August 10, 2012 Yekaterina A. Koshkareva, MD; Michael Cohen, MD; John P. Gaughan, PhD; Vincent Callanan, MD; Wasyl Szeremeta, MD
article
Abstract
We conducted a 3-year retrospective study to examine the results of preoperative
hematologic screening, the incidence of postoperative bleeding, and the possible
relationship between the two factors in patients who had undergone tonsillectomy
with or without adenoidectomy. Our study population was made up of 875 patients—441
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at
our institution from January 2004 through December 2006. In addition to demographic
data, we compiled information on each patient’s medical and surgical history, personal
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative
hematologic screening results. The latter included determinations of the prothrombin
time, activated partial thromboplastin time, international normalized ratio (INR), and
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively,
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality
(7.1%); the difference between the two groups was statistically significant (p = 0.041).
The abnormalities in the latter group consisted of an elevated INR but no otherwise
identifiable coagulopathy. Another 14 patients with an abnormal screening result
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during
our preoperative evaluation; they were treated perioperatively, and none bled
postoperatively. Of 21 patients who had a personal or family history of abnormal
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery.
In conclusion, we found that preoperative hematologic screening identified patients
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able
to prevent some bleeding events in these patients. Our finding that patients with a
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants
further study.
August 10, 2012 Nishant Kumar, MD; Raj Sindwani, MD, FACS
article
Abstract
Bleeding during endoscopic sinus surgery (ESS) can interrupt the flow of the procedure and increase the risk of complications. Advances in microdebrider design now allow for bleeding to be controlled by bipolar energy during the suctioning and shaving of polyps. We conducted a retrospective study to examine the effects of this technology on blood loss and operating times during ESS for chronic rhinosinusitis with nasal polyps (CRS+P). Our patient population was made up of 80 patients who had undergone ESS for CRS+P by the same surgeon from January 2007 through May 2008. All surgeries were performed with either the PK diego bipolar microdebrider (Gyrus ACMI, ENT Division; Bartlett, Tenn.) or a standard microdebrider. There were 40 patients in each group. The PK group was made up of 23 males and 17 females, aged 14 to 66 years (mean: 43.1), and the control group included 21 males and 19 females, aged 17 to 71 years (mean: 43.1); there were no statistically significant differences between the two groups in terms of sex and age. In addition to demographic data, the charts were reviewed for comorbidities and operative variables; the latter included blood loss, operating room (OR) time, and complications. The preoperative treatment and anesthesia protocols were similar for all patients, and all patients demonstrated a similar disease burden on imaging (mean Harvard CT stage: 3.12 for the PK group and 3.15 for the controls; p > 0.05). We found that during ESS, the PK group experienced significantly less intraoperative blood loss than did the controls (means: 86.0 and 123.0 ml, respectively; p = 0.015). In addition, the PK device was associated with significantly shorter OR times (means: 88.9 and 101.4 min, respectively; p = 0.026). There were no complications in either group. We conclude that using a microdebrider with bipolar capabilities during ESS may offer the advantages of less blood loss and shorter operating times in patients with nasal polyps.
July 5, 2012 Min-man Wu, MD; Hong Sun, MD, PhD; Qiong Nan, MD
article
Abstract
We conducted a study to validate the expression of PLUNC (palate, lung, and nasal epithelial clone) protein in nasal polyp and chronic sinusitis tissue by immunohistochemistry. We also explored the relationship between the intensity of positive immunohistochemical staining for PLUNC protein and postoperative therapeutic efficacy. Our study population consisted of 34 patients with nasal polyps and 30 with chronic sinusitis who had undergone surgical treatment, along with 18 healthy controls who did not undergo surgery. All samples were stained according to the streptavidin-peroxidase immunohistochemical method to examine PLUNC protein expression. The surgical patients were evaluated for clinical therapeutic efficacy 6 months postoperatively. The association between efficacy and the intensity of PLUNC protein positivity was examined by the Spearman rank correlation analysis. Intensity was rated as either +++(>50% positive cells), ++ (26 to 50% positive cells),+ (≤25% positive cells), or–(no positive cells). We found that the most common levels of PLUNC positivity were + in the patients with nasal polyps, +++ in the patients with chronic sinusitis, and ++ in the controls (p< 0.01). Analysis of the Spearman rank correlation indicated that the intensity of PLUNC protein expression was significantly correlated with postoperative therapeutic efficacy (p< 0.001). We conclude that PLUNC protein is an essential factor in the innate defense mechanism of the nasal mucosa. The immunohistochemical staining of PLUNC protein could have clinical benefit in terms of predicting therapeutic efficacy and outcomes in patients with nasal polyps or chronic sinusitis.
June 4, 2012 Christopher Y. Chang, MD; Richard Thrasher, MD
article
Abstract
We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.
April 30, 2012 E. Bradley Strong, MD; James R. Tate, MD; Dariusz Borys, MD
article
Abstract
Osteoid osteomas are benign osseous lesions. They have seldom been described in the otolaryngology literature, and they are extremely rare in the ethmoid sinuses. We report a new case of osteoid osteoma of the ethmoid sinus in a 15-year-old girl. The workup consisted of computed tomography. Treatment involved local excision via an external ethmoidectomy approach. The diagnosis was based on histopathologic examination.
April 30, 2012 Subhash C. Gupta, MS; Sachin Jain, MS; Himanshu P. Singh, MBBS; Atul Sachan, MBBS; Soumit Dey, MBBS
article
Abstract
Lymphangiomatous polyp of the nasal cavity is a very rare condition. We are reporting a case of a unilateral nasal mass presenting with noisy breathing during sleep, change of voice, watery nasal discharge, and anosmia in a 5-year-old boy. The mass was removed via a transnasal endoscopic approach, and a diagnosis of lymphangiomatous nasal polyp was established by histopathology.
April 30, 2012 Marc C. Thorne, MD, MPH, Assistant Professor, Associate Program Director
article
Although gross pathologic analysis may seem like a good alternative to examining every specimen microscopically, from the point of view of cost-effectiveness, it is the worst option and is quite unlikely to identify significant pathology.
April 30, 2012 Rabia Shihada, MD; Michal Luntz, MD
article
Abstract
A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.
April 30, 2012 Rima A. DeFatta, MD; Johnathan B. Sataloff; Grace E. Klaris; Robert T. Sataloff, MD, DMA, FACS
April 30, 2012 Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article
It is important to study the anatomy of the roof of the ethmoid sinus both preoperatively and intraopereatively, especially to determine whether there are differences in the height and thickness of the left and right sides.
April 30, 2012 Iosif Vital, MD; Dan M. Fliss, MD; Jacob T. Cohen, MD
article
Abstract
Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.
March 31, 2012 Parker A. Velargo, MD and Jerome W. Thompson, MD
article
Although herniation of parapharyngeal fat into the tonsillar fossa during a tonsillectomy is uncommon, such deftects need to be closed when they occur. One approach is to use a local flap for repair.
