Comparison of the Diagnosis and Treatment of Nasal Bone Fracture by Physicians in China With Different Levels of Experience.

OBJECTIVE: This study aimed to investigate the conflicts in the diagnosis and treatment of nasal bone fracture by Chinese otolaryngologists to improve the diagnosis and treatment accuracy of junior otolaryngologists and emergency physicians. METHODS: A questionnaire was designed and filled out by otolaryngologists in large general hospitals. The questions included how to choose an auxiliary examination to diagnose nasal bone fracture, whether tamponade is required after closed reduction, the selection of packing materials, the timing of an operation, and the evaluation of postoperative effect. The questionnaire results were divided into 3 groups according to the experience levels of experienced of physicians. RESULTS: A total of 151 otolaryngologists with different levels of experience from 26 provinces in China completed the questionnaire. 90.73% of physicians thought that nasal bone computed tomography was the most important auxiliary examination to diagnose a nasal bone fracture. 52.32% of them compared photos before and after the operation to evaluate postoperative effects. About 53% of physicians thought that 7 to 10 days after reducing local swelling is the optimal time for closed reduction. CONCLUSIONS: There is no obvious difference in the diagnosis and treatment of nasal bone fracture among otolaryngologists with different levels of experience in Chinese otolaryngologists with different levels. Most physicians choose nasal bone computed tomography for diagnosis, perform surgery at 7 to 10 days after injury, and compare photos from before and after the operation to evaluate the postoperative effect.

Analysis of the Construction of a Predictive Model for Eosinophilic Chronic Rhinosinusitis.

Purpose: This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit. Patients and Methods: We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model. Results: There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (×109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model. Conclusion: The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.

Characterization of Airflow Parameters in the Olfactory Fissure Zone Based on Fluid Mechanics Method.

OBJECTIVE: Airflow in the olfactory fissure region is a necessary condition for olfaction. However, due to the complex anatomy of the olfactory fissure, it is difficult to characterize the airflow in this region. At present, there are few studies on the airflow characteristics of the olfactory fissure. The aim of this study is to investigate the characteristics of objective indicators of airflow parameters in the olfactory fissure region, such as flow velocity, flow rate, pressure and flow ratio, from the perspective of biofluid mechanics. METHODS: In this study, the anatomical structure of the olfactory fissure zone was reconstructed in three dimensions using raw data from 32 healthy adults and 64 sinus computed tomography scans. To study the characteristics of airflow parameter variations in the olfactory fissure region in healthy adults, 10 cross-sectional sections were established in the olfactory fissure region using computational fluid dynamics after obtaining the airflow parameter values at different anatomical positions in the olfactory fissure region. RESULTS: The average flow rate of the ten cross-sections in the olfactory fissure zone was 19.22±9.74 mL/s, the average flow velocity was 0.51±0.21 m/s, the average flow percentage was 5.45%±2.52%, and the average pressure was -13.35±6.74 Pa. The percentile method was used to determine the range of reference values for P90: average flow rate of 0.02-35.87 mL/s, average flow velocity of 0.24-0.94 m/s, average flow percentage of 1.57%-9.93%, and average pressure of -30.4-4.42 Pa. Among the ten cross-sectional systems of the olfactory fissure, the median of Plane3N-Plane8N is more stable and representative. In the olfactory fissure system, the corresponding anatomical position of Plane3N-Plane8N was in the posterior region of the olfactory fissure, mainly at the junction of the anterior, middle 1/3 to the posterior middle turbinate, which was consistent with the main distribution area of the olfactory mucosa. CONCLUSION: This study shows that the application of computational fluid dynamic can rapidly achieve the characterization of airflow parameters in the olfactory fissure. The airflow through the olfactory fissure in healthy adults accounted for no more than 10% of the total flow volume of the nasal cavity. The airflow parameters in the anterior region of the olfactory fissure fluctuated significantly, while those flowing through the posterior region of the olfactory fissure were more stable. This could be due to the anterior section of the middle turbinate truncating the restriction of airflow into the olfactory fissure.

Correlation analysis of flow parameters in the olfactory cleft and olfactory function.

The olfaction is related to flow in the olfactory cleft. However, There is a lack of studies on the relationship between flow characteristics of the olfactory cleft and olfactory function. In this study, the anatomical structure of the olfactory cleft was reconstructed in three dimensions using the raw data obtained from the CT scans of sinuses of 32 enrolled volunteers. The Sniffin' Sticks test was used to examine the olfaction. We investigated the correlation between airflow parameters and olfactory function of the olfactory cleft in healthy adults by the computational fluid dynamics method. We found that three parameters, airflow, airflow velocity, and airflow ratio, were highly positively correlated with olfactory function. The mean pressure was not correlated with the olfactory function. Furthermore, there is the strongest correlation between air flow through the olfactory cleft and olfactory function. The correlation between the mean velocity in the anterior olfactory cleft region and olfaction was relatively poor, while the airflow velocity at the posterior olfactory cleft region was enhanced gradually. The correlation between the airflow ratio and olfaction was optimal in the initial position of superior turbinate. The flow parameters in the posterior olfactory cleft area were more stable.

Study on a Flexible Odor-Releasing Device for Olfactory Training.

Olfactory training has been shown to be effective in treating olfactory dysfunction. However, there are hardly any devices that can regularly and quantificationally release odors for olfactory training. A new odor-releasing device, which is low-cost, customizable, semi-automatic, and flexible, was developed in this study. The operation of the device can be easily achieved by the examiner, or even by the participant, simply by pressing a few buttons. A controller system with 15 individual relays was employed to master the working logic for the whole process. The device allows the examiner to isolate from the participants using the Bluetooth module in the control board. The odorants and their concentrations stored in the scent bottles can be customized by the specific requirements of different participants. The odors for training are provided by ultrasonic atomizers, which have simple structures, but powerful features. The flow rates of the odors can also be controlled by altering the rotation speed of the fans. Final experiments on practical odor generation further proved the potential of the developed device for olfactory training. More attention should be paid to the improvements of odor generation devices for olfactory training.

A Case Report of Inflammatory Myofibroblastic Tumor of the Sphenoidal Sinus.

Inflammatory myofibroblastic tumor (IMT) is a tumor composed of differentiated myofibroblastic spindle-shaped cells. It occurs in the soft tissues of the abdomen and lungs, and is very rare in the sphenoid sinus. The diagnosis depends on histopathology and immunohistochemistry, and is easily misdiagnosed. Although metastasis is rare, the recurrence rate is high. Surgical resection is the treatment of choice, and where complete resection is difficult, radiation therapy, hormonal therapy, or molecular targeted drug therapy can be administered. We report a rare case of IMT with a primary origin in the sphenoid sinus, which was entirely resected by nasal endoscopy and confirmed by histological examination.