-
The Journal of Medical Investigation :... 2024Surgical treatment is recommended for patients with severe allergic rhinitis (AR) refractory to medical treatment. Endoscopic posterior nasal neurectomy (PNN) is...
BACKGROUND
Surgical treatment is recommended for patients with severe allergic rhinitis (AR) refractory to medical treatment. Endoscopic posterior nasal neurectomy (PNN) is primarily performed to improve rhinorrhea in severe perennial AR, however studies on its long-term prognosis are lacking.
AIMS/OBJECTIVES
This study aimed to investigate the long-term prognosis of PNN.
MATERIALS AND METHODS
A questionnaire survey was administered to 17 patients (12 men and 5 women) at least 1 year after PNN. Nasal symptoms and medications, as well as patient satisfaction with surgery at the time of survey, were scored. Furthermore, scores were compared between patients with postoperative periods of >5 years and <5 years.
RESULTS
Nasal symptoms and medication scores significantly improved after surgery. There was no significant difference between patients with a postoperative period of >5 years and <5 years in both preoperative and postoperative nasal symptoms and medication scores. No correlation was found between patient satisfaction with surgery and postoperative period.
CONCLUSIONS AND SIGNIFICANCE
PNN improved nasal symptoms and medication scores in patients with severe perennial AR. Furthermore, the study results suggest that the long-term effect of PNN for perennial AR lasts for >5 years. J. Med. Invest. 71 : 62-65, February, 2024.
Topics: Humans; Female; Male; Adult; Middle Aged; Rhinitis, Allergic, Perennial; Denervation; Young Adult; Surveys and Questionnaires; Patient Satisfaction; Nose
PubMed: 38735726
DOI: 10.2152/jmi.71.62 -
Acta Otorhinolaryngologica Italica :... Apr 2024Olfactory dysfunction (OD) represents a frequent complaint in general population and especially in patients with chronic sinonasal diseases. The aim of this study was...
OBJECTIVE
Olfactory dysfunction (OD) represents a frequent complaint in general population and especially in patients with chronic sinonasal diseases. The aim of this study was the cross-cultural adaptation and validation of the Self-reported Mini Olfactory Questionnaire (Self-MOQ) into Italian.
METHODS
One hundred fifty patients affected by chronic sinonasal diseases and reporting hyposmia were enrolled. Other 150 normosmic subjects without inflammatory or neoplastic sinonasal disorders were used as a control group. The Short-form 36 (SF-36) questionnaire was used for clinical validity.
RESULTS
Cronbach's alpha coefficient was 0.825. The test-retest reliability was excellent. The good correlation between the Self-MOQ and the Visual Analogue Scale scores (p < 0.05) demonstrated the construct validity of the questionnaire. The Self-MOQ was able to distinguish between subjects with or without OD (p < 0.05). Higher Self-MOQ score was found in case of nasal obstruction and posterior rhinorrhoea (p < 0.05). Self-MOQ showed significant correlation with SF-36 general health, SF-36 role functioning/physical, and SF-36 pain (p < 0.05).
CONCLUSIONS
The Italian version of the Self-MOQ showed good internal consistency, test-retest reliability, construct, and clinical validity.
PubMed: 38712517
DOI: 10.14639/0392-100X-N2386 -
The Egyptian Heart Journal : (EHJ) :... May 2024HACEK endocarditis is usually insidious and can often be difficult to diagnose due to the slow-growing nature of the organisms. This report presents our experience in...
BACKGROUND
HACEK endocarditis is usually insidious and can often be difficult to diagnose due to the slow-growing nature of the organisms. This report presents our experience in treating a patient with Haemophilus parainfluenzae endocarditis.
CASE PRESENTATION
We describe the case of a previously fit and well 23 year-old woman who presented to her local emergency department with a four-week history of persistent febrile illness. She had associated nausea, vomiting, and lethargy. This was preceded by an episode of mucopurulent rhinorrhoea. She was treated empirically with oral amoxicillin for a putative diagnosis of rhinosinusitis. Initially, her symptoms abated, however, she was readmitted with high fevers and a new pansystolic murmur. Transthoracic echocardiography revealed a large, mobile, echogenic mass, tethered to the posterior mitral valve leaflet (PMVL) and mild mitral regurgitation (MR). On examination, she had multiple non-tender, erythematous macules on the plantar surface of her feet, consistent with Janeway lesions. Two separate blood cultures grew H. parainfluenzae. Infectious diseases recommended a four-week course of intravenous ceftriaxone. Transesophageal echocardiography demonstrated a perforation within the P3 segment of the PMVL. Subsequently, the patient underwent mitral valve repair surgery with an uneventful recovery.
CONCLUSIONS
Our case highlights the importance of promptly diagnosing HACEK endocarditis. A prolonged course of antibiotic therapy can be lifesaving, and surgery is often necessary to address complications such as perforation within the mitral valve leaflets. In our patient, we were able to perform a sliding P2 leaflet plasty for good quality repair of the mitral valve, through a minimally invasive right anterior thoracotomy.
PubMed: 38709318
DOI: 10.1186/s43044-024-00482-6 -
Surgical Neurology International 2024Antiphospholipid syndrome is a complex autoimmune condition associated with the formation of recurrent thrombosis in any vascular bed throughout the body. Jugular vein...
BACKGROUND
Antiphospholipid syndrome is a complex autoimmune condition associated with the formation of recurrent thrombosis in any vascular bed throughout the body. Jugular vein thrombosis is very rare with only a 0.9% occurrence and is not typically associated with cerebrospinal rhinorrhea as a result of raised intracranial pressure.
CASE DESCRIPTION
A 54-year-old patient presented with a 9-month history of cerebrospinal fluid (CSF) rhinorrhea and headache on a background of antiphospholipid syndrome. Investigations showed a superior vena cava (SVC) and right internal jugular vein (IJV) obstruction with moderately elevated intracranial venous pressures. Her magnetic resonance imaging (MRI) brain was consistent with a CSF leak. The patient underwent successful endovascular stenting of her obstructed SVC and right IJV followed by surgical repair of a herniating meningocele in the posterior left ethmoid air cells.
CONCLUSION
CSF rhinorrhea is uncommon and never previously reported associated with SVC thrombosis induced by antiphospholipid syndrome. A combination of endovascular techniques and surgical repair is recommended for this challenging presentation.
PubMed: 38468657
DOI: 10.25259/SNI_32_2023 -
Chirurgia (Bucharest, Romania : 1990) Feb 2024Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We...
Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a "fungus ball" is required.
Topics: Humans; Maxillary Sinusitis; Neoplasm Recurrence, Local; Retrospective Studies; Sinus Floor Augmentation; Sinusitis; Treatment Outcome; Adult
PubMed: 38465718
DOI: 10.21614/chirurgia.2024.v.119.i.1.p.76 -
Journal of Comparative Effectiveness... Apr 2024Posterior cranial fossa (PCF) surgery is associated with complications, including cerebrospinal fluid (CSF) leakage. Dural sealants such as polyethylene glycol...
Posterior cranial fossa (PCF) surgery is associated with complications, including cerebrospinal fluid (CSF) leakage. Dural sealants such as polyethylene glycol (PEG)-based hydrogels and fibrin glue can prevent CSF leaks, with evidence suggesting PEG hydrogels may outperform fibrin glue. However, the budget impact of using PEG hydrogels in PCF surgeries in Europe is unclear. A decision tree was developed based on a previous US model, to assess the budget impact of switching from fibrin glue to PEG hydrogel in PCF surgery across five European countries. Input costs were derived from published sources for the financial year 2022/2023. Health outcomes, including CSF leaks, were considered. The model predicted that using PEG hydrogel instead of fibrin glue in PCF surgery can lead to cost savings in five European countries. Cost savings per patient ranged from EUR 419 to EUR 1279, depending on the country. Sensitivity analysis showed that the incidence of CSF leaks and pseudomeningoceles had a substantial impact on the model's results. PEG hydrogels may be a cost-effective alternative to fibrin glue in PCF surgery. The model predicted that cost savings would be mainly driven by a reduction in the incidence of postoperative CSF leaks, resulting in reduced reliance on lumbar drains, reparative surgery and shortened hospital stays.
Topics: Humans; Fibrin Tissue Adhesive; Neurosurgical Procedures; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Postoperative Complications; Hydrogels
PubMed: 38389409
DOI: 10.57264/cer-2023-0047 -
In Vivo (Athens, Greece) 2023Refractory rhinorrhea is common after total laryngectomy (TL). Because botulinum toxin injection and ipratropium bromide nasal spray have shown success in it, suggesting...
BACKGROUND/AIM
Refractory rhinorrhea is common after total laryngectomy (TL). Because botulinum toxin injection and ipratropium bromide nasal spray have shown success in it, suggesting a hyperactive parasympathetic tone may play a role. Therefore, we sought to evaluate whether endoscopic posterior nasal neurectomy (ePNN) to include more nasal secretomotor fibers is a treatment option for laryngectomy-associated rhinorrhea.
PATIENTS AND METHODS
Laryngectomized patients with persistent rhinorrhea who underwent ePNN at both the middle and inferior meatus were enrolled. We evaluated the changes in 2-week Total Nasal Symptoms Score (TNSS) and rhinorrhea subscore over 6 and 12 months post ePNN treatment, as well as self-rated rhinorrhea using the visual analogue scale (VAS) at pretreatment and 12 months post-treatment. Adverse events, post-procedure medication reliance, and patient satisfaction were recorded.
RESULTS
Five males (mean age, 62.4 years) with elapsed time from TL of 97.56±89.91 months were identified. ePNN significantly improved the average rhinorrhea subscore of TNSS at six months (p=0.037, Wilcoxon sign-rank test) and twelve months (p=0.047) compared to baseline. There were marginally significant improvements between baseline and at 12 months for overall TNSS (6.60±2.30 to 2.00±1.22, p=0.056) and VAS for rhinorrhea (7.80±0.84 to 2.00±1.58, p=0.062). No adverse event was reported, and four patients had excellent outcomes.
CONCLUSION
Endoscopic posterior nasal neurectomy is a safe and efficient alternative treatment for laryngectomy-associated rhinorrhea, with lasting improvement over one year. However, a large-scale study with more comprehensive measurements is needed to verify its long-term efficacy.
Topics: Male; Humans; Middle Aged; Laryngectomy; Feasibility Studies; Ipratropium; Rhinorrhea; Denervation
PubMed: 37905635
DOI: 10.21873/invivo.13373 -
Neurology International Sep 2023Ecchordosis physaliphora (EP) is a benign notochordal remnant, which is often an incidental finding; however, it can rarely present with neurological symptoms. We... (Review)
Review
Ecchordosis physaliphora (EP) is a benign notochordal remnant, which is often an incidental finding; however, it can rarely present with neurological symptoms. We performed a systematic review of the literature for cases of symptomatic EP published in PubMed, Web of Science and Embase from January 1982 to May 2023. This is the largest review to date and revealed 60 cases including ours. Headache (55%) and CSF rhinorrhea (32%) were the most frequent clinical manifestations. The majority of symptomatic EP lesions were located in the prepontine region (77%) and required surgical resection (75%). EP should be considered in patients with neurologic symptoms in the setting of prepontine or posterior sphenoid sinus lesions. While symptomatic patients often require surgical intervention, rare cases may respond to oral corticosteroids.
PubMed: 37873832
DOI: 10.3390/neurolint15040075 -
Clinical and Experimental... Nov 2023Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to...
OBJECTIVES
Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis.
METHODS
We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated.
RESULTS
An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement.
CONCLUSION
Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.
PubMed: 37871904
DOI: 10.21053/ceo.2023.01214 -
Journal of Neurological Surgery. Part... Dec 2023Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with endonasal, multilayered reconstructions. Vascularized tissue flaps are...
Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with endonasal, multilayered reconstructions. Vascularized tissue flaps are superior to free mucosal grafts and biomaterials in many cases. Limitations of previously described flaps include reach, rotation, pedicle availability, and postoperative sinonasal morbidity. The objective of this study is to describe the superiorly based middle turbinate flap, a novel vascularized mucosal reconstruction option, and to present a case series demonstrating flap utility. Cadaveric feasibility study with technical description and illustrative case series. Tertiary medical center. Three silicone-injected cadaveric specimens (6 sides); 7 patients with CSF rhinorrhea from bony dehiscence of the anterior cranial fossa repaired with a superiorly based middle turbinate flap. Cadaveric feasibility, in vivo repair outcomes, sinonasal symptoms, and postoperative healing. Cadaveric dissection demonstrated a consistent vascular plexus arising from the anterior and posterior ethmoid arteries, originating at the superior attachment of the middle turbinate and traveling inferiorly to supply the mucosa of the middle turbinate. Mean surface area of the flap was 776.67 ± 114.60 mm . The clinical series of 7 patients involved leaks around the cribriform plate and fovea ethmoidalis. There were no instances of repair failure. All cases showed rapid and complete remucosalization without significant sinonasal morbidity. The superiorly based middle turbinate flap is a reliable, versatile, and effective option for a vascularized mucosal flap onlay that can be used in anterior skull base reconstruction. This flap is particularly useful in the repair of defects involving the cribriform plate and fovea ethmoidalis.
PubMed: 37854540
DOI: 10.1055/a-1934-9095