Outcomes of Using Otoendoscopy During Surgery for Cholesteatoma.

To determine the impact of using otoendoscopy at the time of primary surgery of cholesteatoma in identifying hidden "cholesteatoma remnant". Study was prospective study. Setting was University tertiary care hospital. One hundred fifty, patients diagnosed clinically and by CT as having cholesteatoma, have been operated. 64 patients operated by using canal up technique and 86 patients operated by using canal down technique. Once all visible cholesteatoma was removed with standard microscopic techniques, otoendoscopy was utilized in every patient to identify any hidden "cholesteatoma remnant". Despite apparent total microscopic eradication of cholesteatoma of the operated cases, otoendoscopy at time of primary surgery revealed an overall incidence of hidden cholesteatoma remnants of 18%. The incidence of hidden cholesteatoma remnants identified by otoendoscopy was 23% in the canal up group and 14% in the canal down group. Otoendoscopy should be used as an adjunct with standard microscopic technique to identify hidden cholesteatoma remnants during surgery of cholesteatoma.

Could Nasal Surgery Affect Multilevel Surgery Results for Obstructive Sleep Apnea?

OBJECTIVE: To study the role of nasal surgery as a part of multilevel surgery for management of obstructive sleep apnea (OSA). METHODS: All patients underwent multilevel surgery for relieving OSA symptoms and they were classified according to type of surgical intervention into: group A (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy, suspension (El-Ahl and El-Anwar) sutures and nasal surgery (inferior turbinate surgery). Group B (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy and suspension sutures. Pre and postoperative sleep study, Epworth sleepiness scale, snoring score were reported and compared. RESULTS: Apnea hypoapnea index (AHI) dropped significantly in both groups. The mean preoperative AHI was significantly less in patients who had no nasal obstruction (P = 0.0367), while the difference in postoperative values was nonsignificant (P = 0.7358).The mean Epworth sleepiness scale improved significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. The lowest oxygen saturation elevated significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. As regards snoring scores, they dropped significantly in both groups. The preoperative snoring score was reported to be significantly more in patients who had associated nasal obstruction (group A) (P = 0.0113). But after surgery the difference in postoperative values was nonsignificant (P = 0.1296). CONCLUSION: Treatment of nasal obstruction should be considered a crucial component in the comprehensive management plan for OSA patients as it has significant impact on the patients' AHI and snoring.

Ipsilateral reduced olfactory bulb volume in patients with unilateral nasal obstruction.

OBJECTIVES: To evaluate the effect of unilateral nasal obstruction (by nasal polyps of different histopathology) on olfactory bulb volume using MRI technique. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary university hospitals, Departments of Otolaryngology and Radiology. SUBJECTS AND METHODS: Eleven patients with a few months of complete unilateral nasal obstruction of different pathological etiologies were selected. MRI assessment of olfactory bulb volume was performed using planimetric manual contouring. The contralateral olfactory bulb was used as a comparative control for the same patient. Eleven healthy controls constituted the control group. RESULTS: Mean olfactory bulb volume ± SD of obstructed side = 14.3 ± 3.7 mm(3), mean olfactory bulb volume ± SD of nonobstructed side = 43.49 ± 10.7 mm(3). The difference between the 2 sides was significant (P = .003). The difference in olfactory bulb volume between normal subjects and nonobstructed nasal side was statistically nonsignificant (t = .9118, P = .3727), while the difference between normal subjects' olfactory bulb volume and obstructed nasal side olfactory bulb volume in our patients was extremely statistically significant (t = 9.7320, P < .0001). A strong negative correlation was found between duration of obstruction and olfactory bulb volume (R = -0.9761). CONCLUSION: This study shows that unilateral nasal obstruction may be associated with a lateralized ipsilateral difference of olfactory bulb volume.

Olfactory bulb volume changes in patients with sinonasal polyposis: a magnetic resonance imaging study.

OBJECTIVES: The olfactory bulb (OB) is thought to be a plastic structure with highly active afferent neurons. The aim of this study was to evaluate the effect of olfactory deprivation caused by sinonasal polyps on OB volume. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary university hospital, Department of Otolaryngology. SUBJECTS AND METHODS: Twenty-two subjects were included: 11 adult patients with bilateral allergic sinonasal polyposis (patient group) and 11 adult healthy controls (control group). Both study groups were matched for age and sex. OB volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. RESULTS: In the patient group, OB volume measurements ranged from 5.2 to 19.5 mm(3) (mean ± SD, 10.14 ± 3.8). In the control group, volume measurements ranged from 35 to 75.8 mm(3) (mean ± SD, 47.66 ± 10.75). The difference in OB volumes between patient and control groups was statistically significant (P < .001). CONCLUSION: Our study highlights the significant reduction in OB volume in patients with bilateral sinonasal polyposis as compared with its volume in healthy controls. Further studies are required to evaluate the impact of OB volume reduction on olfactory recovery postoperatively.