ENT Hospital Research Articles

Nasopharyngeal carcinoma: differences in presentation between different ethnicities in the New Zealand setting

There is an elevated incidence of nasopharyngeal carcinoma (NPC) in the Maori and Pacific Island (MPI) population as well as the Asian population in New Zealand; however, no studies have been conducted to evaluate how the two populations differ in their clinical presentation according to the TNM stage. A retrospective review was conducted of all patients presenting to the Auckland City Hospital ENT department with a newly diagnosed NPC between the years 1995 and 2007 inclusive. The patient's radiological and biopsy results were reviewed, and each patient was staged according to the TNM stage at presentation as per the revised 2002 American Joint Committee on Cancer staging criteria. The Fisher's exact test was used to compare the differences between ethnicities in the T and N stages of the disease at presentation; the Cochran-Armitage Trend test was used to look for statistically significant trends. There was a statistically significant difference in T stage at presentation between MPIs and Asians (P < 0.0001), with a positive, statistically significant (P < 0.0001) trend indicating that MPIs present with greater T stage. A statistically significant difference in the N stage at diagnosis between MPIs and Asians, independent of the T stage, was found at stages T2 (P = 0.046) and T4 (P = 0.0083), with a statistically significant trend (T2 -P = 0.009; T4 -P = 0.026). These results show that MPIs have a more advanced local NPC disease than Asians at presentation, and that for specific T stages, the nodal disease is also more advanced than that found in Asians.

Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U‐shaped flap technique: how we do it

Clinical OtolaryngologyVolume 34, Issue 5 p. 479-481 Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U-shaped flap technique: how we do it M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author First published: 24 September 2009 https://doi.org/10.1111/j.1749-4486.2009.01956.xCitations: 3 Dr Mehmet Eken, Kartal Dr. Lutfi Kirdar, Training and Research Hospital 2nd ENT Clinic, Uskudar street, Konak Apartment number: 39/11, Kartal Istanbul, Turkey. Tel.: +90 505 234 45 96; fax: +90216 330 95 02; e-mail: memedken@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume34, Issue5October 2009Pages 479-481 RelatedInformation

Computerassistierte Chirurgie an der Rhinobasis

The procedure of instrument navigation has been an established one since its introduction in ENT by Schloendorff. It facilitates better intraoperative orientation. The opto-electric and electromagnetic procedures are sophisticated principles of intraoperative position recognition. It can be assumed that up to 30% of all ENT hospitals in Germany have access to navigation systems. These systems are used almost exclusively for functional endoscopic sinus surgery (FESS). The impact of instrument navigation is estimated by surgeons predominantly positively. A navigation system enables a saving of up to 10% in terms of operating time. Extended approaches in the frontal skull base appear to benefit from the use of navigation support to a high degree. However, scientific data are still lacking. The current boundaries of simple instrument navigation in the frontal skull base are set by the attainable accuracy of approx. 2 mm and the relatively simple representation of the information in planar sectional views. Instrument navigation should be used in the frontal skull base as frequently as possible, even in less complex procedures. Only in this way can familiarity with the system be achieved.

Ear, Nose and Throat Day-Case Surgery at a District General Hospital

In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

O.328 Neonatal lingual frenectomy to improve breast feeding

Ankyloglossia is a common, congenital abnormality often causing feeding difficulties in infants. This study aimed to evaluate indications and outcomes of frenulotomy performed in infants with ankyloglossia for breast-feeding difficulties.85 patients were prospectively identified as they underwent frenulotomy in Pinderfields Hospital ENT outpatient department between February 2008 and February 2011. 52 patients were successfully followed up with a telephone questionnaire about effects on breast-feeding and any complications.All mothers had experienced problems breast-feeding prior to frenulotomy. Following frenulotomy 40/52 (77%) of mothers reported an improvement in breast-feeding within 2 weeks of the procedure. No complications were reported.This study supports the view that ankyloglossia is a common cause of breast-feeding difficulties. However the lack of universal improvement in breast-feeding following frenulotomy suggests that it is not the only cause of problems and supports the clinician approaching these situations holistically and exploring other causes.

Evaluation of Peripheral Vocal Cord Paralysis by Electromyography

To analyze the predictive value of electromyography (EMG) after peripheral vocal cord paralysis and to estimate regeneration time. Retrospective study based on electromyographic data and medical chart review of university based ENT hospitals. EMG results of 448 patients were classified into neuropraxia, axonotmesis/neurotmesis, or not classifiable and followed until final outcome. Final outcome was classified electromyographically into restitutio ad integrum, defective healing, or not classifiable. The etiology of the paralysis was thyroid gland surgery in 42.9% and other iatrogenic lesions in 11.8%. Idiopathic paralysis was found in 20.3%. Mean follow-up time was 4.8 months. Initial EMG findings were neuropraxia in 31.0%, axonotmesis/neurotmesis in 40.8%, and not classifiable in 28.1%. Restitutio ad integrum was detected by EMG in 17.6% and defective healing in 43.3%. In 39.1%, the outcome could not be classified. The positive predictive value of EMG was 97% and the negative predictive value 60%. The outcome depended significantly on the initial EMG result (P < .0001) but not on the etiology (P = .737) of the paresis. Regeneration time after neuropraxia was 4.0 months and after axonotmesis/neurotmesis 5.6 months. Laryngeal EMG has a high predictive value for acute peripheral vocal cord paralysis. The outcome can be predicted more reliably by means of EMG than by analysis of the etiology of the lesion.

Effect of Flap Thickness on Higher Order Wavefront Aberrations Induced by LASIK: A Bilateral Study

To investigate the effect of flap thickness on wavefront aberrations induced by LASIK. LASIK was performed on 56 eyes of 28 patients with refraction errors that were well matched between the right and left eyes. For each patient, a planned 160-microm flap was created for one randomly selected eye using the Moria M2 microkeratome (130-microm head; thick flap group), and a 110-microm flap was created for the contralateral eye with the same microkeratome (90-microm head; thin flap group). Flap thickness was measured using ultrasonic pachymetry. Wavefront aberrations were measured in the anterior cornea using the Orbscan II (Bausch & Lomb) and in the whole eye using the Wavefront Supported Custom Ablation (WASCA) aberrometer (Carl Zeiss Meditec) preoperatively and at 1 month and 1 year postoperatively. Mean flap thickness was 155 +/- 13 microm in the thick flap group and 112 +/- 11 microm in the thin flap group. Mean root-mean-square of higher order wavefront aberrations were changed for the different test times in the cornea (F = 29.9, P < .0001) and the whole eye (F = 48.0, P < .0001). There was no significant difference between the two flap groups for the cornea (F = 0.76) or for the whole eye (F = 0.07). Similar results were observed for higher order Zernike aberrations such as spherical aberration and comas. The results suggest higher order wavefront aberrations induced by LASIK are independent of flap thickness. Complications in visual outcome for patients with different flap thickness should be attributed to factors other than aberrations.

Clinical manifestation of Laryngeal Tuberculosis

Background: Prevalence of laryngeal tuberculosis is rising due to the increase in risk factors like HIV/AIDS. Any part of the larynx can be affected. Diagnosis depends on high index of suspicion. Objectives: To evaluate the clinical manifestations due to localized laryngeal tuberculosis and their association with pulmonary TB. Patients and Methods: This is a prospective study conducted in ENT Hospital- Khartoum, Sudan from September 2004 to November 2006. All tuberculous patients with laryngeal symptoms and those diagnosed histologically to have laryngeal tuberculosis were included. Results: Eight patients were studied; they were five males and three females, with age range between 12-70 years (mean 41years). Strider, dysphonia and dysphagia were the main complaints. Ulcers and nodules were the main findings in all parts of the larynx. Conclusion: Diagnosis of pulmonary tuberculosis is not mandatory for the diagnosis of laryngeal tuberculosis. Cases are picked up in routine direct laryngoscopy and biopsy for prolonged dysphonia and / or those with known pulmonary tuberculosis who developed laryngeal symptoms Sudan Journal of Medical Sciences Vol. 2 (4) 2007: pp. 275-276

The effect of improved hearing protection regulations in the prevention of military noise-induced hearing loss

Conclusion. Hearing protection regulations have improved the hearing test results of soldiers in the Finnish Defense Forces. Objectives. To investigate the effect of revised regulations regarding usage of hearing protectors of professional soldiers in the Finnish Defense Forces. Subjects and methods. The medical records of non-commissioned officers and officers examined at the Central Military Hospital ENT Department from 1984 to1986 (Period I) and 2003 to 2005 (Period II) were reviewed. The study group comprised 252 persons. Changes in hearing between the two time periods, during which regulations were revised, were investigated. Results. Hearing test results improved both in non-commissioned officers and in officers between the two study periods, in accordance with tightened hearing protection regulations. Improvement was found, especially in the high frequencies; however, the results were milder than expected, particularly in officers.

Hyaluronic acid ester in myringoplasty

To investigate the use of a new technique to close persistent tympanic membrane perforations under general anaesthesia, in patients in whom this has previously been considered impractical. Twenty patients aged 50 years and over were recruited. All had a persistent, symptomatic tympanic membrane perforation in at least one ear. Pre-operatively, an audiogram was performed and the tympanic membrane was assessed in order to establish the site and size of the perforation. Under general anaesthesia, the edges of the perforation were freshened and a sheet of Epifilm, trimmed to a size roughly 2 mm larger in diameter than the perforation, was tucked through the perforation. The ear was dressed appropriately. Patients were seen two weeks post-operatively in the out-patients department and reassessed. The study was based at Poole General Hospital, a District General Hospital. Twenty patients were recruited from the out-patients clinics of Poole Hospital ENT department. (1) closure of the perforation, as a percentage of the original size; (2) improvement of hearing, as an average across all frequencies, expressed in dB hearing level; and (3) presence or absence of discharge. Five patients were operated upon and assessed six weeks post-operatively. The Epifilm had dissolved but the perforations remained the same size in all five patients. There were no other adverse effects. Pure tone audiometry at this stage was redundant. The study was subsequently aborted. The authors conclude that repair of tympanic membrane perforations with hyaluronic acid ester films is not to be recommended.

Comparative study on deep lamellar keratoplasty and penetrating keratoplasty for keratoconus

To investigate the therapeutic outcomes of deep lamellar keratoplasty (DLKP) and penetrating keratoplasty (PKP) for keratoconus. Retrospective review of 29 eyes of 29 keratoconus patients, who underwent surgery in Eye & ENT Hospital of Fudan University from April in 2003 to April in 2006. Eleven eyes underwent DLKP and the rest had PKP. Pre- and post-operative visual acuity, astigmatism, complications and post-operative graft status were assessed. 82% of patients (9 eyes) in DLKP group gained BCVA better than 0.5, while in PKP group the proportion was just 78% (14 eyes). Postoperative astigmatism of two groups had no statistical significant difference with the value (-4.03 +/- 1.87) D and (-3.43 +/- 2.31) D respectively (DS: t = 2.135, P = 0.460, DC: t = -0.643, P = 0.528). The confocal image of epithelial cell, basal epithelium and Bowman's membrane was similar to that of normal cornea. The stromal cell was a little bit smaller and disordered. The endothelium in DLKP-treated eyes had normal cellular size and shape. There was no statistical significance between the density of operated eyes and contralateral unoperated eyes (2311.72 +/- 439.73) cells/mm2 and (2477.81 +/- 535.92) cells/mm2 respectively (t = 1.060, P = 0.780). However, the endothelial cells in PKP-treated eyes were highly pleomorphic with a decreased cellular density of (1642.17 +/- 583.41) cells/mm2, whereas the contralateral unoperated eyes had endothelium density of (2739.05 +/- 401.77) cells/mm2. The difference was statistical significance (Z = 7.32, P = 0.006). Complication rates were similar for DLKP and PKP, although the classification of the complications varied, being less severe in the DLKP group. DLKP seems to be a safe alternative for patients with keratoconus because of its equivalent effect to PKP. DLKP is more technically challenging but allows the risk of endothelial rejection to be avoided and may reduce the risk of late endothelial failure.

Evaluation of vertiginous children

Our objective was to evaluate, using a structured approach method, the history and findings in vertiginous children as compared with a group of healthy children. We evaluated 24 vertiginous children (15 girls, 9 boys) with episodes of true vertigo of unknown etiology and 12 healthy age- and gender-matched controls. A detailed medical history was obtained using a structured approach technique. Vertiginous and healthy children underwent general and otoneurologic examinations, including audiogram, electronystagmography, and tympanometry, at the Helsinki University Hospital ENT clinic. Characteristics of patient histories and clinical findings were compared between the groups. The vertiginous children reported significantly more head traumas and headaches than the controls. The structured data collection approach improved the evaluation process. The predominant diagnoses were benign paroxysmal vertigo of childhood, otitis media-related vertigo, and migraine-associated dizziness.

Increased Levels of Transforming Growth Factor-Beta1 and -Beta2 in the Aqueous Humor of Patients With Neovascular Glaucoma

To measure the concentrations of transforming growth factor-betal and beta2 (TGF-beta1 and TGF-beta2) in the aqueous humor of patients with neovascular glaucoma (NVG). Patients were divided into four groups: NVG secondary to central retinal vein occlusion (group 1), NVG secondary to proliferative diabetic retinopathy (group 2), central retinal vein occlusion without rubeosis (group 3), and senile cataract (group 4). The total TGF-beta 1 and TGF-beta2 concentrations in the aqueous humor of the four groups were measured by enzyme linked immunosorbent assay. The mean concentrations of total TGF-betal were 600.7 +/-436.7 microg/mL in group 1, 802.0 +/-359.5 pg/mL in group 2, and undetectable in groups 3 and group 4 (P < .05). The mean concentrations of total TGF-beta2 were 6,307.9+/- 2,206.2 microg/mL in group 1, 5,908.0+/-2,033.2 microg/mL in group 2, 899.7+/- 425.6 microg/mL in group 3, and 385.7 +/-89.9 microg/mL in group 4. The total TGF-betal and TGF-beta2 concentrations in groups 1 and 2 were significantly higher than those in groups 3 and 4, whereas the total TGF-beta2 concentration in group 3 was significantly higher than that in group 4 (P < .05). There was no significant difference in the TGF-betal or TGF-beta2 concentrations between groups 1 and 2 (P> .05). The abnormally high concentrations of TGF-betal and TGF-beta2 in the aqueous humor of patients with NVG may explain some aspects of the pathogenesis of NVG and the high failure rate of filtering operations in NVG.

Role of Consanguinity in Congenital Neurosensory Deafness

Congenital deafness affects the speech and psychosocial development of the affected child. It could be syndromic or non-syndromic depending on the presence or absence of the associated manifestations. Among various etiological factors described for deafness, consanguinity is an established high risk etiological factor. A prospective study was carried out in 1076 children in the age group of 0-14years attending Government ENT hospital and schools for deaf in and around Hyderabad. The results showed that 41.73% (449) of the cases were the products of consanguineous matings and 58.27% (627) were born to non consanguineous parents. Further analysis revealed a high rate of consanguinity (44.53%) in children with non syndromic deafness.

ENT in general practice: training, experience and referral rates

A postal survey of 500 general practitioners (GPs) in south-west England was undertaken to evaluate the levels of undergraduate and postgraduate otolaryngology training and/or experience received by GPs in that area. Most GPs had received two weeks of undergraduate training in ENT, which had involved no formal assessment. Three-quarters of GPs considered this inadequate. A quarter of GPs had completed a hospital post in ENT prior to entering general practice, most of which lasted three months. Sixty-one per cent of GPs had received some formal postgraduate training in ENT, in the form of courses, lectures or hospital training sessions. Almost half of the GPs considered this inadequate. Seventy-five per cent of GPs stated they would like further training in ENT. Subjective estimates of referral rates to hospital ENT specialist clinics varied considerably. This study illustrates the variability and level of dissatisfaction regarding ENT training amongst GPs at both undergraduate and postgraduate levels.

Swahili Translation and Validation of the Patient Health Questionnaire-9 Depression Scale in the Kenyan Head and Neck Cancer Patient Population

Depression is an important predictor of post therapy quality of life (QOL) in head and neck (H&N) cancer patients. In addition, depression rates may vary among cultures. As part of a larger cross cultural study on post therapy QOL differences in H&N cancer patients, the goal of this project was to translate a well-validated English language depression scale into Swahili, and then validate this scale in Kenyan H&N cancer patients. METHODS, SETTINGS AND SUBJECTS: In Part 1 of the study, we translated the Patient Health Questionnaire-9 (PHQ-9) into Swahili, adhering to established International Quality of Life Association (IQOLA) guidelines. In Part 2, we psychometrically validated the newly translated scale using a prospective study of 48 patients at the Kenyatta National Hospital ENT clinic in Nairobi, Kenya. The Swahili PHQ-9 had good test retest reliability (Intraclass correlation coefficient, 0.71) and internal consistency (Cronbach's alpha = 0.80). It also had good construct validity, as scores correlated strongly with TNM stage (Chi square = 123, p < 0.05), and with the compositeand global scores of an H&N cancer specific QOL scale (UW-QOL, r = -0.87, p < 0.05). The Swahili version of the PHQ-9 is a reliable scale in Kenyan H&N cancer patients, and is a valuable tool in screening for and monitoring of depression as a function of QOL in this population.

Recovery of corneal sensitivity after laser-assisted subepithelial keratectomy

To evaluate the recovery of corneal sensitivity after laser-assisted subepithelial keratectomy (LASEK) for myopia. Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China. In this prospective interventional case series, central corneal sensitivity (CCS) was measured using a Cochet-Bonnet esthesiometer (Luneau Ophthalmologie) in 85 eyes of 50 patients before and 2 weeks, 1 month, 3 months, and 6 months after LASEK for the treatment of myopia. For analysis, the eyes were divided into 2 groups-the low-moderate myopia group (spherical equivalent [SE] -1.0 to -6.0 diopters [D]) and the high myopia group (SE -6.0 to -16.0 D)-and the correlation between ablation depth and CCS was evaluated. In both groups, a significant decrease in CCS was present at 2 weeks and 1 month. In the low-moderate myopia group, the CCS recovered to preoperative values at 3 months. In the high myopia group, recovery of CCS was slower and preoperative values were reached only at the 6-month follow-up. Measured CCS was significantly correlated with the ablation depth used at the 3-month and 6-month examinations (r = -0.262 and r = -0.264, respectively; P<.05). Recovery of corneal sensitivity began 1 month after LASEK and was completed by 3 months in eyes treated for low-moderate myopia and at 6 months in eyes with high myopia. The depth of ablation during surgery affected the recovery of corneal sensitivity.

Teaching and Assessing in Clinical Practice

A structured teaching programme was designed for second year student nurses who were on a 1-week placement at the ENT hospital of Mauritius. As part of the programme, this article discusses how a teaching session on tracheostomy suctioning and humidification was implemented. The teaching session incorporated both the pedagogical and andragogical techniques in order to make the learning experience meaningful for the students. The learning outcomes were evaluated in terms of, knowledge, skill and attitude and were found to have been mostly met. However, more practice was required on the part of the students in order to become more proficient. Formal training and assessing in clinical practice can contribute significantly towards improving the quality of care and satisfying the needs of patients.

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance

In the present study, we evaluated the effect of nasal surgery on snoring time, snoring intensity, and sleep-disordered breathing. The role of abnormal cephalometry in treatment outcome was assessed. A cross-sectional prospective study. University teaching hospital. Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea. The patients underwent anterior rhinomanometry and polysomnography (PSG) with recording of snoring before and after operative treatment of nasal obstruction. Cephalometric radiographs were obtained before surgery. Nasal resistance decreased significantly in the overall patient group. Snoring time, snoring intensity, nocturnal breathing, and sleep architecture did not change after nasal surgery. Cephalometry did not predict operative outcome in these patients. Snoring intensity was found to be significantly higher during non-rapid eye movement (NREM) sleep than during rapid eye movement sleep. Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity, snoring time, or sleep-disordered breathing in an objective assessment by PSG performed after surgery. The effect of treating inflammatory nasal changes during nocturnal breathing, as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation. Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening.

副鼻腔陰影を伴うアレルギー性鼻炎に対するマクロライドと抗アレルギー薬の併用療法

Patients with allergic rhinitis are frequently complicated with some abnormal findings in the paranasal sinuses by X-ray examination. Recently this disease is being diagnosed as allergic rhinosinusitis. In many allergic rhinosinusitis cases, antiallergic drugs such as antihistamines and topical steroids comprise effective medication, but additional macrolide therapy for sinusitis has been reported to be in effective and unnecessary. In this study, the relationship between the type of X-ray shadow of sinuses and the efficacy of macrolide with antiallergic therapy in allergic rhinosinusitis cases was studied as a retrospective therapy. Subjects were 44 allergic rhinosinusitis patients aged from 4 to 60 years old enrolled in the outpatient clinic of the Kagoshima University Hospital ENT clinic. All the allergic rhinosinusitis cases were classified into 3 groups based on the type of X-ray shadow in the sinuses; mucosal thickness, polypous, and diffuse patterns. The X-ray findings were compared between before and after antiallergic therapy with/without macrolide in children and adult cases. X-ray examination revealed that the diffuse type was found in 18 of 42 (42%) children and in 26 of 136 (19%) adults cases. In child cases the diffuse type X-ray shadow was seen more often and macrolide therapy was thought to be more effective in combination with antiallergic medication than in adult cases. This study suggests the efficacy of macrolide therapy in the field of pediatric allergic rhinosinusitis.