Influence of different approaches to the cerebellopontine angle on the function of the intermediate nerve

Object Surgery in the cerebellopontine angle (CPA) is a standard procedure at many centers. Outcome is focused mainly on preservation of hearing and facial function postoperatively. The nonmotor part of the facial nerve, the intermediate nerve, is nearly neglected nowadays. Methods A retrospective study was designed, including a questionnaire that was sent to 178 patients who had undergone surgery between 2000 and 2004. Data were obtained in 156 cases. The questionnaire was divided into five parts assessing the presence of increased tearing, reduced tearing, salivation disturbances, increased nasal secretions, and abnormalities in taste. Finally, a self-assessment of patient symptoms was a…

Endonasal Sinus Surgery Improves Mucociliary Transport in Severe Chronic Sinusitis

A total of 22 patients with extensive chronic sinusitis were examined before and 7.2 ± 1.1 months after microscopic endonasal sinus surgery. Pre- and postoperative nasal mucociliary transport was measured using a modified saccharine test and ciliary beat frequency of nasal respiratory cells using video interference contrast microscopy. In patients suffering from chronic sinusitis, nasal ciliary beat frequency was significantly lower (8.0 ± 1.8 Hz) than in normals (9.5 ± 1.7 Hz, p < 0.02). Following endonasal sinus surgery, ciliary beat frequency in patients with chronic sinusitis remained reduced (8.3 ± 1.2 Hz). Nasal mucociliary transport time was significantly (p < 0.05) longer (20…

Ultrasonography for the diagnosis of Lyme disease in cases of acute facial paralysis.

Ultrasonography of the parotid gland was introduced in 1989 as part of the diagnostic protocol of every patient treated in our clinics with acute facial paralysis. Ten of 50 patients so tested were found to have unilateral nonpalpable enlarged lymph nodes in the caudal portion of the parotid gland around the stylomastoid foramen. All 10 patients were eventually diagnosed as having Lyme disease. It is suggested that in patients with acute facial paralysis, ultrasonography is an inexpensive tool to improve diagnosis of Lyme disease and may have a more useful purpose in monitoring therapy.

Selective Chemical Vestibulectomy

In an attempt to destroy the peripheral vestibular labyrinth selectively in patients suffering from intractable vertigo as a result of end-stage Meniere’s disease, 25 patients underwent selective chem

Orbital Decompression for Endocrine Ophthalmopathy: The Endonasal Approach

A surgical endonasal procedure is described to perform orbital decompression in patients suffering from ophthalmopathy in Grave's disease. The decompression technique employs removal of the lamina papyracea as an exclusive modality or in conjunction with a transmaxillary or lateral decompression approach. This present series contain 23 patients who underwent decompression over a 3-year period and were followed for at least 6 months postoperative. The results of decompression were assessed by measuring reduction in proptosis and visual acuity. All patients demonstrated improved visual acuity. Measuring retroplacement of the globe, the endonasal approach proved to equal the results obtained …

Effects of the Breathe Right Nasal Strips on Nasal Ventilation

The Breathe Right nasal strips are more and more commonly used, mainly by athletes, who hope to enhance their physical performance in competition and training. The effect of the device in such situations is uncertain and perhaps somewhat controversial. To investigate the effects of the nasal strips on nasal ventilation, 20 Caucasian individuals were objectively assessed using anterior rhinomanometry and acoustic rhinometry. The results showed a significant increase in all subjects of transnasal airflow and in the average cross-sectional area of the nasal cavity that quantifies objectively the subjective impression of improved nasal breathing. In such patients where an improvement in nasal …

Ultrasonography for evaluation of the carotid artery in head and neck cancer.

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of th…

Subacute effects of ozone exposure on cultivated human respiratory mucosa.

This study was designed to investigate subacute effects of long-term exposure of both healthy and chronically inflamed human respiratory mucosa to ozone. Functional and metabolic effects on ciliary beat frequency (CBF), release of interleukin 8 (IL-8), interleukin 4 (IL-4), and γ interferon (g-INF), as well as cellular viability and cytotoxicity, were monitored. Cell cultures of 60 specimens (healthy mucosa: n = 30, inflamed mucosa: n = 30) were exposed to synthetic air and to ozone-enriched synthetic air in different concentrations of WO, 500, and WOO μg/m3. Continuous expositions were performed using an air/liquid interface cell culture technique for a period of 4 weeks. CBF was monitore…

Olfactory function after microscopic endonasal surgery in patients with nasal polyps.

A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1–3 days before surgery (V1), 7–10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hypo…

Proliferative Activity and Cytometric Characteristics in Polyps of the Nasal Cavity and Paranasal Sinuses

Although several investigations have revealed the influence of cytokines, allergy, and environmental factors in polyp development, the etiology of nasal polyps is still unknown. To estimate the biology of this common disease the operative specimens of 50 patients who underwent surgery for polyps of the nasal cavity and the paranasal sinuses were examined; of these, 10 patients had recurrent disease and 23 patients had an allergy. The investigations included routine histology and quantitative DNA measurements, along with immunohistochemical identification of proliferation markers (i.e., MIB-1; proliferating cell nuclear antigen, PCNA). Histologically, most polyps revealed an infiltration wi…

Possible roles of nitric oxide in the physiology and pathophysiology of the guinea pig cochlea.

Two nitric oxide synthase isoforms (NOS-I and NOS-III) are present in the mammalian cochlea, and many regulatory functions of the inner ear could be mediated by NO. In this study, cochlear potentials and immunohistochemical measures were analyzed by changing the concentration of NO in the guinea pig during intracochlear and intravenous application of an NOS inhibitor and an NO donor. In anesthetized guinea pigs the NOS inhibitor NG-nitro-L-arginine-methylester (L-NAME) was applied by intracochlear perfusion or intravenously. The cochlear potentials and blood pressure were measured during and after the application. Cochleae were removed and prepared for morphological and immunohistochemical …

Eosinophil Cationic Protein in Nasal Secretions and Blood Serum in Grass-Pollen Allergic Rhinitis

Concentration of the Eosinophil Cationic Protein (ECP) measured in different body fluids has been demonstrated to be a good marker of eosinophilic inflammation. In allergic asthma, ECP levels in both broncho-alveolar-lavage (BAL) fluid and serum can be used to monitor disease activity. In allergic rhinitis, the value of ECP determinations in serum and nasal secretions was not directly compared, so far. In the present study, ECP levels in blood serum (Se) and nasal secretions (NS) of grass pollen allergic and healthy individuals under pollen exposure were analyzed. Forty-three grass-pollen allergic subjects and 19 healthy volunteers were included. Grass-pollen counts were measured using Bur…

Comparison of Conventional Instruments and Mechanical Debriders for Surgery of Patients with Chronic Sinusitis

Background This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery. Methods Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long…

Three-dimensional ultrasound evaluation in the head and neck.

We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.

Intratympanic Dexamethasone and Hyaluronic Acid in Patients with Low-Frequency and Ménière's-Associated Sudden Sensorineural Hearing Loss

Steroids are widely used for the treatment of cochleovestibular disorders. Direct steroid application in the middle ear cavity, when combined with a round window membrane permeability-modulating substance, increases the level of the steroid reaching the target cells. We measured hearing in patients with idiopathic isolated low-frequency sensorineural hearing loss and in patients with sudden sensorineural hearing loss and a history of Ménière's disease. Contradictory reports about effectiveness of intratympanic steroid therapy on vertigo control and hearing improvement in patients with Ménière's disease exist in the literature.Eighteen patients with isolated low-frequency idiopathic sudden s…

Aspirin Intolerance in Patients with Chronic Sinusitis

Aspirin intolerance in patients with chronic sinusitis is often a cause of early recurrence of symptoms after surgical treatment. This study assesses 84 patients who were tested for acetylsalicylic acid intolerance after presenting with symptoms like chronic rhinosinusitis, sometimes bronchial asthma, coexisting allergies or a history of aspirin sensitivity. Nasal polyposis was found in a majority of cases, often recurrent after previous surgery. The levels of eicosanoids such as peptido-leukotrienes and prostaglandin E<sub>2</sub> were analyzed in isolated blood cells and compared with a healthy control group. Aspirin-intolerant patients showed elevated basal levels of peptido-…

Microscopic Endonasal Surgery for Repair of CSF Leaks

This manuscript will detail our experience using a microscopic endonasal surgery (MES) approach in the repair of spontaneous, traumatic, and/or iatrogenic cerebrospinal fluid (CSF) fistula into the ethmoid and sphenoid sinuses. The location of the fistula in 22 patients was determined by a direct endoscopic or microscopic visualization, intrathecal fluorescein, or computed tomography (CT) with metrizamide. Several of these patients had been treated unsuccessfully with previous neurosurgical, intracranial, and extracranial approaches to stop the leak. The CSF fistulas in all these patients were repaired with a MES approach, packing the leak with either a septal mucosal graft, or abdominal f…

Head and neck paragangliomas: Report of 175 patients (1989-2010)

Attention of the otorhinolaryngologist needs to be drawn to the versatile aspects of head and neck paragangliomas (PGLs).This study is a retrospective, nonrandomized clinical study of all 175 individuals with PGLs treated in our department between 1989 and 2010. A genetic analysis was performed on 86 patients.The 175 patients presented 224 head and neck PGLs as well as 2 thyroid papillary carcinomas. Genetic analysis resulted in 1 patient positive for a von Hippel-Lindau (VHL) gene mutation and 34 for succinate dehydrogenase (SDH) gene mutations (22 SDHD, 7 SDHC, and 5 SDHB), 12 of the latter carrying a novel mutation. Thirty-three patients (18.9%) had multiple PGLs and 11 patients (6.3%) h…

Modifications of a nerve integrity monitor useful in skull base surgery.

Endoscope‐microscope combination for endonasal sinus surgery

The Use of Acoustic Rhinometry in Predicting Outcomes after Sinonasal Surgery

Today's healthcare environment demands objective assessment of surgical outcomes. The recent otolaryngologic literature has established acoustic rhinometry (AR) as a valid instrument to objectively document nasal patency. The purpose of this article is to evaluate the utility of AR in predicting outcomes after sinonasal surgery. All patients scheduled for sinonasal surgery at the Tulane University and University of Mainz Departments of Otolaryngology between 10/1/98 and 12/15/98 were enrolled. All subjects underwent AR and completed a sinonasal outcome survey (SNOT-20) one day before and two months after their surgical procedure. Thirty-one patients were enrolled. The SNOT-20 raw scores im…

An Assessment of Radiologic Discrepancies in Patients with Paranasal Sinus Disease

The importance of computerized tomographic (CT) imaging of the paranasal sinuses in patients with chronic or recurring sinusitis is well documented. Nevertheless, the accuracy and reliability of this examination is not absolute. In this study of 80 cases, a considerable percentage of CT scans (57.5%) failed to detail accurately the extent of pathology in the sinus cavities. In 39 cases the extent of disease was underestimated using CT, and in seven cases it was overestimated. Discrepancies in pathology were encountered most commonly in the posterior ethmoid sinus. In our opinion, the primary role of CT in the assessment of patients with paranasal sinus disease is to detail precisely the co…

Radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates: a new method in the treatment of chronic nasal obstruction.

Twenty-two Caucasians (16 male and 6 female) with chronic bilateral nasal obstruction due to hypertrophic inferior turbinates were followed up over a three-month period. They were assessed by clinical examination, as active anterior rhinometry, and acoustic rhinometry before and after topical decongestion, preoperatively and three months after surgery. All patients were treated by application of radiofrequency-volumetric-tissue reduction (RFVTR, or somnoplasty) to both inferior turbinates. Initial postoperative edematous response disappeared during the first week after RFVTR. Three months postoperatively 20 of 22 patients (91%) reported subjective improvement of nasal patency. The average …

Endonasal Approach for Nasal and Paranasal Sinus Tumor Removal

Patients with benign (53) and malignant (22) tumors of the nose and paranasal sinuses were treated for tumor removal via an endonasal approach. Patient selection was based on tumor location (centrally) rather than histology. Tumors attainable by the endonasal approach were located in the nasal cavity, the ethmoid sinus, the sphenoid sinus and the medial wall of the maxillary sinus. Endonasal microscopic techniques including endonasal orbital decompression and endonasal closure of CSF-leaks were combined with surgical navigation tools in selected cases. Surgical trauma and morbidity could be minimized without compromising radicality of tumor removal. Postoperative hospitalization was compara…

Diltiazem for Prevention of Acoustical Trauma during Otologic Surgery

100 patients were tested in a prospective, randomized, double-blinded study to assess the perioperative efficacy of a calcium channel blocker (diltiazem) in preventing acoustical trauma during otologic surgery. The patients were randomly divided into a therapy group (diltiazem) and a control group (placebo). Bone conduction hearing thresholds were examined preoperatively and again 1 day and 3 months postoperatively. Frequency-dependent changes in postoperative bone conduction and the number of patients with various degrees of postoperative hearing loss in both groups were statistically analyzed. The results indicated only a small postoperative hearing loss after ear surgery in both groups. …

Tracheomalacia Repair Using Ceramic Rings

Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance p…

Management of head and neck paragangliomas: review of 120 patients.

Head and neck paragangliomas (PGL) are rare, mostly benign tumors. About 10% to 15% of PGL are caused by mutations in the succinate dehydrogenase genes B, C, or D and may appear multifocally.A retrospective review of 120 patients with 146 head and neck PGL, including 46 carotid body tumors (CBT), 13 vagal tumors, 55 jugulotympanic tumors (JTT), 25 tympanic tumors (TT) and 7 tumors in other locations are included. The internal carotid artery was preserved in 97.5% of CBT resections. Preservation of hearing was achieved in 92% of JTT and 88% of TT resections.According to our experience, the treatment of PGL must be individualized, taking into account the patient's age, medical condition, tumo…

Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis.

Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, snee…

Epiphora Secondary to Blockage of the Lacrimal System: The Role of Endonasal Dacryocystorhinostomy

Stenosis of the lacrimal system may occur secondary to tumor, infection, trauma, and congenital etiologies. Attempts to remedy this problem often include irrigation and probing. However, if these fail, external or internal dacryocystorhinostomy (DCR) with or without stenting may be performed. The purpose of this article is to detail our experience with a microscopic endonasal approach to DCR utilized in 23 patients. This is a modification of an older accepted procedure which utilizes the modern techniques of endonasal sinus surgery. This approach has allowed for immediate restoration of drainage in 22 of 23 cases. In one case, the procedure was repeated because of restenosis at the level o…

Endonasal Sinus Surgery: Extended versus Limited Approach

Background This study was designed to investigate whether two different surgical approaches in endonasal sinus surgery lead to different postoperative results in patients with chronic rhinosinusitis. Methods Sixty-five patients suffering from chronic rhinosinusitis were operated on with either a limited approach or an extended approach. They were examined preoperatively and reassessed during 3 months, 6 months, and long-term follow-up visits that included endoscopy, saccharin transport time, and the assessment of symptoms. Results The concept of this study was prospective, randomized, and multicenter (Mainz, Germany, and Moscow, Russia). The results of the two different surgical approaches …

Orbital complications of pediatric sinusitis: treatment of periorbital abscess.

Twenty-six children requiring surgical intervention for orbital complications of acute sinusitis were treated at our institutions between 1985 and 1995. Twenty patients were successfully treated surgically utilizing endoscopic/microscopic endonasal surgery, or traditional external ethmoidectomy. However, six patients failed to respond to initial surgical attempts and ultimately required a revision. In one of these six patients the development of an intracranial abscess also necessitated a craniotomy for surgical drainage. Analysis of these six failures was performed with special attention given to the reasons for initial surgical failure and possible means for preventing revision surgeries…

The Drainage System of the Paranasal Sinuses: A Review with Possible Implications for Balloon Catheter Dilation

Background Intersinus connections and accessory ostia of the maxillary sinus are well known to rhinologic surgeons but are less known for the remaining paranasal sinuses. Probing and dilatation of the natural ostia of diseased sinuses is being popularized currently by the clinical value of balloon catheter dilation (BCD). Although short-term high success rates with treatment of the dilated ostia/duct have been reported with this technique, the potential impact of fractures of adjacent bony septae on accessory sinus ostia, on mucosally lined surfaces, and on intersinus drainage pathways still has not been considered. The aim of this study was to review the literature on accessory sinus ostia…

Hearing results after hypotympanotomy for glomus tympanicum tumors.

We postulate, that glomus tympanicum tumors (GTTs) may be safely removed without interference with the ossicular chain via a hypotympanotomy approach.Prospective, nonrandomized anatomic and clinical study.Tertiary referral center.All 17 patients between 1989 and 2009 with GTTs without involvement of the lumen of the jugular bulb.We used a modified hypotympanotomy approach. Our technique is a modification of the one first published by Shambaugh (1955). Pure-tone audiograms were performed in all patients. Preoperative and postoperative audiograms were modeled in a linear mixed model evaluating hearing threshold for air and bone conduction and air-bone gap at 500, 1,000, 2,000, and 3,000 Hz. I…

Breathe Right Nasal Strips and the Respiratory Disturbance Index in Sleep Related Breathing Disorders

This investigation assesses the effects of Breathe Right nasal strips on the respiratory disturbance index (RDI) measured by polysomnography in patients suffering from obstructive sleep apnea and snoring. The positive effect of these strips on nasal ventilation was shown in earlier studies. Twenty-six patients with an RDI higher than 10 in an initial measurement underwent a second preoperative polysomnography with Breathe Right nasal strips in place. Nineteen of these 26 patients showed reduction of RDI during the second night of polysomnography using the nasal strips, indicating that nasal obstruction seems to be a predominant factor in the etiology of snoring and apnea in these individua…

Measurement of Pharyngeal Pressure in Patients using Nasal CPAP

In patients with obstructive sleep apnea syndrome (OSAS), nasal continuous positive airway pressure (nCPAP) prevents pharyngeal collapse by applying positive pressure transnasally. Currently there are not objective criteria to determine whether surgical improvement of nasal resistance is necessary in patients undergoing nCPAP treatment. In 16 patients with documented OSAS, inspiratory and expiratory pressures in the pharynx were measured during nCPAP with pressures ranging from 5 to 20 mbar. Identical studies were performed in 12 patients with severe nasal obstruction without OSAS and in eight normal patients. The results of each group were compared to the nasal resistance as measured by a…

Characterization of nitric oxide synthase isoforms expressed in different structures of the guinea pig cochlea.

Nitric oxide synthase (NOS) activity and NADPH diaphorase staining has previously been reported in mammalian cochlea. Here we demonstrate immunoreactivity for neuronal-type NOS I and endothelial-type NOS III in the cochlea of the guinea pig. NOS I immunoreactivity was seen in inner and outer hair cells, and spiral ganglion cells. Staining for NOS I was also shown in basal and intermediate cells of the stria vascularis, spiral ligament cells, and the media of vessels near the modiolus. An antibody to NOS III stained primarily vascular endothelial cells. Some NOS III immunoreactivity was also detected in spiral ganglion cells. An antibody to the inducible-type NOS II did not stain any structu…