Treatment of rhinosinusitis and histopathology of nasal mucosa: A controlled, randomized, clinical study.

OBJECTIVES/HYPOTHESIS: To study the pathology of upper airway mucosa, as well as valuate and compare changes in pathology after the treatment of chronic rhinosinusitis (CRS) patients with balloon sinuplasty versus uncinectomy. METHODS: A prospective randomized controlled trial in patients with CRS of the maxillary sinuses without severe pathology of other sinuses. Patients were randomized into two groups: uncinectomy and balloon sinuplasty. The main variables in our study are histopathology of nasal mucosa and expression of metalloproteinase-9 protein. These parameters were analyzed preoperatively and at 3 months, 6 months, and 12 months postoperatively. RESULTS: Thickened epithelium, absence of cilia, metaplasia of epithelium, hyperplasia of mucosal glands, angiogenesis, and increased inflammatory cells were observed in the majority of preoperative samples. History of allergy was associated with a higher number of goblet cells, and shedding of epithelium was associated with worse quality of life. A higher number of inflammatory cells were associated with an increased number of goblet cells preoperatively, as well as after treatment. Both treatments resulted in a decrease of inflammation in the mucosa and epithelium. Hypertrophy of the mucosal glands, hyperplasia of blood vessels, and mucosal edema decreased after treatment. These changes were more noticeable in uncinectomy group. Balloon sinuplasty was associated with a higher number of inflammatory cells at 6 months after treatment (P = 0.05). LEVEL OF EVIDENCE: 1b. Laryngoscope, 126:2652-2658, 2016.

A Controlled, Randomized Clinical Study on the Impact of Treatment on Antral Mucociliary Clearance: Uncinectomy Versus Balloon Sinuplasty.

OBJECTIVES: To find out the effect of minimal invasive sinus surgery and balloon sinuplasty on mucociliary clearance and compare different methods of measuring mucociliary clearance. METHODS: Twenty-nine patients with chronic rhinosinusitis were randomized in 2 operative groups (uncinectomy or balloon sinuplasty). Before and 6 months after the treatment, patients filled out a quality of life questionnaire (Sino Nasal Outcome Test-22 [SNOT-22]), and mucociliary clearance was measured with endoscope and gamma camera after 0.03 ml of saccharine, methylene-blue dye, and human albumin labeled with Tc99m was introduced to the bottom of maxillary sinuses. RESULTS: In uncinectomy group, SNOT-22 score decreased, but treatment had no effect on mucociliary clearance. Based on saccharine test, smoking was associated with worse mucociliary clearance (r = 0.618, P < .05). Methylene blue test results associated with saccharine test (r = 0.434, P < .05) and Tc99m-labeled tracer technique (r = 0.261, P = .039) separately. CONCLUSION: Treatment positively affects patients' quality of life; however, it has no effect on mucociliary clearance. There was a statistically significant correlation between the Tc99m-labeled tracer technique and the methylene blue technique. The saccharine technique was even less accurate, but it can be useful in clinical practice because it is a quick, easy, and safe technique.

Acute supraglottitis in adults in Finland: review and analysis of 308 cases.

OBJECTIVE: The aim of this article is to study the clinical features, management, and outcome in adult patients with acute supraglottitis. STUDY DESIGN: Retrospective review. METHODS: We searched the medical records from our database from the years 1989 to 2009 using codes of international statistical classification of diseases and related health problems for acute epiglottitis or supraglottitis. In total, 308 patients were identified. RESULTS: Incidence of acute supraglottitis increased from 1.88 (first decade) to 4.73 per 100,000 cases (second decade) (P = .05). The mean age of the patients was 49 years old with a slightly male predominance. Sore throat and odynophagia were the most common symptoms. Concomitant disease were common among the patients. Isolated inflammation of epiglottis without involvement of other supraglottic tissue was detected only in 51 patients. Intravenous cephalosporins were the most common empiric antibiotic treatment regimen. Intravenous corticosteroids were administered to half of the cases. Streptococcus was the most common organism in throat cultures. In total, 45 patients needed airway intervention. Complications were rare and mortality was 0.6% in our series. CONCLUSIONS: Acute supraglottitis in adults seems to be a different entity than epiglottitis in children, and inflammation does not usually exclusively involve the epiglottis. Early diagnosis seems to decrease the need for airway intervention and to permit the successful treatment of the patient with intravenous antibiotics and corticosteroids. Streptococcus appears as the dominant causative microorganism. However systemic diseases and other local infections that compromise the regional supraglottic immunity may increase the risk for acute supraglottitis.

Ectopic internal carotid artery presenting as an oropharyngeal mass.

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx.

Langerhans cell histiocytosis presented as bilateral otitis media and mastoiditis.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple organs. The etiology of LCH remains unclear to date. It is currently believed that clonal accumulation and proliferation of CD1a-positive Langerhans cells are causative. The term LCH or histiocytosis X refers to three separate illnesses (listed in order of increasing severity): eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy presented with history of recurrent bilateral otitis media and rash and seborrheic areas on his scalp. Two days prior, his mother noticed a small lump over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic lesion on right temporal bone. The computerized tomography scan showed inflammatory changes with bone erosion. During surgical exploration, fragile slightly yellowish tissue with necrotic areas was found that was determined as LCH on histology. Chemotherapy was subsequently initiated. The initial presentation of LCH with bilateral ear and skull involvement is a very rare condition. The signs and symptoms of otologic histiocytosis can mimic those of acute and chronic infectious ear disease. Only a surgically obtained biopsy leads to definitive diagnosis and appropriate therapy.