Investigation on mechanical properties and corrosion resistance of Ti-modified AA5083 aluminum alloy for aerospace and automotive applications.

Casting of aluminum with different concentration of alloying elements such as Mg, Mn (similar to that in AA5083) with additional percentages of 0.1, 0.2 and 0.3% Ti, are carried out using graphite crucible. The as-cast microstructure is modified by hot rolling to a thickness of ~ 2 mm. Mechanical and metallurgical and characterization of heat-treated thin sheets are carried out using tensile testing, hardness measurement, metallography, image analysis and optical microscope. By increasing the Ti content, the results show grain refinement and increase in the formation of Al3Ti which reflected positively on the mechanical properties. Specifically, Ultimate tensile strength is increased from 260 MPa (0 wt% Ti) to 345 MPa (0.3 wt% Ti) when using water quenching, 32.6% improvement for air cooling, and 23.3% for furnace cooling. Electrochemical corrosion behavior of heat-treated water quenched, air cooled and furnace cooled samples were tested in 3.5% NaCl solution. The results show that the heat-treated alloys have very good resistance against corrosion, while by increasing the Ti content, the corrosion rate increases due to the grain refinement phenomena.

Evaluation of Adding Lidocaine to Dexamethasone in the Intra-tympanic Injection for Management of Tinnitus: A Prospective, Randomized, Controlled Double-blinded Trial.

OBJECTIVES: Assessment of adding lidocaine to dexamethasone in the intratympanic injections for the treatment of subjective idiopathic tinnitus (SIT). METHOD: A prospective, controlled, randomized, double-blind study of forty-four patients with SIT diagnosed in the Department of Otolaryngology, Tanta University Hospital, a tertiary academic medical centre from March 2015 to October 2016. 44 patients were recruited in the study and were categorized into two groups; (A) included 22 patients managed with ITLD, and (B) included 22 patients managed with intratympanic postoperative ITD injection. Intratympanic injections were double-blind performed three times with one weak interval. After three and six months, the tinnitus improvement was studied using the following parameters: Arabic tinnitus questionnaires (ATQ), loudness matching test and Tinnitus handicap index (THI). RESULTS: The effectiveness rates of ITLD for idiopathic tinnitus reported in the ATQ, THI, and in the loudness matching test were 74.5% in the ITDL group and 50.0%, 50.5%, and 40.0% in the ITD group, respectively. Statistically, there was a significant difference between both groups in 6 months duration. CONCLUSION: ITLD seems to be effective for SIT than ITD alone. The indication of ITLD for tinnitus needs to be limited to specific cases of resistant medical treatment.

Topical blood stopper agents during adenoid surgery in young children; a prospective randomized controlled trial.

OBJECTIVE: To investigate the safety and efficacy of two topical blood stopper modulators; Ankaferd blood stopper (ABS) and feracrylum 1% solution (FS) during adenoid surgery. STUDY DESIGN: Prospective randomized trial. METHODS: Two hundred and twenty five consecutive pediatric adenoid patients aged from 9 months to 2 years old were studied. Patients were randomly allocated into two haemostatic groups; (ABS, FS) and normal saline (control group). RESULTS: ABS and FS groups showed a significantly less intra operative blood loss (16.4 ± 2.6/22 ± 6.2), operative time (9.31 ± 1.9/11.2 ± 1.6 min), use of cautery (10.6/25.3%), postoperative analgesics (3 ± 1.1/3.8 ± 1.2), duration to return normal diet (2.4 ± 1.2/3.9 ± 0.9) and operating theatre cost (233 ± 48$ and 279 ± 40$) than the control group. CONCLUSION: AFS and FS are easy, safe, and reliable topical haemostatic modulators that could be used in adenoid surgery.

Powered versus conventional endoscopic sinus surgery instruments in management of sinonasal polyposis.

To conduct a prospective randomized controlled trial investigating the efficacy and safety of powered versus conventional endoscopic sinus surgery instruments in the management of sinonasal polyposis. Two hundred patients with sinonasal polyposis who failed conservative therapy were included in the study. They were equally randomized into powered and conventional instruments groups. A subjective visual analogue scale (VAS), endoscopic examination, saccharine clearance time and coronal CT were done preoperatively. Intraoperatively, the operative time, the surgical conditions and degrees of dryness of the operative field were carefully rated and recorded. Postoperatively, VAS, polyp grades, saccharine clearance time, the number of endoscopic debridement and time to mucosalization were recorded. Complications, smoothness of postoperative course were reported. Both groups experienced a significant improvement in the VAS with no statistically significant difference in symptom improvement between the two groups except for olfaction where there was significant improvement in the powered group. Similarly, the two groups demonstrated a significant improvement in the objective parameters including polyp grade and saccharine clearance time changes, but no significant difference between the two groups was found. The operative time as well as the surgical conditions and dryness of the operative field score were significantly better in the powered group. There was a tendency for improvement in the number of endoscopic debridement and time to mucosalization in powered group when compared to conventional instruments group, but this did not reach statistical significance. The incidence of postoperative synechiae was significantly lower in powered endoscopic group. Powered endoscopic sinus surgery offers a better therapeutic approach for patients with sinonasal polyposis when compared to endoscopic surgery with the conventional instruments. It provides a bloodless dry operative field with better visualization for a more precise, less traumatic procedure with minimal intraoperative complications and shorter operative time. Additionally, patients have a smoother postoperative course, less incidence of synechiae, with a tendency for a faster healing.

Mitomycin C-enhanced revision endoscopic dacryocystorhinostomy: a prospective randomized controlled trial.

OBJECTIVES: (1) To conduct an adequately powered randomized controlled trial investigating the safety and efficacy of mitomycin C-enhanced revision endoscopic dacryocystorhinostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. STUDY DESIGN: A randomized controlled study. SETTING: General hospital. SUBJECTS AND METHODS: Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mitomycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient's subjective improvement, to judge ostium patency on irrigation, and to record any complications. RESULTS: Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and complete closure of nasolacrimal stoma with tough fibrous tissue (63%). There was no significant difference between the 2 groups in subjective and objective success rates and adverse events. Group I demonstrated a significantly longer operative time and a significantly lower number of debridement sessions (mean of 1.2 vs 1.9). CONCLUSIONS: Recurrent nasolacrimal duct obstruction after primary endoscopic DCR is mainly due to reclosure of the nasolacrimal stoma with synechia and fashioning of the small misplaced bony window. Mitomycin C does not increase the success rate of revision endoscopic DCR. It is a safe procedure and may be of value only in patients inaccessible to strict follow-up because it induces a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.

Endoscopic dacryocystorhinostomy with double posteriorly based nasal and lacrimal flaps: a prospective randomized controlled trial.

OBJECTIVES: To conduct the first prospective randomized controlled trial assessing and comparing the safety and efficacy of endoscopic dacryocystorhinostomy (DCR) with double posteriorly based nasal and lacrimal flaps to conventional endoscopic DCR in adult patients with acquired complete nasolacrimal obstruction. STUDY DESIGN: A prospective randomized controlled study. SETTING: General hospital. SUBJECTS AND METHODS: Seventy-four adult patients with a total of 80 procedures were recruited to undergo endoscopic DCR. They were prospectively equally randomized into 2 groups: endoscopic DCR with flaps (group I) and conventional endoscopic DCR (group II). Regular follow-up settings were done to document the patient's subjective improvement, judge ostium patency on irrigation, and record any complications. RESULTS: Endoscopic DCR with flaps had a higher (92.1%) but nonsignificant difference in success rate when compared with conventional endoscopic DCR (87.4%). There was no significant difference between the 2 techniques in operative time, adverse events, and tolerability of the technique to be done under local anesthesia with minimal sedation. Group I demonstrated a significantly lower number of debridement sessions than did group II. CONCLUSION: Endoscopic DCR with double posteriorly based nasal and lacrimal flaps provides a viable alternative to conventional endoscopic DCR in managing acquired nasolacrimal duct obstructions in adults. It has a comparable success rate, operative time, and safety profile, with a suggestion of a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.

Endocanalicular, high-pressure balloon catheter, endoscopic dacryocystorhinostomy: a randomized controlled trial.

OBJECTIVES: To conduct a prospective randomized controlled study to investigate the safety and efficacy of endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction. STUDY DESIGN: Prospective randomized controlled study. SETTING: General hospital. SUBJECTS AND METHODS: Sixty-six adult patients with a total of 70 procedures were recruited to undergo endoscopic DCR. They were prospectively, equally randomized into 2 groups: endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow-up sessions were conducted to document the patient's subjective improvement, judge ostium patency on irrigation, and record any complications. RESULTS: Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in group I (P < .001). The number of adverse events was significantly higher in group II (P < .05). Group I showed statistically significantly more comfort during surgery under local anesthesia with minimal sedation (P < .05). CONCLUSION: Endocanalicular balloon catheter endoscopic DCR shares the advantages and success rate of conventional endoscopic DCR. In addition, the former is simpler, requires less manipulation, consumes a shorter operative time, has a better safety profile, and can be conducted under local anesthesia with minimal sedation.

Impact of chronic rhinosinusitis therapy on quality of life: a prospective randomized controlled trial.

OBJECTIVES: To conduct the first prospective randomized controlled trial, evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis (CRS) on quality of life. MATERIALS AND METHODS: Ninety patients with CRS, who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche, were randomized either to medical or surgical therapy. All patients underwent pre- and post-treatment assessments of the Sinonasal Outcome Test-20 (SNOT-20), and the Short Form 36 Health Survey (SF-36). Each patient had three assessments: before starting the randomized treatment, after six months and finally after one year. RESULTS: Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 (p<0.05), with no significant difference being found between the medical and surgical groups (p>0.05). CONCLUSION: Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients, providing further evidence that chronic rhinosinusitis should be targeted with maximal medical therapy in the first instance, with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps does not imply any negative effect on the quality of life after CRS therapy, either medical or surgical.

Headscarf pin, a sharp foreign body aspiration with particular clinical characteristics.

The process of wearing head scarf is very complex; girls used to hold a number of pins in the mouth and utilize them one by one to fix the scarf. Loss of concentration results in pin aspiration. We presented our experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem. We reviewed the records of 73 patients who underwent bronchoscopy for scarf pin inhalation during the period from January 1995 to May 2009. The following data were collected, history of aspiration, time lag before presentation, symptoms and signs, radiological findings, bronchoscopic findings, number of repeated bronchoscopy, complications, need for thoracotomy and time of discharge. All patients were female, mean age 13.4 years. The time lag before admission was <12 h for 59 (81%) patients. Positive history was present in all cases. Chest radiography identified the pins in all cases. The foreign bodies were seen in the left bronchial system in 37 (50.7%) patients, in the right bronchial system in another 24 (32.9%), and in the trachea in 12 (16.4%) patients. In 66 (90.4%) patients, the foreign body was removed in the first bronchoscopic trial; a second trial was needed in 5 (6.8%) patients, and thoracotomy was performed in two patients. In conclusion, head scarf pin aspiration occurs in adolescent Islamic girls. The clinical presentation and radiological findings are diagnostic in all cases. Rigid bronchoscopy is the preferred treatment modality. Health education is the key issue in the prevention of this problem.

Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach.

OBJECTIVES: To conduct the first prospective randomized controlled study 1) evaluating the possibility of improving the quality of the operative field and to provide a bloodless functional endoscopic sinus surgery (FESS) in children through total intravenous anesthesia (TIVA) using remifentanil combined with propofol, and 2) testing the safety and efficacy of remifentanil in propofol-TIVA in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. STUDY DESIGN: Randomized controlled trial. SETTING: General hospital. SUBJECTS AND METHODS: Seventy children underwent FESS under hypotensive general anesthesia with equal randomization into two groups. Group I received TIVA with remifentanil, whereas group II had balanced anesthesia (BA) with esmolol. Heart rate, blood pressure, operative time, blood loss, and quality of the surgical conditions were recorded. RESULTS: Intraoperative blood loss in the TIVA group was less than in the BA group. The quality and dryness of the surgical field in both the visual analogue scale and the six-point scale was significantly better in the TIVA group than in the BA group. Hypotension was sustained at the target mean arterial blood pressure of 50 mm Hg in the two groups, without any significant difference. CONCLUSION: Improving the quality of the surgical field and providing a bloodless FESS in children is attainable with TIVA. TIVA using a combination of remifentanil and propofol is superior to BA, even with the use of additional potent hypotensive agents such as esmolol. Both techniques are safe and effective in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg.

Radiophonosurgery of vocal fold nodules.

PURPOSE OF REVIEW: To describe the current support in the literature for radiophonosurgery in cases of vocal fold nodules. RECENT FINDINGS: Radiophonosurgery is a recent innovation in the field of laryngeal surgery. It is emerging as a reliable and practical method for treating benign superficial vocal fold lesions that is increasingly becoming popular. It induces an excellent subjective and objective improvement in voice parameters. Histologically, it produces unremarkable lateral thermal damage and char penetration, which is quite crucial in a functional surgery such as in phonosurgery. Well designed probes are still lacking in the market. SUMMARY: Radiophonosurgery provides a new approach for patients with vocal fold nodules. It combines the advantages of both cold knife and laser phonosurgery and is easy, well tolerated, precise and effective with excellent tactile and hemostatic properties.

Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension.

OBJECTIVES: To assess the efficacy and safety of endoscopic assisted antral window approach in advanced nasopharyngeal angiofibroma with infratemporal fossa extension. MATERIALS AND METHODS: Sixteen cases diagnosed as juvenile nasopharyngeal angiofibroma type III with infratemporal fossa extension were surgically managed using endoscopic assisted antral window approach (group A) and compared with another group of similar number that were managed using endoscopic assisted midfacial degloving (group B). Inclusion criteria were type III JNA with infratemporal fossa extension and a minimum follow-up of 2 years. Operative time, blood loss, adverse events and recurrences were recorded in all cases. RESULTS: The amount of blood lost in group A was significantly less than group B. The operative time of group A was significantly less than group B. No major complications were seen in both groups. Twenty-eight patients showed complete tumor clearance. Four recurrences were seen: two in group A and two in group B. CONCLUSION: Endoscopic assisted antral window approach provides a safe, reliable, effective and minimally invasive technique in management of type III JNA with infratemporal fossa extension. Preoperative embolization is a safe measure in the experienced hands that helps to reduce intraoperative blood loss and improves the quality of the surgical field.

Topical intranasal fluorescein: the missing partner in algorithms of cerebrospinal fluid fistula detection.

OBJECTIVE: The aim of this work was to focus on the development and validation of the use of topical fluorescein in the intraoperative localization of cerebrospinal fluid (CSF) fistulas, and to screen its use in preoperative diagnosis of CSF rhinorrhea as well as postoperative detection of a recurrence. MATERIALS AND METHODS: Twenty-five patients with CSF rhinorrhea were treated with an endoscopic endonasal technique. Topical intranasal 5% fluorescein was used for preoperative diagnosis and intraoperative localization of the site of the leak. A change in the color of the fluorescein from yellow to green fluorescence and sometimes streaming the fluorescein over the nasal mucosa and blood denoted the presence of CSF, and the site of the leak could be traced. RESULTS: The cause of the leak was accidental trauma in 11 patients, spontaneous in 9 patients, and iatrogenic in 5 patients. The ethmoidal roof was the most common site of leak (52%) followed by the cribriform plate (40%) and then the sphenoid sinus (8%). We have achieved 100% success rate in sealing the CSF fistulas in our 25 patients with no recurrence detected during the follow-up period (mean, 19+/-10 months). The preoperative use of fluorescein-soaked cotton pledgets was 100% accurate in diagnosing CSF rhinorrhea when compared with B2 transferrin testing. The intraoperative use of topical intranasal fluorescein was also 100% accurate in locating the site of the CSF fistula when compared with the surgical findings. No major complications have been reported. CONCLUSION: In the presence of a clinically diagnosed CSF leakage, topical fluorescein is a very easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas, and should be considered a viable noninvasive alternative to intrathecal fluorescein. We also recommend its use as a simple and quick outpatient clinic test for preoperative diagnosis of CSF rhinorrhea. It can be used postoperatively as well when there is a doubt of recurrence of the CSF leak.

Radiophonosurgery of benign superficial vocal fold lesions.

OBJECTIVE: To conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of radiosurgical excision of benign superficial vocal fold lesions. MATERIALS AND METHODS: Fifty patients with benign superficial vocal fold lesions (20 vocal nodules, 27 vocal polyps and three Reinke's oedema) who failed conservative therapy were included in the study. They were equally randomized into cold knife or radiosurgical excision. Clinical and voice assessments were done pre-operatively and after surgery. Voice analysis included a subjective visual analogue scale (VAS) and a perceptual assessment with a simplified version of the GRBAS scale (GRB) consisting of G (grade), R (roughness), and B (breathiness). Acoustic voice evaluation included jitter and shimmer. Post-operative voice therapy was provided for all patients. Complications, smoothness of post-operative recovery, and administration of analgesia were reported. RESULTS: Both groups experienced significant improvement in VAS, perceptual evaluation and acoustic analysis after surgery, with no evidence of significant differences between the cold knife and radiofrequency groups. The radiofrequency group showed a decrease of 17 per cent in the mean operative time when compared with the cold knife group, but this was not statistically significant. No evidence of a significant difference was noticed in the smoothness of post-operative recovery, administration of analgesia and complication rate. CONCLUSION: Radiophonosurgery opens a new therapeutic approach for patients with benign superficial vocal fold lesions. It combines the advantages of both cold knife and laser phonosurgery, being easy, safe, precise and effective, and having excellent tactile and haemostatic properties.

Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial.

OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. CONCLUSION: BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

The effect of radiofrequency and mitomycin C on the closure rate of human tympanostomy.

OBJECTIVES: To conduct a prospective, randomized, controlled trial determining the feasibility of radiofrequency with or without topical mitomycin C application in delaying the closure time of human tympanostomy and screening its efficacy in management of recurrent acute otitis media and otitis media with effusion. METHODS: From November 2002 to January 2004, 96 patients (180 ears) who were to undergo surgical intervention for recurrent acute otitis media or otitis media with effusion were included in this study. Sixty ears with a diagnosis of recurrent acute otitis media were equally randomized to three procedures: cold knife myringotomy (Group A), radiofrequency tympanostomy (Group B), and radiofrequency tympanostomy with topical mitomycin C application (Group C). One hundred twenty ears diagnosed as having otitis media with effusion were equally randomized to the last two procedures only. Patients were followed-up every week in the first month, every 2 weeks in the second month, and monthly after that until closure of the tympanostomy. A special follow-up setting was designed 3 months after tympanostomy closure where tympanograms and pure-tone audiograms were obtained. RESULTS: Groups B and C showed a significantly slower rate of closure than Group A. At the same time, Group C demonstrated a slower rate when compared with Group B. The mean closure time of Group B was 3.5 weeks, with no difference between recurrent acute otitis media and otitis media with effusion. In contrast, the mean closure times for Group C were 5.3 and 7 weeks in cases of otitis media with effusion and recurrent acute otitis media, respectively, with the latter demonstrating a significantly slower closure rate. No recurrence of acute otitis media was reported in 10, 45, and 80% of Groups A, B, and C, respectively. Fifty-nine percent of Group C showed no clinical or tympanometric signs of otitis media with effusion 3 months after closure of tympanostomy. In contrast, Group B reported a lower cure rate (28%), with a statistically significant difference between both groups. Absence of recurrence and improvement in tympanometry signs correlated significantly with the duration of patency of tympanostomy (p < 0.01). The success rate was higher in patients who underwent adenoidectomy, but this did not reach statistical significance except in Group C (p < 0.01). CONCLUSION: Radiofrequency and mitomycin C delay the closure rate of human tympanostomy. The efficacy of mitomycin C seems to be amplified in the presence of an inflamed tympanic membrane. Radiofrequency-assisted mitomycin-enhanced tympanostomy is a precise, safe, and cost-effective procedure that provides a viable approach in the management of recurrent acute otitis media and otitis media with effusion, especially when used in conjunction with adenoidectomy.

Telescopic-assisted radiofrequency adenoidectomy: a prospective randomized controlled trial.

OBJECTIVES/HYPOTHESIS: The objective was to conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of transoral telescopic-assisted radiofrequency adenoidectomy in young children. STUDY DESIGN: Prospective randomized controlled trial. METHODS: One hundred twenty patients who were 36 months of age or less and planned to undergo adenoidectomy or adenoidectomy with insertion of tympanostomy tubes were included in the study. Children were prospectively and randomly assigned into two equal treatment groups: the telescopic-assisted adenoidectomy using radiofrequency curette and the conventional adenoid-curette adenoidectomy. The main parameters included visual analogue scale score for nasal breathing, amount of blood loss, operating time, completeness of adenoid resection, smoothness of postoperative recovery, and complications. RESULTS: Both groups had a significant improvement in the visual analogue scale score after surgery with no evidence for a significant difference between the conventional adenoid-curette and radiofrequency groups. The amount of blood lost during radiofrequency adenoidectomy was minimal, with a mean difference of 31 mL and a median difference of 26 mL. There was a tendency for shorter operative time in the radiofrequency group, but this did not reach a statistical significance. No evidence for a significant difference was noticed in the smoothness of postoperative recovery or complication rate. CONCLUSION: Telescopic-assisted radiofrequency-curette adenoidectomy allows removal of huge adenoids completely in a precise, easy, and cost-effective procedure, with minimal blood loss and short operating time. The use of transoral telescopes provides a clear visualization that helps complete removal of the adenoids, reduction of unnecessary trauma, and effective control of bleeding.

Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial.

OBJECTIVES: To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS). MATERIALS AND METHODS: Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre- and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test-20 (SNOT-20), the Short Form 36 Health Survey (SF-36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year. RESULTS: Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS (P <.01), with no significant difference being found between the medical and surgical groups (P >.05), except for the total nasal volume in CRS (P <.01) and CRS without polyposis (P <.01) groups, in which the surgical treatment demonstrated greater changes. CONCLUSION: CRS should be initially targeted with maximal medical therapy (e.g., a 3 month course of a macrolide antibiotic, douche, and topical steroid), with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps is not a poor prognostic factor for the efficacy of CRS therapy, either surgical or medical.