option to overcome chronic sinus dysfunction. OBJECTIVE: The goal of this study was to describe the functional status of a post-MMM sinus cavity. METHODS: A consecutive series of patients who underwent at least a unilateral MMM by three tertiary rhinologists were retrospectively reviewed. Prospectively collected data included patient demographics (including age, gender, smoking status and comorbidities), disease-specific factors, microbiology, and preoperative patient-reported symptoms based on the 22-item Sinonasal Outcome Test-22 (SNOT-22) and radiology. The primary outcome of the study was the presence of sinus dysfunction, defined by mucostasis or pooling on endoscopic examination at the last follow-up. Secondary outcomes included the need for revision surgery as a result of sinus dysfunction and the improvement in SNOT-22 score. RESULTS: A total of 551 medial maxillectomies (47.0% female, 52.9 ± 16.8 years) were performed. Very few patients experienced post-operative sustained mucostasis following MMM (10.2%) and even fewer required revision surgery (5.0%). Chronic obstructive pulmonary disease (odds ratio (OR) = 6.82, P < 0.002.) and asthma (OR = 2.48, P = 0.03) were associated with mucostasis. Patients who underwent an MMM experienced a notable postoperative improvement in SNOT-22 score (45.9 ± 23.7 (pre-op) vs. 23.6 ± 19.4 (post-op); paired t-test, P < 0.0001). CONCLUSION: The MMM, whether performed for access to pathology or with the intent to avoid mucous 'sumping' with the sinus, can provide a long-term functional maxillary sinus cavity with minimal morbidity.

Utilizing Cognitive Training to Improve Working Memory, Attention, and Impulsivity in School-Aged Children with ADHD and SLD.

Students' use of working memory (WM) is a key to academic success, as many subject areas and various tasks school-aged children encounter require the ability to attend to, work with, and recall information. Children with poor WM ability typically struggle with academic work compared to similar-aged peers without WM deficits. Further, WM has been shown to be significantly correlated with inattention and disorganization in those with ADHD, and WM deficits have also been identified as a potential underpinning of specific learning disorder (SLD). As an intervention technique, the use of computerized cognitive training has demonstrated improved attention and working memory skills in children with WM deficits, and children that have completed cognitive training protocols have demonstrated performance improvements in reading and math. The current study aimed to examine the effectiveness of cognitive training (conducted in a clinical setting) for students diagnosed with ADHD and SLD. Using paired-samples t-tests and a psychometric network modeling technique, results from data obtained from a sample of 43 school-aged children showed (1) that attention and working memory improved following cognitive training and (2) that cognitive training might be related to cognitive structural changes found pre- to post-training among the variables being measured. Implications for clinical practice and school-based interventions are discussed.

Ventilatory support in Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are blistering cutaneous disorders that often manifest with epidermal and mucosal necrosis. In extreme cases, the upper or bronchial airways are threatened, necessitating intubation and mechanical ventilation. This systematic review and meta-analysis examines the prevalence of mechanical ventilation (MV) in patients with SJS or TENS, despite maximal medical therapy, and additionally aims to identify the risk factors associated with this requirement. MATERIALS AND METHODS: A systematic review of the literature was performed using the PRISMA guidelines and meta-analysis of proportions. RESULTS: Six articles were included, with pooled total of 18648 cases. The weighted prevalence of MV was 27.5% (95%CI 17.8-39.9%). The need for MV was more closely associated with TEN, compared to SJS (OR 4.40, 95%CI 2.73-7.10, I2=48%, p<.00001.) Risk factors associated with the need for MV included bacteremia (OR 5.02, 95%CI 2.87-8.79, I2=0%, p<.00001), shock/organ failure on admission (OR 261.99, 95%CI 21.88-3137, I2=71, p<.0001), total body surface area (TBSA) >30% (OR 4.47, 95%CI 1.41-14.20, I2=71, p=.01.). CONCLUSION: Limited published evidence with significant heterogeneity exists within the literature regarding the need for MV in SJS and TEN. Greater cutaneous involvement, and more critically unwell patients appear more likely to require MV.

Routine vocal cord mobility assessment post cardiac surgery via median sternotomy approach.

OBJECTIVES: Surgery of the aortic arch carries a risk of injury to the vagus and recurrent laryngeal nerves, particularly in a young child, as these structures lie in close proximity to aortic arch. This study aimed to determine the incidence, symptomatology and natural history of vocal cord dysfunction (VCD) following aortic arch reconstructive surgery through a median sternotomy approach. METHODS AND MATERIALS: Prospective assessment was performed of all consecutive newborns who underwent cardiac surgery for aortic arch surgery via median sternotomy between January 2016 and May 2017 at a tertiary paediatric hospital. All patients underwent post-operative flexible fibreoptic nasolaryngoscopy (FNL) after extubation to assess for the presence of vocal cord dysfunction (VCD). Those with VCD were re-examined at followup. A feeding assessment performed by speech pathologists (SPs) and a video fluoroscopic swallow study (VFSS) were also performed in those with VCD or feeding difficulties. RESULTS: A total of 35 newborns were included in the study. At initial review, left sided VCD was demonstrated in 65.7% of patients (n=23). Significant associations with VCD were younger age (3.0 versus 6.5 days, p=0.041) and a weak or absent cry (Relative Risk=16.4, 95%CI 3.8-47.8, p<0.001). 52.5% (n=11) of patients with VCD had evidence of aspiration on VFSS. There was no significant difference in intensive care unit stay or overall hospital stay between patients with VCD compared to those without (33.0 days vs 28.8 days, p=0.73; 52.5 vs 45.9, p=0.72.) Infants with either proven VCD or a weak cry were more likely to be discharged home with a nasogastric (NG) tube (RR=4.67, p= 0.048; RR=7.00 p=0.022 respectively). At followup after 106 days, complete resolution was seen in 100% patients with partial VCD and 61.5% with complete VCD. CONCLUSIONS: VCD is a common complication following neonatal aortic arch surgery, although most experience resolution of symptoms over time. The authors recommend post-operative laryngoscopy in all patients should be routine, and particularly those with a weak cry.

Colonization rates of tracheostomy tubes associated with the frequency of tube changes.

BACKGROUND: Tracheostomy-tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post-insertion to 3 monthly thereafter. However, currently no evidence-based guidelines exist to justify these protocols. This study aims to assess the colonization of tracheostomy-tubes associated with the frequency of changes. METHODS: A prospective cohort study over 18-months of adult tracheostomy patients at a single institution (inpatient/outpatients). Patients were grouped based on whether tubes were changed at ≤4 weeks or >4 weeks and microbiology swabs sent for microscopy, culture and sensitivities. RESULTS: A total of 65 patients were enrolled. No statistically significant difference in colonization in patients undergoing tube changes more than every 4 weeks to those less than every 4 weeks was found (56.2% versus 57.1%, χ2 = 0.004, P = 0.95). CONCLUSION: The timing of tracheostomy-tube changes may not affect colonization and infection rates. Routine changes for the purpose of reducing infection risk may not be needed unless clinically indicated.

Comparison of arytenoid vertical height discrepancy in normal versus patients with vocal cord palsy.

OBJECTIVE: Cadaveric experiments and more recently clinical data have demonstrated that patients with vertical height discrepancy between their arytenoids experience poorer voice outcomes in patients with unilateral vocal cord palsy (UVP) after medialisation laryngoplasty. However, the presence or severity of height discrepancy in normal patients without UVP has not yet been clearly defined. STUDY DESIGN: Case-control study. SETTING: Tertiary Australian hospitals. SUBJECTS AND METHODS: A retrospective review was performed on patients who underwent high computed tomography imaging of the neck. Scans were assessed for discrepancy in arytenoid vertical height discrepancy and compared to a cohort with known UVP. RESULTS: 44 normal patients (50% female, mean age 57.6 ±â€¯14.8 years) were compared to 23 patients with UVP (43.4% female, mean age 52.3 ±â€¯14.9 years.) Normal patients were found to have a smaller height discrepancy compared to UVP patients (student's t-test,2.00 mm ±â€¯0.00 vs 2.39 mm ±â€¯0.72, p < .001.) CONCLUSION: This study suggests that discrepancy is pathologic, and it is plausible that this results in acoustic consequences.

Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function.

OBJECTIVE: The impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery. STUDY DESIGN: Retrospective case series. SETTING: Tertiary Australian Hospitals. SUBJECTS AND METHODS: A retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0-4) was determined by the number of inferior or middle turbinate subtotal resections. Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.) RESULTS: 294 patients (age 52.9 ±â€¯17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93-3.38], OR = 0.60[0.33-1.12], B = 0.56[-1.58-2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04-4.13], P = 0.04, OR = 3.97[1.08-14.49], P = 0.04, respectively). CONCLUSION: In patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.

An alternative technique for pituitary tumour removal: Sequential endoscopic-microscopic pituitary procedure (SEMPP).

Several authors have reported advantages of the purely endoscopic (PE) approach over traditional purely microscopic (PM) techniques for many sinus and anterior skull base procedures. However, in pituitary surgery, the PE approach carries a number of limitations. Experienced microscopically-trained neurosurgeons are required to master the endoscopic technique which has a steep learning curve due to its one-handed nature and optically-distorted 2-dimensional view. We describe our novel technique, the sequential endoscopic and microscopic pituitary procedure (SEMPP) which does not require microscopically-trained neurosurgeons to alter their technique. We compare SEMPP with the PE approach in terms of outcome and safety. Retrospective chart review of consecutive SEMPP cases performed at our institution between January 2010 and December 2013 was conducted. Operative time, gross total resection rate, resolution of endocrine and visual dysfunction, hospital length of stay, cerebrospinal fluid (CSF) leak rate and revision rates were recorded. 32 patients were identified (50% female, mean age 53.0 years), and 33 SEMPP cases. Mean operating time was 132 min (range 90-200). 69% of patients experienced gross total resection. Most patients (81.3%) with preoperative visual deficit either experienced complete resolution or improved symptoms. The remainder experienced no change in vision. 12.5% (n = 4) of patients experienced intraoperative CSF leaks. All were repaired intraoperatively or with conservative management. Two patients (6.3%) experienced epistaxis managed with conservative measures. The SEMPP technique demonstrates comparable outcomes, complication rates and operative time to PE and PM techniques described in the literature.

Frontal Sinus Osteoma: From Direct Excision to Endoscopic Removal.

Frontal sinus osteomas are benign bone-forming neoplasms. Ongoing advancements in endoscopic surgery have allowed less invasive surgical approaches to be adopted for removal. The authors systematically reviewed the literature to provide analysis and recommendations for management.One hundred ninety-three publications encompassing 1399 patients met inclusion, with mean age 42.1 ±â€Š13.8 years and a male predominance (59.2%). Symptoms included pain (70.8%); orbital/ocular (20.7%); sinonasal (36.4%); neurologic (6.0%); other (14.5%); and asymptomatic (4.8%). Osteoma was isolated to the frontal sinus (82.9%) or extended into the ethmoid (16.6%), maxillary (0.3%), and sphenoid sinuses (0.2%). There was intracranial extension in 9.5% and intraorbital extension in 18.7%. Of those proceeding to surgery, majority (59.8%) underwent open approaches, followed by endoscopic (25.0%) and combined (11.5%). A significant (P < 0.01) increase in proportion of cases utilizing endoscopic approaches versus open/combined was observed over the period studied. Seventy-one postoperative complications were reported, in 7.5% of endoscopic cases, 27% of open, and 8.8% of combined. Complications were more likely in open/combined surgery, compared with endoscopic (22.3% versus 7.5%, P < 0.001). In 181 patients, completeness of resection was reported (complete resection; 87.8%) and found to be a significant predictor (P < 0.01) for disease recurrence/progression. Mean length of stay for the endoscopic group was 3.1 ±â€Š1.3 days, compared with 7.9 ±â€Š3.1 for open/combined (P < 0.0001).In the management of frontal sinus osteoma, indications for selecting endoscopic versus open approaches have expanded over the past 30 years, as techniques, equipment, and understanding of pathophysiology have evolved. Where endoscopic approaches are possible, they are associated with reduced morbidity and length of stay compared with open approaches.

Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes.

BACKGROUND: The elderly represents one of the most rapidly growing subsets of the population. This population experiences a higher incidence of thyroid pathology. However, there are concerns that the elderly also experiences increased perioperative complications and are poor candidates for thyroidectomy. METHODS: Patients who underwent thyroidectomy over the age of 80 years at three tertiary head and neck units were included. Data regarding age, sex, presenting symptoms, comorbidities, preoperative investigations, type of surgery, postoperative complications, and final thyroid pathology were retrieved from hospital records. RESULTS: Of a total of 39 patients (69% women, mean age 83.1), the majority (40.1%) presented with a combination of symptoms: shortness of breath, feeling of pressure in the neck, dysphagia, or tiredness. Two (5.1%) were asymptomatic. Low rates of postoperative complications were encountered and were minor (n = 5). No intensive care unit admissions or mortality was experienced. CONCLUSION: Thyroid surgery in octogenarians carries an acceptable complication profile.

Occupational Burnout among Otolaryngology-Head and Neck Surgery Trainees in Australia.

OBJECTIVES: Surgical trainee burnout has gained attention recently as a significant factor leading to poorer quality of patient care, decreased productivity, and personal dysfunction. As a result, we aimed to determine the prevalence and associated risk factors for burnout among otolaryngology-head and neck surgery (OHNS) trainees in Australia. STUDY DESIGN: Cross-sectional survey. SETTING: National cohort of accredited OHNS trainees in Australia. SUBJECTS AND METHODS: Participants completed the Maslach Burnout Inventory (MBI). Trainee burnout was defined if any threshold of the 3 MBI domains-emotional exhaustion, depersonalization, or personal accomplishment-reached an established high threshold. Demographic data on potential predictors of burnout, such as stressors, workload, satisfaction, and support systems, were collected from survey responses. Predictors were compared with the burnout status. RESULTS: Of 67 OHNS trainees, 60 responded (66.7% men). Burnout was common among respondents, with 73.3% suffering from burnout in at least 1 of the 3 MBI domains (70.0%, emotional exhaustion; 46.7%, depersonalization; 18.3%, personal accomplishment). Trainee burnout was significantly influenced by training location (chi-square, P = .05), living geographically apart from social supports (odds ratio [OR], 3.49; chi-square, P = .007), number of years trained rurally or away from social supports (Kendall's tau-B, P = .03), difficulty balancing work and nonwork commitments (OR, 10.0; chi-square, P = .03), training negatively affecting their partner or family (OR, 14.30; chi-square, P = .05), and feeling uncomfortable approaching a supervisor (OR, 2.50; chi-square, P < .0001). CONCLUSION: Burnout was found to be very common among OHNS trainees in Australia. The statistically significant predictors identified should be addressed to minimize trainee burnout.

Patient-reported olfaction improves following outside-in Draf III frontal sinus surgery for chronic rhinosinusitis.

OBJECTIVES: The Draf III frontal sinusotomy is an established surgical procedure with an important role in the surgical management of recalcitrant chronic rhinosinusitis (CRS). In 2012, the outside-in approach to the Draf III was described as a safe and efficient procedure. Smell recovery in inflammatory CRS is challenging, and to date there is limited evidence suggesting that Draf III improves patient-reported olfactory dysfunction from CRS. METHODS: A consecutive series of patients who underwent an outside-in Draf III for inflammatory CRS by a single, tertiary rhinologist were reviewed. Patients were excluded if the Draf III was performed for noninflammatory conditions. Postoperatively, patients were maintained on long-term corticosteroid irrigations, and adherence was assessed. Prospectively collected data included patient demographics, a visual analogue scale for smell, overall Sinonasal Outcome Test Score (SNOT-22), global nasal function score, and a clinician-graded clinical outcome score. RESULTS: One hundred and four patients (41.1% female) aged 54 ± 12 years underwent an outside-in Draf III. The median follow-up time was 30.6 months (range 12.2-72.1). The majority of patients rated their smell loss as moderate or worse preoperatively; however, this was significantly improved at postoperative review (71.2% vs. 27.6%; Kendall tau-b, P < 0.01). The SNOT-22 score improved after surgery (2.32 ± 1.09 vs. 0.78 ± 0.69, P < 0.0001). Medication adherence was significantly associated with improved clinical outcome score (Kendall tau-b, P < 0.004). Aspirin exacerbated respiratory disease was found to be a significant risk factor predicting poor clinical outcome on univariate analysis (Odds Ratio = 4.69 (1.03-21.2), P = 0.04). CONCLUSION: The outside-in Draf III appears to facilitate sustained, meaningful improvement in several self-reported outcomes, including smell. However, further study and comparison to less aggressive surgery will be required to confirm its true benefit. LEVEL OF EVIDENCE: Level 4 Laryngoscope, 129:25-30, 2019.

Inner ear exosomes and their potential use as biomarkers.

Exosomes are nanovesicles involved in intercellular communications. They are released by a variety of cell types; however, their presence in the inner ear has not been described in the literature. The aims of this study were to determine if exosomes are present in the inner ear and, if present, characterize the changes in their protein content in response to ototoxic stress. In this laboratory investigation, inner ear explants of 5-day-old Wistar rats were cultured and treated with either cisplatin or gentamicin. Hair cell damage was assessed by confocal microscopy. Exosomes were isolated using ExoQuick, serial centrifugation, and mini-column methods. Confirmation and characterization of exosomes was carried out using transmission electron microscopy (TEM), ZetaView, BCA protein analysis, and proteomics. Vesicles with a typical size distribution for exosomes were observed using TEM and ZetaView. Proteomic analysis detected typical exosome markers and markers for the organ of Corti. There was a statistically significant reduction in the exosome protein level and number of particles per cubic centimeter when the samples were exposed to ototoxic stress. Proteomic analysis also detected clear differences in protein expression when ototoxic medications were introduced. Significant changes in the proteomes of the exosomes were previously described in the context of hearing loss and ototoxic treatment. This is the first report describing exosomes derived from the inner ear. These findings may present an opportunity to conduct further studies with the hope of using exosomes as a biomarker to monitor inner ear function in the future.

Outcomes of Primary Total Knee Arthroplasty in Patients With Parkinson's Disease.

BACKGROUND: Parkinson's disease is a degenerative disorder causing rigidity, bradykinesia, and tremor of the motor system. There is significant paucity of evidence regarding whether total knee arthroplasty (TKA) is of benefit in patients with both Parkinson's disease and osteoarthritis. We aimed to compare outcomes and complications of TKA between patients with Parkinson's disease and those without. METHODS: A cohort of 43 knees from 35 patients with Parkinson's disease who received a primary TKA between January 2004 and December 2015 were retrospectively extracted from a private clinical database held by 2 surgeons and compared to an age and gender-matched control group of 50 knees from 41 patients. TKAs were performed by 2 surgeons at 1 tertiary private hospital.The indication for TKA in both groups was osteoarthritis. Difference between preoperative and 1-year range of movement (ROM) and 12-point Oxford Knee Score (OKS) was assessed using Student's unpaired t-test. Postoperative complications and revision procedures were also recorded during the follow-up period. The minimal clinically important difference for OKS at 1-year follow-up, defined as improvement of ≥6, was also assessed. RESULTS: In the Parkinson's group, mean ROM improvement was 14° (100° preoperatively to 114° at 12 months), compared to 12° in the control group (102°-114°, respectively). Mean OKS improvement was 15 in the Parkinson's group (23 preoperatively to 38 at 12 months) compared to 17 in the control group (23 and 40, respectively.) No significant difference was identified between the 2 groups for either ROM (P = .96) or OKS (P = .45.) All Parkinson's patients achieved the minimal clinically important difference at 1-year follow-up. There were no mortalities during the study follow-up period and no significant difference in complication rates between the 2 groups (P = .41). CONCLUSION: Parkinson's disease was not associated with poorer functional outcomes or increased complications compared to controls in our study. We suggest that Parkinson's disease is not an absolute contraindication to TKA.

Comparison of the classic and Broms methods of rhinomanometry using model noses.

Calculation of nasal airway resistance (NAR) using rhinomanometry can be obtained using different methods of analysis of the pressure-flow curve. The two commonest methods for measuring NAR in rhinomanometry are the classic method at 75 and 150 Pa and the Broms method at radius 200. The objective of this study was to compare the unilateral NAR values measured using both classic and Broms method over four artificial model noses (R1, R2, R3 and R4). The study found that at low resistances (R1 and R2), NAR measurements of Broms were not significantly different from measurements of classic method at 75 Pa but were significantly different from measurements of classic method at 150 Pa. At high resistances (R3 and R4), NAR measurements of Broms were not significantly different from measurements of classic method at 150 Pa but were significantly different from measurements of classic method at 75 Pa. The magnitude of any change in resistance due to surgery or medical intervention is therefore also dependent on the method used to analyze the pressure-flow curves, with bigger change observed in Broms method at certain level of nasal resistances compared to classic measurements in the same patient. In conclusion, nasal airway resistance is not a standardized measurement like blood pressure. Clinicians need to be careful when comparing unilateral measurements of resistance from the classic and Broms methods because the two methods can give either similar or different measurements depending on the level of nasal resistance.

Comparison of classic and 4-phase rhinomanometry methods, is there any difference?

BACKGROUND: There are various different parameters used to measure nasal airway resistance (NAR) in rhinomanometry, which include the classic method at fixed pressure of 150Pa or 75Pa and 4-phase rhinomanometry. This study aims to determine if there is any difference between the measurements of NAR obtained by the classic and 4-phase rhinomanometry methods. METHODOLOGY: In-vitro study with measurements of NAR using both methods when applied across four artificial nose models. RESULTS: No statistically significant differences were found between NAR values obtained from both methods. Strong, positive correlations were found between NAR measured with both methods, which were statistically significant. Bland-Altman method also showed good agreement between both methods with narrow limits of agreement. CONCLUSION: There is high level of conformity between the values of nasal airway resistance measured using both methods.

Unilateral non-Hodgkin's lymphoma of the frontal sinus presenting as Pott's puffy tumour.

Malignant lymphoma of the paranasal sinuses and nasal cavity is very rare and can mimic those of infectious, non-lymphomatous neoplastic and granulomatous process in their initial presentation, thus delaying its diagnosis. This report describes a case of unilateral frontal sinus B-cell lymphoma presenting as Pott's puffy tumour. Key features to differentiate the two conditions are discussed. A 61-year-old woman presented with 4 weeks history of a gradually enlarging right-sided forehead swelling, which was smooth and firm with no tenderness, fluctuation or overlying skin changes. Initial computed tomography (CT) of the paranasal sinuses revealed a mildly opacified right frontal sinus with an overlying soft tissue swelling. A repeat CT scan one week later showed evidence of osteomyelitis of the medial wall of the right frontal bone and orbit, suggesting diagnosis of Pott's puffy tumour. A third CT scan was performed as the swelling continued to enlarge despite antibiotics, which demonstrated a collection over the frontal sinus. No pus was found from a frontal sinus trephine. Histopathologic analysis of the frontal sinus biopsy showed diffuse large B cell lymphoma. The patient was treated successfully with 6 cycles of chemotherapy. In conclusion, it is not easy to differentiate Pott's puffy tumour from frontal sinus lymphoma at their initial presentation. With clearer understanding of both conditions, we can raise the index of suspicion among clinicians of the possibility of frontal sinus lymphoma even when evidence of osteomyelitis is present, therefore prompting earlier tissue biopsies for confirmation of diagnosis.