Qualitative development of the sinus control test: a survey evaluating sinus symptom control.

BACKGROUND: Ideal management of chronic rhinosinusitis (CRS) requires ongoing monitoring of disease and its control. Existing control instruments are limited in their correlation to patient reported outcomes, the need for endoscopy, or lack of validation from a multidisciplinary group. The goal of this study was to develop a patient-based Sinus Control Test (SCT) for determining CRS control. METHODS: A systematic literature review and focus groups consisting of 20 patients and 11 medical experts in CRS from various medical specialties were used to generate items. A draft 13-item questionnaire was administered to 50 patients with CRS in a prospective fashion. Patients were evaluated using the 22-item Sino-Nasal Outcome Test (SNOT-22) instrument, Lund-Mackay computed tomography (CT) score, and Lund-Kennedy endoscopy score. A rhinologist blinded to the questionnaire results also provided an overall control of the disease for each patient. A regression model was generated to identify which subset of items showed the greatest discriminate ability in relation to specialist's and patient's global rating of disease control. RESULTS: Four questions were included in the final questionnaire (p < 0.05), each with a scale of 0 to 4, with an overall total score ranging from 0 to 16. Optimal classification resulted in patients with a score from 1 to 3 (well controlled), 4 to 11 (partially controlled), and 12 to 16 (uncontrolled). SCT scores correctly classified control levels 72% of the time when compared to physician's assessment. CONCLUSION: The SCT is a simple, patient generated questionnaire that can measure the control of CRS without requirement of endoscopy or CT evaluation.

Maxillary air cyst.

Pathologic dilatation of the maxillary sinus by air is a rare condition with unclear etiology. We present a case of a 17 year old male with a maxillary air cyst diagnosed by computed tomography. The CT demonstrated air-filled expansion of the maxillary sinus beyond the normal anatomical limits with associated cortical bone thinning. The case report highlights the pathognomonic computed tomography findings of this rare entity and discusses the perplexing nomenclature, proposed etiologies and various treatment options.

Apnea and oxygen desaturations in children treated with opioids after adenotonsillectomy for obstructive sleep apnea syndrome: a prospective pilot study.

BACKGROUND: Recent case reports have alerted the medical community of fatality in children receiving codeine after tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome. OBJECTIVE: The objective of this study was to compare the rates of oxygen desaturation before and after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS), and to examine the relationship between cytochrome P450 2D6 (CYP2D6) genotype and respiratory events. STUDY DESIGN: This was a prospective observational study. METHODS: Twenty-six children with OSAS (mean age 78 months, range 1.8-17 years) who underwent adenotonsillectomy were studied. CYP2D6 genotype was characterized in 21 of these children. The primary endpoints of the study were the change in the rate of desaturation and in the nadir oxygen saturation values before and in the first 24 hours after surgery as measured by pulse oximetry. RESULTS: Twenty-two children received codeine and four were managed with hydrocodone. There was no post-operative improvement in the mean rate of desaturation (1.84 ± 1.45/hour pre-operative vs 2.97 ± 3.3/hour post-operative; p = 0.119; 95% CI -2.56, 0.313), or the post-operative nadir of oxygen saturation (85.2 ± 5.8% pre-operative vs 84.0 ± 6.8% post-operative; p = 0.632; 95% CI -3.00, 4.84) on the night after surgery. Prior to surgery, six children had an oxygen saturation nadir <80%, while post-surgery, the number increased to eight children. Ten children improved their parameters after surgery. CYP2D6 genotype by itself did not predict the changes in desaturation or nadir. CONCLUSION: Post-operative use of opioids following OSAS may not be safe for all children. It is conceivable that if the child is among the significant proportion that experiences increased oxygen desaturations, the CNS depressing effects of codeine or hydrocodone and their respectively potent morphine or hydromorphone metabolites can further compromise respiratory drive. Larger studies are needed to investigate the potential contribution of CYP2D6 genotype.

Staple-assisted endoscopic management of Zenker's diverticula: a role in the geriatric population.

Endoscopic stapling technique (modified Dohlman procedure) for treatment of hypopharyngeal diverticula (Zenker) has been shown to produce outcomes similar to open techniques but with shorter operating times and shorter hospitalization.

Tactile dysgeusia: a new clinical observation of middle ear and skull base surgery.

OBJECTIVE: To describe a new clinical observation of "tactile dysgeusia," a phenomenon associated with otologic and skull base surgery likely caused by injury to the chorda tympani nerve (CTN) or the nervus intermedius (NI) with subsequent aberrant cross-innervation with somatosensory fibers in the surgical field. STUDY DESIGN: Descriptive case series. SETTING: Tertiary university referral center. METHOD: Eight patients described a sensation of touch-evoked dysgeusia after surgery. Seven patients underwent a variety of middle ear procedures including stapedotomies and mastoidectomies. One patient had a large cerebellopontine angle meningioma excised through a translabyrinthine approach. There were no preoperatively sensory symptoms of any kind. RESULTS: In five of seven patients who had an otologic procedure, the CTN nerve was transected, whereas in the remaining two, the nerve was preserved but stretched. In the meningioma patient, the facial nerve was preserved without clear identification of the NI; the facial nerve function was normal postoperatively. All of the otologic patients experienced symptoms of dysgeusia and sensory alteration triggered by touching various parts of the outer ear. One also has a secondary trigger in the V2 dermatome. In the meningioma patient, taste and sensory alteration was induced by stimulating the ipsilateral V2 and V3 dermatome. In all patients, the symptom was located in the lateral aspect of the ipsilateral hemitongue. CONCLUSION: Tactile dysgeusia is an unusual complication after otologic and neurotologic procedures. It is likely related to aberrant re-innervation of the special sensory fibers within the CTN nerve or the NI with somatosensory fibers. Postoperative "tactile dysgeusia" may not be so rare; its true incidence could only be ascertained through a more rigorous postoperative assessment.