Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients.

OBJECTIVE: Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated disease-specific questionnaire for the assessment of Nasal Obstruction (NO). The aim of this study was to validate the Greek-NOSE questionnaire. STUDY DESIGN: Prospective instrument validation study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: NOSE questionnaire was translated into Greek and then translated back into English. A prospective study was conducted on adult patients with NO due to septal deviation (SD). Test-retest evaluation of SD patients was carried out. Internal consistency was assessed with Cronbach's alpha test and test-retest reliability with Pearson's test (correlation), kappa (reproducibility), and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores of a control group of volunteers without NO to preoperative scores of SD patients undergoing septoplasty with Mann-Whitney test. Responsiveness was assessed by comparing preoperative to 3 months postoperative scores of SD patients with paired t test and evaluating the magnitude of surgery effect. RESULTS: Test-retest evaluation was accepted on 109 patients. The Greek-NOSE had good internal consistency (Cronbach's alpha 0.74 for test and 0.76 for retest). All its items were significantly correlated between test and retest evaluation. NOSE showed high reproducibility (mean kappa: 0.75), and almost all differences in Bland-Altman plot were between agreement thresholds. Controls (123 volunteers) had significant lower score. Postoperative scores were significantly lower than preoperative, and magnitude of surgery effect was high, both indicating good responsiveness. CONCLUSION: The Greek-NOSE questionnaire is a valid instrument with satisfactory internal consistency, reliability, reproducibility, validity, and responsiveness.

Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy?

The objective of this study is to assess the impact of perioperative dexamethasone on post-thyroidectomy voice outcomes. This study is a retrospective review of prospectively collected data in a tertiary referral center. This is a retrospective analysis of prospectively collected data on adult patients undergoing total thyroidectomy. Exclusion criteria were: previous neck surgery, thyroid lobectomy, neck dissection or other procedure together with thyroidectomy, pathological findings on laryngeal examination, preoperative or postoperative steroid therapy, diabetes mellitus, pregnancy, and postoperative recurrent laryngeal nerve palsy. In all patients, flexible laryngoscopy was performed and Voice Handicap Index (VHI) scores were obtained the day before, 48 h and 1 month after surgery. Patients' medical records were reviewed to find the patients who had received dexamethasone by the anesthesiologist as nausea and vomiting prophylaxis or analgesia. Thus, two groups of patients were formed: dexamethasone (D) group and non-steroid (NS) group. Mann-Whitney test used to compare VHI between the two groups. 122 patients fulfilled the criteria. D group consisted of 50 patients (44 females; mean age 53.16 ± 17.61), in which a single IV dose of 8 mg dexamethasone had been administered perioperative, and NS group consisted of 72 patients (58 females; mean age 50.53 ± 13.60), where no steroids had been administered. No significant difference was noticed between D and NS groups for preoperative VHI score, VHI scores 48 h and 1 month after surgery. In our study, a single perioperative IV dose of 8 mg dexamethasone did not seem to add any benefit on voice-related quality of life after thyroid surgery.

The sino-nasal outcome test (SNOT)-22: validation for Greek patients.

The aim of this study was to perform translation, cross-cultural adaptation, and validation of the sinonasal outcome test 22 (SNOT-22) in the Greek language. SNOT-22 was translated into Greek. A prospective study was conducted on adult patients with chronic rhinosinusitis (CRS) according to rhinosinusitis and nasal polyps (EPOS) criteria. Test-retest evaluation of the patients was carried out. Internal consistency was assessed with Cronbach's alpha test, and test-retest reliability with Pearson's test (parametric correlation coefficient), kappa (reproducibility) and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores between a control group of volunteers without CRS and the CRS group using Mann-Whitney test. Responsiveness was assessed on CRS patients who underwent surgery, by comparing preoperative to 3 months postoperative scores with paired t test. Furthermore the magnitude of surgery effect was evaluated. Test-retest evaluation was accepted in 64 patients. Cronbach's alpha was 0.84 and 0.89 at test and retest, respectively, suggesting good internal consistency. Pearson's correlation coefficient was 0.91 (p < 0.001), revealing good correlation between initial and retest scores. Mean kappa value was 0.65, indicating a high level of reproducibility, while in Bland-Altman plot the differences were located between agreement thresholds. The control group consisted of 120 volunteers. Mann-Whitney test showed a statistically significant lower score for the control group (p < 0.0001). 32 CRS patients underwent surgical treatment. Postoperative scores were significantly lower than preoperative (p < 0.0001) while the magnitude of surgery effect was considered high. Greek SNOT-22 is a valid instrument with good internal consistency, reliability, reproducibility, validity and responsiveness.

Reversible facial nerve palsy due to parotid abscess.

INTRODUCTION: A facial nerve palsy combined with parotid enlargement usually suggests malignancy. It is highly unusual for facial nerve palsy to result from a benign situation such as inflammation or infection of the gland. PRESENTATION OF CASE: We present a rare case of facial nerve palsy due to parotid abscess. DISCUSSION: A literature search retrieved thirty-two cases of facial nerve palsy due to benign parotid lesions since 1969. Only nine reported the presence of a parotid abscess. The etiology of paralysis remains unknown although certain factors such as the virulence of the offending organisms or perineuritis, have been suggested. Best diagnostic evaluation and management are discussed. CONCLUSION: In clinical practice, exclusion of malignancy is mandatory, as it represents the most common cause of facial palsy in the presence of a parotid lump.

An inflammatory pseudotumour of the larynx: a case report and literature review of an unusual tumour.

BACKGROUND: Inflammatory pseudotumour (IPT) is a rare benign pseudoneoplastic proliferation of unknown etiology, often showing locally aggressive behaviour. Conflicting theories about exaggerated response to injury versus true neoplastic origin have been suggested. METHODS: We report a case of laryngeal pseudotumour in a 73-year-old man presenting with hoarseness and slowly progressive dyspnea and a short review of the English language literature on the subject. RESULTS: Management consisted of midline vertical thyrotomy, excision of the tumour, and a temporary tracheotomy. No recurrence observed eight months postoperatively. CONCLUSIONS: Laryngeal IPT is extremely rare, and it may easily be misinterpreted as a malignant tumour. Conservative excision and anti-inflammatory therapy are advocated, since its general behaviour is benign.

Superior thyroid cornu anatomical variation causing globus pharyngeous and Dysphagia.

Objective. Rare case presentation of thyroid cartilage variation causing globus sensation and dysphagia. Method. Case report and review of the literature concerning thyroid cartilage variant of clinical significance. Results. Middle-aged male patient presented with globus sensation and painful swallow without previous injury of the larynx. Clinical examination and diagnostic procedures revealed a rare anatomic aberrance of the thyroid cartilage. Surgical treatment was declined by the patient who accepted a yearly followup. Conclusion. Morphometric studies do not report the dislocation of the superior thyroid cornu, and very few cases have been described either of which were attributed to trauma or to unknown cause. The present case is to be added to the very few cases of superior thyroid cornu dislocation of unknown aetiology. Clinicians should be aware of this rare variation using CT neck as the imaging study of choice. Direct endoscopy rules out any synchronous disease or malignancies.

Case of perilymphatic fistula caused by medially displaced tympanostomy tube.

OBJECTIVE: We present a rare case of perilymphatic fistula which occurred due to bony erosion by a tympanostomy tube that had migrated into and become interred in the middle-ear space. METHOD: We present a case report and a literature review concerning migration of tympanostomy tubes into the middle ear as a complication of tubes insertion. CONCLUSION: Medial migration of tympanostomy tubes into the middle-ear space is a rare complication of tympanostomy tubes insertion. To our knowledge, this is the first report of perilymphatic fistula caused by a tympanostomy tube which had migrated into the middle ear. This case highlights the need for early removal of tympanostomy tubes which migrate into the middle ear.

Optimal time for nasal packing removal after septoplasty. A comparative study.

OBJECTIVE: The objective of this study was to evaluate the efficacy and subjective discomfort of one-day internal dressing compared to that of two-day in patients undergoing nasal septal surgery. STUDY DESIGN/METHODS: Prospective, randomized, clinical trial conducted on 75 patients undergoing septoplasty in a tertiary ENT clinic. Discomfort caused by nasal dressings was evaluated by means of a visual analog scale. Postoperative complications were also compared. RESULTS: Mean discomfort score for group A (nasal packing for 48 hours) was 3.5 (SD 1.15) vs. 2.7 (SD 1.52) for group B (nasal packing for 24 hours). Significant lower discomfort is reported when the nasal packing is removed the first day instead of after two or more days. No increase in complication rate was noticed. CONCLUSION: Our results point out that one-day internal nasal dressing is preferable to that of two or more days, because of less patient discomfort and increased cost-effectiveness without increasing immediate complications.

In vitro enzymatic treatment and carbon dioxide laser beam irradiation of morphologic cartilage specimens.

OBJECTIVES: To determine the role of the main cartilage components in the internal system of interlocked stresses and to clarify the effect of laser beam irradiation on cartilage. DESIGN: Control and experimental series. SUBJECTS: Rabbit ear cartilage. INTERVENTION: Rabbit ear cartilage strips incubated in collagenase and hyaluronidase enzyme solutions for specific periods were examined, and the observed changes in shape, strength, and elasticity were recorded, as well as the effect of carbon dioxide laser irradiation. Laser-pretreated cartilage strips were also incubated in the enzyme solutions to determine whether the laser-provoked changes were susceptible to enzymatic action. All cartilage pieces were examined by light and electron microscopy. RESULTS: Collagenase-treated cartilage strips gradually lost their interlocked stresses, while hyaluronidase-treated strips mostly maintained their shape and their physical characteristics. Hyaluronidase-incubated cartilage strips altered their shape when they were laser treated. Collagenase-treated cartilages did not modify their shape when they were laser treated. Laser-pretreated cartilage pieces lost their new form in collagenase solutions but kept their laser-evoked shape when put in hyaluronidase solutions. CONCLUSION: The macroscopic observations combined with light and electron microscopy findings argue for the distinct role of the collagen network in morphologic cartilage shape and tensile strength preservation and provide a probable mechanism of cartilage transformation owing to carbon dioxide laser irradiation.

Osteoid osteoma of the ethmoid bone associated with dacryocystitis.

BACKGROUND: Osteoid osteomas (OO) are small, benign osteoblastic lesions. Ethmoid bone OO has been very rarely reported so far. CASE PRESENTATION: We report a case of a 16-year-old boy suffering from persistent epiphora and a mild pain in the area of median canthus, due to a bone density mass within the right ethmoid air cells extending to the ipsilateral right orbit. The mass was removed via an external ethmoidectomy approach. Histopathologic examination of the specimen set the diagnosis of OO. One year after the operation the patient is free of symptoms, while no recurrence occurred. CONCLUSION: A case of ethmoid bone OO associated with dacryocystitis is reported. Although benign and rare, OO should be considered in differential diagnosis of the ethmoid bone osteoblastic lesions.

Primary nasal non-Hodgkin lymphomas presented initially as benign disease.

BACKGROUND: Primary non-Hodgkin lymphomas (NHLs) of the sinonasal tract comprise a rare entity that constitutes 1.5% of all NHLs and 2.2% of extranodal lymphomas in the whites. Clinical diagnosis may be very challenging because of the variety and low specificity of the presenting symptoms and signs. METHODS-RESULTS: We present three cases of NHLs, initially diagnosed as benign diseases. All three cases have been eventually correctly diagnosed and treated in our hospital between January 2000 and December 2003. The patients have been under close follow-up from 11 to 36 months after the initial treatment. One of them remains without clinical or radiological evidence of recurrence, whereas the two others died 11 and 16 months after the initial diagnosis. CONCLUSION: It is important to underline that atypical or persistent symptoms of rhinosinusitis may represent the initial expression of a more serious condition such as deep fungal infection, vasculitis, lymphoma, or other malignancy.

Canal wall down mastoidectomy for cholesteatoma: experience at the University of Crete.

OBJECTIVE: To evaluate clinical and audiologic data as well as operative findings and postoperative follow-up in the management of chronic cholesteatomatous otitis media with canal wall down mastoidectomy (CWDM). STUDY DESIGN: A retrospective review of cases followed up between 1990 and 2002. SETTING: Tertiary referral centre. METHOD: Two hundred one patients with chronic otitis media with cholesteatoma underwent CWDM. MAIN OUTCOME MEASURES: Clinical presentation, surgical findings, and audiologic evaluation were assessed. RESULTS: Preoperatively, eight patients suffered from vertigo and four presented with facial nerve paralysis. In 40 patients (20%), erosion of the lateral semicircular canal was found, and in 31 patients (15%), there was dehiscence of the facial nerve canal. Dural plate erosion and sinus plate dehiscence were found in 13 and 17 patients, respectively. Nine patients experienced serious endocranial complications at their admission. The malleus was noted to be intact in the majority of patients in all age groups. The incus was eroded or absent in most of the cases in all age groups. On postoperative evaluation 3 months after surgery, 195 audiograms were performed, with a mean pure-tone average of 55 dB HL and a mean air-bone gap of 30 dB HL. CONCLUSION: Although CWDM has the disadvantages of the necessity to avoid water insertion in the external auditory canal and lifelong mastoid care, it is an effective treatment in a single-step procedure for patients with advanced disease and for those who refuse to submit to postoperative follow-up.

Bilateral sudden sensorineural hearing loss caused by Charcot-Marie-Tooth disease.

Charcot-Marie-Tooth (CMT) disease or hereditary motor and sensory neuropathy (HMSN) is a relatively common neurological syndrome, which has seldom been associated with hearing dysfunction, particularly sudden sensorineural hearing loss (SNHL). Families with autosomal dominant, autosomal recessive and X-linked forms of inheritance have been described. Sudden sensorineural hearing loss is a frustrating and frightening condition, especially if the hearing loss is bilateral. Regarding the site of the lesion, the evidence from the literature on HMSN suggests that either the VIIIth nerve or central auditory pathways are primarily involved in patients with hearing loss. We report the first case in the English literature of a patient with Charcot-Marie-Tooth type II disease presenting bilateral SNHL in the course of his disease. The patient was hospitalized for 15 days, and undergoing treatment without any audiological improvement. Detailed clinical, audiological and laboratory examination was performed. The aetiology and prognostic indicators of bilateral SNHL are discussed, as well as, the incidence of hearing loss in CMT patients.

The role of laser assisted tympanostomy (LAT) in treating allergic children with chronic serous otitis media.

OBJECTIVES: To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure. METHOD: Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters. RESULTS: Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome (P < 0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome (P < 0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome. CONCLUSION: A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail.

Palate ulcer due to mucormycosis.

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence. A case of deep hard palate ulcer due to sinonasal mucormycosis in a 79-year-old man is reported. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks. By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers.