Rhinology

Endoscopic closure of a frontocutaneous fistula

October 23, 2013     Alexandros Tsikoudas, DLO, FRCS(Otol), FRCS(ORL-HNS); Christos Georgalas, PhD, MRCS, FRCS(ORL-HNS)
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Abstract

A frontocutaneous fistula is a rare sequela of frontal sinus pathology. Management via an endoscopic approach is not frequently reported in the literature. We describe such an approach with the aid of still photography and imaging plus videoendoscopy, and we discuss the current literature.

A case and a series of published cases of esthesioneuroblastoma (ENB) in which long-standing paraneoplastic SIADH had preceded ENB diagnosis

October 23, 2013     Uri Gabbay, MD, MPH; Leonor Leider-Trejo, MD; Gideon Marshak, MD; Merav Gabbay, MD; and Dan M. Fliss, MD
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Abstract

Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.

Progressive blindness caused by an unusual sphenoid sinus dehiscence

September 18, 2013     Mariana Marquez, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold R. Neitzschman, MD, FACR, FACNM, FAAP
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The optic nerve and other important structures in the anterior skull base can be involved in chronic sphenoidal sinus disease.

Extranasopharyngeal angiofibroma originating in the inferior turbinate

September 18, 2013     Jae Hoon Lee, MD; Ha Min Jeong, MD
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An extranasopharyngeal angiofibroma should be differentiated from other vascular tumors, particularly a hemangioma.

A case of a nasal polyp originating in the cribriform plate

September 18, 2013     Osman Kursat Arikan, MD; Nuray Bayar Muluk, MD; Ozden Cirpar, MD
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Abstract

Nasal polyps were once believed to originate in sinus cavities, and from there to pass through ostia and into the nasal cavity. However, data gained from subsequent anatomic studies revealed that they can actually originate in numerous locations in the sinonasal area. We report a case of a nasal polyp that originated in the cribriform plate, which is a very rare site of origin for a nasal polyp.

An unusual case of angiolymphoid hyperplasia with eosinophilia of the nose

September 18, 2013     Sheng-Chang Chiu, MD
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Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular lesion that most commonly involves the ear and preauricular area. We report the case of a 38-year-old man who presented with a progressively enlarging mass of the left nasal vestibule. The lesion was diagnosed as a nasal ALHE and treated with surgical excision. There were no complications.

Comparison of clinical differences between patients with allergic rhinitis and nonallergic rhinitis

September 18, 2013     Mustafa Akarcay, MD; Murat C. Miman, MD; Tamer Erdem, MD; Semih Oncel, MD; Orhan Ozturan, MD; Erol Selimoglu, MD
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Abstract

We conducted a retrospective study to investigate the clinical differences between subtypes of rhinitis patients. Our findings were based on a detailed history and nasal examination. The study population was made up of 910 patients who had at least two rhinitis symptoms. These patients were categorized into one of three rhinitis groups: nonallergic rhinitis (NAR), seasonal allergic rhinitis (SAR), and perennial allergic rhinitis (PAR); there were 212 patients (23.3%) in the NAR group, 473 (52.0%) in the SAR group, and 225 (24.7%) in the PAR group. In addition to demographic data, we compiled information on the season when each patient presented, specific symptoms and their triggers, parental history, associated allergic diseases (e.g., skin, lung, and eye allergies), and nasal examination findings. The SAR patients represented the youngest of the three groups. Most SAR patients presented in spring and summer, and this group had the highest incidence of eye itchiness, pharyngeal itchiness, eye redness, and palatal itchiness. In terms of triggering factors, a visit to a green area was significantly more common in the SAR patients, while detergent odor, sudden temperature change, and cold air were significantly more common in the NAR patients. On nasal examination, a pale nasal mucosa was significantly more common in the NAR group. In clinical practice, it is crucial to differentiate between allergic and nonallergic rhinitis. We conclude that relevant information from the history can predict allergic rhinitis. Future studies of prevalence should take into consideration the important findings of our study, including the significance of age and the seasonality of exacerbation of rhinitis symptoms.

Endoscopic view of the drainage pathway of a pneumatized uncinate process

August 21, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; and Eiji Yanagisawa, MD, FACS
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Pneumatized structures of the nose and sinuses have a mucosal lining whose mucociliary clearance will be associated with a drainage pathway into the nose.

Endoscopic view of an ethmochoanal polyp

July 21, 2013     Jae Hoon Lee, MD
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The main symptom of a choanal polyp is unilateral nasal obstruction. Most of these masses arise from the maxillary sinus.

Nasal actinomycosis mimicking a foreign body

July 21, 2013     Dimitrios Batzakakis, MD; Petros D. Karkos, AFRCS, MPhil, PhD; Sotirios Papouliakos, MD; Samuel C. Leong, MRCS, DO-HNS; Ioannis Bardanis, MD
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Abstract

Nasal actinomycosis is a rare disease. We present a case of nasal actinomycosis causing symptoms similar to those of a nasal foreign body. A 34-year-old woman presented with a long history of halitosis and unilateral offensive, purulent rhinorrhea. Rigid nasendoscopy showed a hard, dark gray mass between the middle and inferior turbinates. Computed tomography findings were typical of a nasal foreign body. Endoscopic removal of the mass was performed, and histopathology established a diagnosis of actinomycosis. We suggest that every clinician confronted with unilateral nasal symptoms and/or signs should have this clinical entity in mind, since it has justifiably been characterized as the head and neck “mimic.”

Endoscopic view of ostial polyps of the maxillary sinus

June 11, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; and Eiji Yanagisawa, MD, FACS
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Ostial polys in the maxillary sinus can cause recurring maxillary sinus disease by obstructing the ethmoid infundibulum and natural ostium of the maxillary sinus.

Relief from cluster headaches following extraction of an ipsilateral infected tooth

June 11, 2013     Matthew R. Hoffman, PhD; and Timothy M. McCulloch, MD
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Abstract

A 60-year-old man with a 7-year history of cluster headaches was seen by an oral surgeon for evaluation of pain in the left upper second molar ipsilateral to the side affected by the headaches. During extraction of the tooth, infection, decay, and inflammation were discovered. Since the extraction in November 2008, the patient has experienced one episode of cluster headaches as of April 2013.

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