Subjective and objective parameters in the evaluation of radiofrequency ablation of the inferior turbinate do not correlate: A pilot study.

Inferior turbinate hypertrophy is a common cause of nasal obstruction. We conducted a prospective study to correlate subjective and objective parameters in assessing the effectiveness of radiofrequency ablation (RFA). Our initial study population was made up of 10 patients who presented with nasal obstruction; 1 patient was lost to follow-up, leaving us with 7 women and 2 men, aged 26 to 65 years (mean: 37.9 ± 12.8), and 16 turbinates (7 bilateral, 1 right, and 1 left). Visual analogue scale (VAS) scores, Nasal Obstruction and Symptom Evaluation (NOSE) questionnaire scores, rhinomanometry results, and CT- and MRI-based volumetry were obtained before RFA and 6 months afterward. For the subjective parameters, the mean pre- and postoperative VAS scores for the 16 turbinates were 6.6 ± 1.6 and 2.8 ± 2.0 (p < 0.001), respectively, and the mean pre- and postoperative NOSE scores in the 9 patients were 15.3 ± 3.1 and 5.8 ± 5.4 (p = 0.003). For the objective parameters, the mean pre- and postoperative rhinomanometry values at 150 Pa were 241.0 ± 141.3 and 265.4 ± 157.3 ml/sec (p = 0.403), and the mean pre- and postoperative volumetry values were 5.3 ± 2.5 and 5.0 ± 2.1 cm(3) (p = 0.551). Note that only the differences in the subjective parameters reached statistical significance. RFA of the inferior turbinates as a treatment for nasal obstruction is safe and easy. However, our study found a discrepancy between the subjective and objective outcomes parameters, as the former showed highly significant improvement and the latter showed only a slight improvement that did not reach statistical significance.

Sudden unilateral hearing loss as first sign of cerebral sinus venous thrombosis? A 3-year retrospective analysis.

INTRODUCTION: Recently, several studies and case reports have dealt with the topic of cerebral sinus venous thrombosis (CSVT) and focused on sudden hearing loss as an early and rare symptom, to diminish the delay in diagnosing this serious disease. MATERIALS AND METHODS: We conducted a retrospective analysis over 3 years and investigated MRIs of all inpatients who were treated for sudden sensorineural hearing loss. The aim of the study was to evaluate whether sudden hearing loss could be an early indicator, or the first sign, of CSVT. RESULTS: In total, 554 patients were included. Only 2 patients with CSVT could be identified. In both, sudden unilateral sensorineural hearing loss was not the only symptom. They also reported headache, and 1 patient also reported tinnitus and vertigo. CONCLUSION: In our opinion, sudden unilateral sensorineural hearing loss alone is not a reliable indicator of CSVT. In combination with headache or visual impairment, this rare vascular disease should be taken into account.

Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: a safe treatment option?

OBJECTIVE: Septic thrombosis of the sigmoid and lateral sinus is a rare complication of acute otitis media, mastoiditis and cholesteatoma. Hence, the aim of this chat review was to analyze the demographics, presenting symptoms, diagnosis, and therapeutic management of otogenic sigmoid sinus thrombosis. Especially the role of low molecular weight heparin in the therapy of septic intracranial sinus thrombosis in children should be illuminated. METHODS: A retrospective chart review was performed. RESULTS: Six patients were included in this trial. One patient was treated completely conservatively. All other patients underwent surgical treatment consisting of mastoidectomy (n=5), additional thrombectomy (n=3) and ligation of the internal jugular vein (n=2). All patients received intravenous antibiotics and anticoagulants. Unfractionated heparin was administered for three days after surgery followed by an anticoagulant therapy with low-molecular weight heparin for three months. The activated partial thromboplastin time (aPTT) and the anti-factor-Xa-plasma-levels were monitored during anticoagulation in short term intervals. There were no complications related to the anticoagulant therapy. Recanalization was found in all patients who were treated without thrombectomy or ligation of the internal jugular vein and in the case of complete conservative treatment. CONCLUSION: Simple mastoidectomy combined with broad spectrum antibiotics is the therapy of choice. Our results indicate that anticoagulants represent a safe treatment option if they are administered correctly.

Misdiagnosis of acute peripheral vestibulopathy in central nervous ischemic infarction.

INTRODUCTION: Vertigo is a very common symptom at otorhinolaryngology (ENT), neurological, and emergency units, but often, it is difficult to distinguish between vertigo of peripheral and central origin. PATIENTS AND METHODS: We conducted a retrospective analysis of a hospital database, including all patients admitted to the ENT University Hospital Graz after neurological examination, with a diagnosis of peripheral vestibular vertigo and subsequent diagnosis of central nervous infarction as the actual cause for the vertigo. Twelve patients were included in this study. RESULTS: All patients with acute spinning vertigo after a thorough neurological examination and with uneventful computed tomographic scans were referred to our ENT department. Nine of them presented with horizontal nystagmus. Only 1 woman experienced additional hearing loss. The mean diagnostic delay to the definite diagnosis of a central infarction through magnetic resonance imaging was 4 days (SD, 2.3 d). CONCLUSION: A careful otologic and neurological examination, including the head impulse test and caloric testing, is mandatory. Because ischemic events cannot be diagnosed in computed tomographic scans at an early stage, we strongly recommend to perform cranial magnetic resonance imaging within 48 hours from admission if vertigo has not improved under conservative treatment.

Management of otogenic sigmoid sinus thrombosis.

OBJECTIVES: To analyze the demographics, presenting symptoms, diagnosis, and management of otogenic sigmoid sinus thrombosis and to propose an algorithm in diagnosis and treatment. METHODS: A retrospective chart review was performed. Six patients who were treated at the ENT University Hospital Graz between 2005 and 2010 were included. RESULTS: The mean age of the patients was 11.7 years. Patients were experiencing symptoms for 9.8 days on average. Presenting symptoms were headache, neck stiffness, fever, otalgia, postauricular pain, and erythema. One patient presented with sixth nerve palsy. The otoscopic findings were abnormal in all cases. Computed tomography with contrast enhancement was performed in all patients. It was possible to detect the thrombosis in all cases with computed tomographic scans after contrast administration. An additional magnetic resonance imaging was performed in 3 patients. One patient was treated completely conservatively. All other patients underwent surgical treatment consisting of mastoidectomy. Additional thrombectomy was performed in 3 patients, and ligation of the internal jugular vein was performed in 2 of these 3 patients. All patients were administered intravenous antibiotics and anticoagulants. There were no complications related to the therapy. Recanalization was found in all patients who were treated without thrombectomy or ligation of the internal jugular vein and in the patient with complete conservative treatment. CONCLUSION: Otogenic sigmoid sinus thrombosis is a rare complication of otitis media. Early treatment with broad-spectrum antibiotics combined with simple mastoidectomy is the standard treatment. Anticoagulants represent a safe treatment option if they are administered correctly.

Breast Cancer Metastases of the Left Occipital Condyle Diagnosed through Extended Mastoidectomy: Case Report.

Skull base metastases are rare conditions. Usually breast or prostate cancers are responsible primary tumors. Definite diagnosis can only be obtained through biopsies. We report the first case of breast cancer metastases into left occipital condyle, which was biopsied successfully through radical extended mastoidectomy under computer-assisted intraoperative navigation. This access proved to be feasible and safe, and enough material could be obtained for histological examination. According to the result, optimal adjuvant treatment strategies could be planned.