Rhinology

Thrombophlebitis of the temporal vein as an extracranial complication of acute bacterial rhinosinusitis

August 26, 2015     Markus E. Huth, MD; Marco D. Caversaccio, MD, PhD
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Abstract

A 39-year-old white man presented with a swollen left upper eyelid secondary to progressive acute bacterial rhinosinusitis (ABRS). Physical examination found a 40% reduction in vision in the left eye and right-sided erythematous temporal swelling with tenderness to palpation. Computed tomography revealed the presence of an inflammatory lesion in the left orbit. Duplex ultrasonography demonstrated a thrombotic occlusion in the right superficial temporal vein (STV). For treatment of the complicated ARBS, the patient received intravenous antibiotics and underwent surgery. The STV thrombophlebitis was treated with low-molecular-weight heparin. Postoperatively, the patient recovered completely and his vision normalized; 10 days later, duplex ultrasonography showed a patent STV. The development of contralateral STV thrombophlebitis is conceivably facilitated by venous anastomoses of the scalp in the front of the head. As a result, embolic spread would be a possible complication of infectious ABRS foci communicating with intraorbital and pericranial veins. To the best of our knowledge, this is the first reported case of such a complication of ARBS in the literature.

Minimally invasive resection of olfactory neuroblastoma by transnasal endoscopy

August 26, 2015     Chin-Fang Chang, MD; Sheng-Chang Chiu, MD; Shiou-Yu Yeh, MD, MPH; Mu-Kuan Chen, MD, PhD; Yung-Sung Wen, MD, MS
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Abstract

Olfactory neuroblastoma is rare. We conducted a retrospective study to review our experience with minimally invasive resection of olfactory neuroblastomas via a transnasal endoscopic technique, including an analysis of surgical outcomes. Our series included 5 patients-3 men and 2 women, aged 29 to 75 years (mean: 48). Surgical outcomes were evaluated on the basis of each patient's preoperative Dulguerov classification and postoperative evaluation on computed tomography and magnetic resonance imaging. One patient was treated with surgery alone, 3 with surgery plus radiotherapy, and 1 with surgery, radiotherapy, and chemotherapy. During follow-up of 18 to 115 months, all 5 patients remained alive and disease-free. We found that endoscopic resection of olfactory neuroblastoma is a feasible and effective procedure, even in patients with more aggressive stages of disease. We also believe that the Dulguerov classification is more useful than other classifications for clinical management and surgical planning. Long-term follow-up is necessary to look for late recurrence.

Hybrid frontal sinus surgery with balloon dilation and microdebrider resection

August 26, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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In cases with polyps obstructing the sinus ostia, if a hybrid procedure employing both microdebrider resection and balloon dilation is performed, a satisfactory sinus outflow tract can be obtained.

Diplopia: An uncommon presentation of silent sinus syndrome

July 20, 2015     Juan Gomez, MD; David Liu, MD; Enrique Palacios, MD; Jeremy Nguyen, MD
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The etiology of the disease is based on the primary predisposing factor, which is an obstruction of the ostiomeatal complex that results in hypoventilation of the maxillary sinus gases

Radiographic findings of a well-differentiated sinonasal neuroendocrine neoplasm: Case report and review of the literature

July 20, 2015     Cui Ping Mao, PhD; Ming Zhang, MD; Chen Niu, PhD; Min Li, MD; Yuan Wang, MD
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Abstract

Typical carcinoid is a rare tumor among other neuroendocrine neoplasms that occur in the nasal cavity. Only a few cases of typical carcinoids in the nasal cavity have been reported. We report a case of typical carcinoid of the nasal cavity in a 61-year-old man who had a history of persistent nasal obstruction and epistaxis for approximately 17 years. Computed tomography revealed a huge, lobulated mass in the nasal cavity with extension into the posterior sphenoid sinus. Extensive bone destruction could be seen in the neighboring sphenoid sinus. MR imaging suggested that the tumor was close to the dura. The final histologic evaluation of the excised biopsy specimen yielded a diagnosis of a well-differentiated neuroendocrine neoplasm (typical carcinoid). In this article, the relevant reports in the literature are reviewed, and the role of radiographic findings on tumor diagnosis and on the establishment of a surgery plan is emphasized.

Maxillary sinus angiomyolipoma: A case report and overview

July 20, 2015     Steven M. Weindling, MD; David M. Menke, MD; William E. Bolger, MD, FACS
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Abstract

Otolaryngologists are called upon to evaluate and treat sinonasal masses discovered incidentally on imaging studies. Although common conditions such as sinonasal polyps and mucus retention cysts predominate, it is prudent practice to formulate a differential diagnosis to identify unusual conditions. We present a case of a maxillary sinus mass in a 78-year-old man that was discovered incidentally on brain imaging and subsequently identified on biopsy as an angiomyolipoma (AML). AMLs are benign hamartomatous tumors that rarely occur in extrarenal locations. Only a few cases have been reported in the nasal cavity. We believe our case represents the first reported instance of AML arising within a maxillary sinus. Identification of intratumoral fat within the mass on imaging studies may suggest the diagnosis of AML preoperatively. Close interdisciplinary collaboration among the otorhinolaryngology, radiology, and pathology services is beneficial for patient management. We report this case to raise awareness that AML can arise in this previously unreported location. Moreover, we wish to emphasize that AML should be considered in the differential diagnosis when imaging studies demonstrate a well-defined, heterogeneous, fat-containing solitary mass in the nasal cavity or maxillary sinus.

Nasal myiasis: A case report

July 20, 2015     Zrria L. White, MD; Michael W. Chu, MD; Richard J. Hood, MD
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Abstract

Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.

The ostium of the posterior ethmoid sinus seen in the superior meatus

July 20, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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The division of the anterior from the posterior ethmoid cells is determined by the basal lamella of the middle turbinate.

Juvenile nasopharyngeal angiofibroma staging: An overview

June 4, 2015     Nada Ali Alshaikh, MD; Anna Eleftheriadou, MD, PhD
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Abstract

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

A rare case of pleomorphic adenoma of the nasal septum

June 4, 2015     Tejinder Singh Anand, MS, PhD; Gautam Bir Singh, MS; Sunil Garg, MS; Garima Yadav, MBBS; Anita Nangia, MD
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Pleomorphic adenomas of the nasal cavity differ from those found elsewhere in that they have more myoepithelial cells and little or no stromal component.

Improvement in allergic and nonallergic rhinitis: A secondary benefit of adenoidectomy in children

June 4, 2015     Meir Warman, MD; Esther Granot, MD; Doron Halperin, MD, MHA
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Abstract

Chronic rhinitis (CR) is a common disorder in children. Allergic rhinitis (AR) is a risk factor for CR, and children with AR tend to suffer more from hypertrophic adenoids than do patients with nonallergic rhinitis (NAR). Few studies have addressed the issue of alleviating symptoms of pediatric CR or AR following adenoidectomy alone. We conducted a retrospective chart review to determine whether CR in children improves after adenoidectomy and whether children with AR will benefit more than those with NAR. Charts of 47 children who had undergone adenoidectomy for nasal obstruction and chronic middle ear effusion were reviewed. AR and NAR subgroups were classified based on symptoms, signs, blood IgE, and nasal smear (allergic criteria). Hypertrophic adenoids were graded using the adenoid-to-nasopharyngeal ratio (ANr >0.8). A questionnaire was used to assess the change in chronic rhinitis postoperatively. Improvement in CR was reported in 37 of 47 (79%) children. Patients with AR improved to a higher extent than those with NAR (12 of 14 [86%] vs. 25 of 33 [76%], respectively), but the difference was not statistically significant. A total of 41 lateral postoperative nasopharyngeal x-rays were obtained. The x-rays revealed that 20 of 26 (77%) of patients with ANr >0.8 had complete and 4 of 26 (15%) had partial resolution of symptoms of CR for a total resolution rate of 92%, compared to only a 53% resolution in the ANr <0.8 subgroup (6 of 15 and 2 of 15 patients, respectively [p <0.05]). The correlation between adenoid size and resolution of CR was not related to any of the AR/NAR subgroups. We conclude that symptoms of CR may improve after adenoidectomy in children who are experiencing nasal obstruction and chronic otitis media with effusion. Clinical improvement did not differ between AR and NAR patients, and was more prominent in children with hypertrophic adenoids (ANr >0.8).

Th1 and Th2 cytokine gene expression in atopic and nonatopic patients with nasal polyposis

June 4, 2015     Mohammad Farhadi, MD; Mitra Barati, MPH; Azardokht Tabatabaii, MS; Mehdi Shekarabi, PhD; Samileh Noorbakhsh, MD; Shima Javadinia, MD
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Abstract

The pathogenesis of nasal polyps has been debated for many years. The lymphocytes that infiltrate nasal polyps have been identified as predominantly memory T cells in an activated state, and these cells produce a mixed cytokine pattern of T1 helper (Th1) and T2 helper (Th2) cells. We conducted a prospective study to compare the expression levels of some Th1 and Th2 cytokines in atopic and nonatopic patients. Our study population consisted of 75 adults-42 men and 33 women (mean age: 38 yr)-with nasal polyposis. Patients with an allergy were distinguished from those without an allergy on the basis of the history, the results of skin-prick testing, and measurement of total IgE serum concentrations. Based on these criteria, patients were divided into two groups: atopic (n = 38) and nonatopic (n = 37). Levels of cytokine gene expression in the atopic patients were compared with those of the nonatopic patients by real-time polymerase chain reaction. Statistical analysis found no significant differences in the rate of interleukin (IL) 10 and IL-12 gene expression between the allergic and nonallergic patients. On the other hand, rates of interferon gamma and IL-4 gene expression were significantly higher in the atopic patients (p = 0.03 and p = 0.02, respectively). Our research suggests that an imbalance of Th1 and Th2 cells plays an important role in the pathophysiology of nasal polyps. Although nasal polyposis is a multifactorial disease associated with several different etiologic factors, chronic persistent inflammation is undoubtedly a major factor, regardless of the specific etiology.

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