Rhinology

Balloon sinus dilation in the office setting

August 27, 2014     Joseph P. Mirante, MD, FACS; Michael A. Munier, MD, FACS; Dewey A. Christmas Jr., MD; Eiji Yanagisawa, MD, FACS
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The ability to complete operative procedures in the office setting avoids the time and cost of working in a hospital or outpatient surgical center operating room.

A study of adherence to the AAO-HNS "Clinical Practice Guideline: Adult Sinusitis"

August 27, 2014     Ilaaf Darrat, MD; Kathleen Yaremchuk, MD; Spencer Payne, MD; Michelle Nelson, MBA, CPC
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Abstract

A retrospective study was conducted to determine if physicians in otolaryngology practice adhered to the clinical practice guideline for adult sinusitis that had been issued by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 3 years earlier. We analyzed data obtained from the charts of 90 adults who had presented to an otolaryngology outpatient department with a diagnosis of chronic rhinosinusitis (CRS), acute bacterial rhinosinusitis (ABRS), or acute viral rhinosinusitis (AVRS); there were 76 cases of CRS, 11 cases of ABRS, and 3 cases of AVRS. Our goal was to ascertain how closely the treating physician had adhered to the AAO-HNS recommendations with respect to diagnosis, treatment, and prevention of these diseases. The study group was made up of 10 otolaryngologists. We evaluated 7 clinical practice metrics for CRS, 7 metrics for ABRS, and 3 for AVRS. We found that individual physician adherence rates for cases of CRS ranged from 0 to 100%; average scores for the 7 metrics ranged from 4 to 88%. For cases of ABRS, adherence scores ranged from 0 to 100%; average scores for the 7 metrics ranged from 0 to 41%. For AVRS, the rate of adherence for all 3 metrics was 0%. This study revealed wide variations in adherence to the AAO-HNS guideline, but overall adherence was generally poor. Adherence appeared to be worse for the acute types of rhinosinusitis than for chronic rhinosinusitis. In view of these findings, a worksheet was developed that clinicians could use to improve compliance with the guidelines.

Two cases of pyogenic granuloma in pregnancy

August 27, 2014     Alex Fernandez, MS; Jason Hamilton, MD, FACS; Raphael Nach, MD
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Management and treatment of rhinologic issues in pregnant patients can be complex because of the limited availability of safety data.

Primary diffuse large B-cell lymphoma of the ethmoid sinus: A case report

August 27, 2014     Jing-pu Yang, MD; Lian-ji Wen, MD; Chun-shun Jin, MD; Yan Liu, MD
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Abstract

B-cell lymphoma of the paranasal sinuses is rare. We present the case of a 42-year-old woman who presented with proptosis, diplopia, and vision disturbances in the right eye. She was diagnosed with diffuse large B-cell lymphoma of the ethmoid sinus. We describe the general clinical presentation, diagnosis, and differential diagnosis of this entity, and we review the pathology of diffuse large B-cell lymphoma.

Non-otogenic lateral sinus thrombosis: A complication of acute sphenoid sinusitis

August 27, 2014     Jessica M. Somerville, MD; Erik Lyman, MD; Jerome W. Thompson, MD, MBA; Rosemary Stocks, MD, PharmD
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Abstract

The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.

Large osteoma of the maxillary sinus accompanied by an unerupted tooth

July 13, 2014     Jae-Hoon Lee, MD
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CT of the maxillofacial region is required for patients with an osteoma to rule out Gardner syndrome, which should be considered when a patient has more than one osteoma.

Rhinosporidiosis: An unusual presentation

July 13, 2014     Borlingegowda Viswanatha, MS, DLO, PhD
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Abstract

Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by Rhinosporidium seeberi. Clinically it presents as a reddish, bleeding, polypoid mass with a characteristic strawberry-like appearance on its surface, which is caused by the presence of mature sporangia. In the case described here, a 35-year-old man presented with a 6-month history of a slowly growing polypoid mass in his left nasal cavity. The surface of the mass was smooth, pale, and covered with nasal mucosa. It was attached to the nasal septum. Fine-needle aspiration cytology was suggestive of a parasitic cyst. The mass was excised with the use of local anesthesia. Histopathologic examination of the resected specimen revealed rhinosporidiosis. Prior to this diagnosis, the patient had not exhibited most of the typical clinical features that are suggestive of rhinosporidiosis. In the case of a nasal mass, a diagnosis of rhinosporidiosis is important to establish prior to any surgery because bleeding during and after surgery is usually profuse and can be life-threatening. The site of the excised mass should be cauterized to prevent recurrence.

Meningeal carcinomatosis in undifferentiated nasopharyngeal carcinoma: A case report

July 13, 2014     Daniel M. Cushman, MD; German Giese, MD; Panta Rouhani, MD, PhD, MPH
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Abstract

Meningeal carcinomatosis is the tumoral invasion of the leptomeninges. It is caused by the spread of malignant cells throughout the subarachnoid space, which produces signs and symptoms due to multifocal involvement. Cranial nerve symptoms are the most common focal findings. The diagnosis is usually made by imaging and/or cytology. Head and neck cancers are the cause of approximately 2% of all cases of meningeal carcinomatosis; in very rare cases, they are caused by a nasopharyngeal carcinoma. We report a case of meningeal carcinomatosis that was caused by a recurrence of undifferentiated nasopharyngeal carcinoma. The patient, a 60-year-old woman, experienced no focal neurologic symptoms and exhibited no radiologic evidence of meningeal involvement. We also review the literature on meningeal carcinomatosis secondary to nasopharyngeal carcinoma.

Endoscopic view of a middle meatal cyst

July 13, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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Obstruction of the middle meatus and ethmoid infundibulum can occur as a result of swelling of the mucosal surfaces of the soft tissues, although most such obstructions are caused by polyps. Obstruction from a cystic mass is less common.

Endoscopic view of osteogenesis imperfecta of the maxilla

June 8, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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Osseous lesions in the maxilla can represent ossifying fibroma, fibrous dysplasia, amelogenesis imperfecta, or osteogenesis imperfecta.

Nasal vestibule schwannoma: Report of a rare case

June 8, 2014     Ismail Fadzilah, MSurg(ORL-HNS); Husain Salina, MSurg(ORL-HNS); Baharudin Khairuzzana, MSurg(ORL-HNS); Omar Rahmat, MSurg(ORL-HNS); SHA Primuharsa Putra, MSurg(ORL-HNS)
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Abstract

Schwannomas of the nasal cavity and paranasal sinuses are quite rare, especially in the nasal vestibule. We report the case of a 61-year-old woman who presented with a 2-month history of progressively worsening right-sided epistaxis and nasal blockage. Rigid nasoendoscopy showed a mobile, smooth, globular mass occupying the right nasal vestibule. The mass arose from the lateral nasal wall and impinged on the anterior part of the middle turbinate posteriorly. Computed tomography of the paranasal sinuses showed a 3.8 x 1.7-cm enhancing mass in the right nostril. The mass obliterated the nasal cavity and caused mild deviation of the septum. The preoperative histopathologic examination showed positivity for vimentin and S-100 protein, suggesting a diagnosis of schwannoma. The patient underwent an intranasal laser-assisted excision biopsy. The histopathologic examination confirmed the diagnosis of schwannoma. Postoperative recovery was uneventful, and no recurrence was seen in the follow-up period.

An abnormal sigmoid sinus with a dire clinical implication

June 8, 2014     Perianan Puraviappan, MS(ORL); Naryanan Prepageran, FRCS Ed; Cheng Ai Ong, MS(ORL); Raffique Abd Karim, MS(ORL); Omkara Rubini Lingham, MS(ORL); Rajagopalan Raman, MS(ORL)
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In reviewing CT scans before surgery, the location of the sigmoid sinus should always be noted.

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