[Diagnosis and treatment of subperiosteal orbital abscess].

Subperiosteal orbital abscess is a complication of acute bacterial sinusitis. In this review, we summarise the theoretical background and highlight the importance of a fast diagnostic workup. The treatment of acute sinusitis with involvement of an eye is antibiotic therapy and daily evaluation by both an ophtalmologist and a rhinologist. In case of clinical stagnation and/or formation of an abscess, surgery is the treatment of choice.

Subjective tiredness does not correlate with the Apnoea-Hypopnoea Index.

INTRODUCTION: Sleepiness is a frequent complaint and might be a symptom of obstructive sleep apnoea. Our aim was to examine if patient-reported tiredness on either the Epworth Sleepiness Scale or on a visual analogue scale was associated with the Apnoea-Hypopnoea Index. METHODS: We conducted a retrospective database study on 215 patients referred on suspicion of obstructive sleep apnoea. Before cardiorespiratory monitoring, all patients answered the Epworth Sleepiness Scale Questionnaire and rated their tiredness on a visual analogue scale. RESULTS: No correlation was found between the Apnoea-Hypopnoea Index and the Epworth Sleepiness Scale (Spearman's ρ = 0.02) or the visual analogue scale of tiredness (ρ = -0.04). This also applied for a subgroup of patients with an Apnoea-Hypopnoea Index score > 15. CONCLUSIONS: Monosymptomatic patient-reported tiredness should not raise suspicion of obstructive sleep apnoea. Conversely, if obstructive sleep apnoea is suspected, a lack of tiredness should not postpone further evaluation. FUNDING: none. TRIAL REGISTRATION: not relevant.

10-year-old with concha bullosa pyogenic mucocele.

A 10-year-old girl presented with episodes of migraine. A nasal mass was found randomly during work-up. Interpreted as an osteoma, the mass was removed during endoscopic surgery. However, the histopathological examination turned out to be a pyomucocele in the right middle turbinate, which is an extremely rare yet benign condition in children.

[Treatment of recurrent posterior epistaxis].

30% of the patients presenting with epistaxis at emergency wards and otorhinolaryngeal specialist departments have posterior bleeding. Traditional treatment with packing often leads to initial treatment failure, and many patients experience recurrent bleeding within the following month. Recurrent posterior epistaxis should be treated with local electrocautery or endoscopic ligation of the sphenopalatine artery to reduce patient discomfort, hospital stay, risk of treatment failure and recurrence.

Role of narrow band imaging in the diagnostics of sinonasal pathology.

Malignancies of the nasal cavity and paranasal sinuses are well known, but have uncommon presentations. Late diagnosis and local extension are significant prognostic factors associated with a poorer treatment outcome. Thus, refinements of the diagnostic procedures to enhance the sensitivity of the clinical evaluation are desirable. We here describe a case of endonasal lymphoma, in which the lesion was hardly visible and initially ignored at ordinary white light (WLI) nasoendoscopy, but easily recognisable, clearly pathogenic and well demarcated when illuminated with narrow band imaging (NBI) at a later session. In general, with regard to mucosal-derived pathology of the upper aerodigestive tract, the diagnostic gain of NBI-assisted endoscopy in comparison with that of WLI has been proved in several articles. The focus has however been on neoplasm in laryngopharynx and oesophagus. The authors recommend broadening the use of NBI to include all evaluations of nasal mucosa, when malignancy is suspected.