Position paper on nasal obstruction: evaluation and treatment.

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Fungal sensitization in nasal polyposis.

BACKGROUND: There are indications that polyposis is somehow related to allergic phenomena. Fungal sensitization in substantial proportions of patients has been cited as a trigger of inflammatory mechanisms involving either an immunoglobulin (Ig) E-mediated reaction to fungal colonization or fungal invasion of tissues. OBJECTIVE: To confirm whether fungi were involved in the development of polyposis by examining sensitivity to fungal allergens and potential local contamination by fungal species. METHODS: We performed a study of 190 patients with polyposis and 190 controls in which we compared the results of skin prick tests to 12 fungi, total IgE, and specific IgE to 15 fungal extracts and nasal fungal cultures. RESULTS: The specific fungi eliciting a reaction from the largest proportion of patients in the skin prick tests were Fusarium solani (13.7%), Penicillium frequentans (12.6%), Trichophyton mentagrophytes (11.1%), and Candida albicans (8.4%) (P < .001). The proportion of individuals that tested positive for fungal-specific IgE was 22.4% (38/170) for patients and 10.1% (19/189) for controls (P = .04). The respective proportions of positive responses to fungal cultures were 58.7% and 60%. Furthermore, no significant differences between patients and controls were found for the results of in vitro tests with cultured fungal allergens. CONCLUSIONS: Although the patients with polyposis exhibited sensitization to fungal allergens, we found that nasal colonization by fungi was similar in patients and the general population. We were also unable to find a correlation between a positive response to the cultures and the presence of fungal allergen-specific IgE. It therefore seems that nasal colonization by fungi does not induce fungal sensitization.

Allergenic profile of nasal polyposis.

BACKGROUND: Nasal polyposis is highly prevalent in the general population. Its exact origin is unknown, although several factors are involved in the etiology and development of this condition. Clinical patterns, a history of atopy, environmental exposure, eosinophil-mediated inflammation, the presence of inflammatory mediators, and sensitization to some allergens indicate that nasal polyposis is associated with allergic phenomena. The aim of this study was to identify the association between nasal polyposis and allergic factors by examining hypersensitivity reactions to common allergens and environmental exposure that could lead to the development of atopy. METHODS: We conducted a comparative study of 190 patients with nasal polyposis and 190 healthy individuals. The study included clinical and epidemiological variables, environmental exposure factors, and an allergology workup using skin prick tests with 18 inhaled allergens. RESULTS: A total of 121 patients (63.7%) of the 190 were male; 62.1% had a family history of allergy. The incidence of asthma was 48.9% among the patients and only 2.3% among the controls (P < .001). The factor most frequently involved in the patients' symptoms was weather changes (67.4%). Skin prick tests were positive in 63.2% of the patients and 31.1% of the controls. The allergens that most frequently elicited a reaction from the patients in the prick tests were Dermatophagoides pteronyssinus (27.7%), Dermatophagoides farinae (21.3%), and Olea europaea (21.1%). The difference between these results and those of the controls was statistically significant. CONCLUSIONS: Patients with nasal polyposis are sensitive to the most common allergens in our environment and exhibit a clear-cut correlation with other allergic factors, as confirmed by personal and family histories, the presence of chronic rhinitis, and the results of in vivo tests.

[Endoscopic nasal surgery in sellar tumors]. / Cirugía endoscópica nasal de procesos selares.

The advances in endoscopy have improved the approach to the sellar region throught nasal cavity. We studied 20 patients with pituitary adenomas operated on using an endoscope through nasal cavity with transseptal- trassphenoidal approach during the last two years. Average age was 45.6 years, and 75% were females. 30% of the patients had non functioning adenomas, 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications occurred during surgery. The more common complications were diabetes insipidus (two cases) and CSF leak (one case). Two patients needed hormonal treatment because panhypopituitarism. No patients developed septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula.

[Congenital laryngeal atresia: apropos of a case]. / Atrésie laryngée congénitale: a propos d'un cas.

A case of congenital laryngeal atresia in which the laryngeal lumen was obstructed by a soft, smooth protrusion is reported. Laryngeal stenosis was located at the glottic level and appeared as a protrusion reducing the laryngeal lumen to a few millimeters. The stenotic tissue consisted of striated muscle fibres cross-linked through their midlines.

[Tuberculoma as expansive process of the cerebellopontine angle. Case report and bibliographical survey]. / Tuberculoma como proceso expansivo del angulo pontocerebeloso. Presentación de un caso y revisión de la literatura.

We present a case of intracranial Tuberculoma of the cerebellopontine angle and discuss the problems to set up the preoperative etiological diagnosis. Finally we make a review of the literature of the subject.

[Clinical aspects and diagnosis of expansive processes in the cerebellopontine angle]. / Clínica y diagnóstico de los procesos expansivos del ángulo pontocerebeloso.

The AA. present a review of the expansive processes of the cerebellopontine angle (CPA) diagnosed at their Department, during the six last years. Emphasis is made upon the clinic findings gained through neuro-otological explorations and imaging, both helpful for preoperative diagnosis of the nature of the tumor.

[Our experience in the management of parapharyngeal tumors]. / Nuestra experiencia en el manejo de los tumores del espacio parafaríngeo.

The rate of occurrence of neoplasma arising from the parapharyngeal space is scarce, about 0.5 percent of neck and face tumors. In the paper is reported our 10-year experience on its clinical diagnosis and therapeutical management as well. We have found 13 percent (3/23) malignancies and 87 percent (20/30) benign growth. 35 percent were paragangliomas and 22 percent represent salivary tumors. Diagnostic procedures, ways of approach and surgical complications are considered.

[Idiopathic cerebral hernia in the middle ear]. / Herniación cerebral idiopática en oído medio.

Idiopathic brain herniation into the middle ear and the mastoid process is an infrequent condition. There are only 29 cases reported in the world literature covering the last 40 years. The paper inform on one of those cases, a man, of spontaneous encephalocele and deals with the pathogenesis, the clinical features and the suitable surgical approach.

[Metastatic neck adenopathies without known primary tumor. Incidence study 1996-2001]. / Adenopatías metastásicas cervicales sin tumor previo conocido. Estudio de incidencia 1996-2001.

We made a retrospective descriptive study reviewing 92 patients with cervical lymph node metastases from unknown primary tumour. The study was accomplished during 6 years. (January 1996 to December 2001) in the Department of Otorhinolaryngology of the Hospital Reina Sofia, Córdoba. The median age was 61.7 years old, male 96.7% and heavy smoker (89.1%) and drinkers most of them. According to TNM categories, 72.2% patients were in phase N2a and half of them were localized Level II. Squamous cell carcinoma was the predominant histologic type. The patients were treated with surgery in 70.6% of the cases with or without radiation therapy and/or chemotherapy.

[Forestier-Rotes Querol syndrome]. / Síndrome de Forestier-Rotes Querol.

The diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is characterized by an hyperostosis of the anterolateral margin of the vertebral bodies. It is an uncommon cause of dysphagia in old patients. In the differential diagnosis of mechanical dysphagia we must have present this disease. Cervico-dorsal spine radiographies reveal large anterior osteophytes creating pharyngeal encroachment.

[Rhinocerebral mucormycosis: differential diagnosis of invasive fungal sinusitis]. / Mucormicosis rinocerebral: diagnóstico diferencial de las sinusitis fúngicas invasivas.

Mucormycosis is an opportunistic infection caused by molds Mucoraceae of the family Phycomycetes. This invasive FS is found in debilitated hosts, most frequently in patients with hematologic malignancies, burn patients and diabetes mellitus. There are several differents forms: rhino-cerebral, pulmonary or disseminated. We describe a case of invasive fungal sinusitis (FS): Rhino-orbital-cerebral mucormycosis, treated at our hospital with radical surgery and medical treatmen We reviewed the clinical presentation of the different types.

[Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis]. / Sinusitis fúngicas no invasivas: micetoma y sinusitis fúngica alérgica.

We have made a study about different cases of non-invasive fungal sinusitis (FS) treated at our hospital with surgery (endoscopic sinus approach) and medical treatment. We review two cases: Mycetoma and allergic fungal sinusitis, following the recent classification based on physiopathology, treatment and prognosis. We review the clinical presentation of the different types.

[Endoscopic surgery of nasopharyngeal angiofibroma]. / Cirugía endoscópica del angiofibroma nasofaríngeo.

Juvinile nasopharyngeal angiofibromas are highly vascular benign tumors but with an agressive behaviour with invasion of skull base and vital structures. Our study includes 11 male patients that underwent surgery for angiofibromas between 1992-2002 with an endoscopic surgical approach and embolization before surgery. The average age was 14.7 years old. Using Fisch staging, 8 patients were stage II. All cases achieved symptomatic remission, with no complications but the recurrence was 36.3%. The endoscopic excision is a safe and effective minimally invasive surgical treatment in patients in stage I and II. It should be considered as a first-choice option for these cases.

[Efficacy of topical ciprofloxacin in the treatment of chronic otorrhea]. / Eficacia del ciprofloxacino tópico en el tratamiento de la otorrea crónica.

The aim of the present study was to assess the clinical and bacteriological efficacy of ciprofloxacin in the treatment of chronic otitis media. Ciprofloxacin was randomly administered for ten days to two groups of patients. Group A was given 500 mg. orally twice a day. Group B received drops of ciprofloxacin in saline solution locally twice a day. We obtained a favorable clinical and bacteriological response. Bacteriological response observed in group B was statistically higher than that of group A (p < 0.01). Results obtained in this study suggest that ciprofloxacin locally administered is very effective in the treatment of chronic otitis media.

[Mediofacial degloving in extramedullary plasmacytoma with orbital invasion]. / Degloving medio-facial en un plasmocitoma extramedular con invasión orbitaria.

Extramedullary solitary plasmacytoma is a rare plasmatic cell tumor occurring in the head and neck. We report the case of a patient with a mass that arose from the sphenoidal base, extended toward the right paranasal sinuses, and invaded the orbit. The clinical characteristics, diagnostic criteria, and therapeutic problems are discussed and reviewed in the literature, with special attention to an alternative therapeutic approach, midfacial degloving.

[Osteoma and polyposis: an unusual association]. / Osteoma y poliposis: una inusual asociación.

A case of osteoma of the ethmoidal sinuses associated with nasal polyposis was treated by endoscopic nasal surgery. The pathophysiology of both diseases is reviewed. The therapeutic strategy is described and the bibliography is reviewed.

[Endoscopic closure of nasal fistulas leaking cerebrospinal fluid. Our experience]. / Cierre endoscópico de fístulas nasales de líquido cefalorraquídeo. Nuestra experiencia.

UNLABELLED: Cerebrospinal fluid (SCF) rhinorrea results from a breakdown of the dura and supporting structures of the skull base. Trauma is responsible for 81 to 90 percent of the cases of SCF rhinorrea, and it occurs in approximately 2 percent of all head injuries. This is a retrospective review of 5 patients who underwent endoscopic treatment of CSF rhinorrea during 1997 in our hospital. The aetiology of leaks was: iatrogenic in two cases (by transphenoidal hypophysectomies), traumatic in two cases (by head injuries) and spontaneous in one (nasal encephalocele). CONCLUSION: we recommend endoscopic approach as the first line in managing CSF rhinorrea because it avoids an external incision, requires less cumbersome instrumentation and in our hands in the safest and most successful. Furthermore, we prefer the autogenous mocuperiosteum of the inferior turbinate glued over the fistula offers several advantages: it is readily available in sufficient size for the closure of most defects, only minor surgery for graft harvesting is necessary and, the texture of the mucoperiostium permits a good secure seal.

[Trans-septal endoscopic approach of pituitary tumors]. / Abordaje endoscópico transseptal de tumores hipofisarios.

The advances in endoscopic instruments have eased the approach to the sellar region through the nasal cavity. We carry out an analysis of the surgical results on 20 patients that underwent surgery for sellar tumours through a transeptal-transphenoidal approach in the last 2 years in our hospital. The average was 45.6 years old, and 75% were females. 30% of cases were pituitary adenomas and another 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications were encountered during surgery being the most common postoperative complications, diabetes insipida in two cases (10%) and CSF leak in one case. At present 2 patients are having hormonal treatment for panhypopituitarism. No patients developed a septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula. The rest did have good results noith no recurrence and hormonal values back to normal.

[The nuclear determination of the DNA content by flow cytometry as a fixed sample of the healthy larynx]. / Contenido de ADN nuclear por citometría de flujo en muestras no fijadas de laringe sana.

We analyzed the DNA nuclear content and cellular cycle distribution of the healthy laryngeal tissues without any laryngeal disease (healthy) and that of from patients afflicted with laryngeal epidermoid carcinoma (healthy/Ca). We have carried out studies on fresh samples, unfixed samples, and analysing them immediately after their extraction in the flow cytometer, using human peripheral blood lymphocytes as control of the ploidy in each case. In the study effected, we did not find any differences in the DNA content of the healthy laryngeal tissues and those macroscopically healthy from patients with epidermoid carcinoma of the larynx. However, the laryngeal tissues show a significantly higher DNA content than the human peripheral blood lymphocytes used as check.