Patency Of Passage Research Articles

Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis.

To estimate the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. The clinical data of 105 subjects with chronic dacryocystitis enrolled into our hospital were analyzed retrospectively. The subjects were distinguished into nasal endoscopic group (endoscopic dacryocystorhinostomy; i.e., 51 cases) according to their surgical methods and external-route group (external-route dacryocystorhinostomy; i.e., 54 cases). The therapeutic effect, lacrimal gland secretion function, tear film stability, degree of epiphora, lacrimal passage patency, complications, and recurrence rate were contrasted between the 2 groups. The nasal endoscopic group exhibited a higher effective remedy rate (98.04%) compared with the external-route group (83.33%). Three months postoperation, both groups showed improvements in lacrimal gland secretion function and tear film stability, with the nasal endoscopic group demonstrating more significant enhancement in lacrimal gland secretion function than the external-route group. Six months postoperation, a reduction in the degree of epiphora was observed in both groups, with the nasal endoscopic group displaying a more pronounced decrease in epiphora severity and a higher lacrimal passage patency rate than the external-route group. Furthermore, the nasal endoscopic group experienced lower incidences of postoperative complications and recurrence rates. Endoscopic dacryocystorhinostomy is safe and effective in the remedy of chronic dacryocystitis.

Importance of etiology in canalicular obstruction surgery.

The treatment options for canalicular obstruction remain controversial, and there are different approaches. In this study, we aimed to evaluate the success of balloon dilatation and silicon tube intubation according to the etiology in patients with canalicular obstruction. The files of 91 patients with isolated monocanalicular obstruction were retrospectively reviewed. Patients were grouped according to surgical methods (Group A: both balloon dilatation and silicon tube intubation; Group B: Only balloon dilatation) and etiologies (topical anti-glaucomatous usage-related, inflammatory, chemotherapy-related, radiotherapy-related, trauma-related, idiopathic). Preoperative and postoperative Munk scores and lacrimal irrigation results were noted in all cases. Munk score was found to be statistically significantly lower in the 1st year in both groups. The patency rate with lacrimal syringing was found to be statistically significantly higher in group A. Success rates both in the munk score and lacrimal passage patency were found to be statistically significantly lower in inflammatory etiology than other etiologies. Both techniques can be used as first-line therapies for canalicular obstruction. It should be considered that recurrence may develop in stenosis of inflammatory origin and more invasive surgery may be required.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair

Locating the medial cut end during late repair of canalicular lacerations can be challenging. The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end. This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis). There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48±1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P<0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66±0.66vs. 3.09±1.72mm, P=0.006) and comparable to that on the unaffected side (2.78±0.40mm). Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

Late-term Effects of Surgery on Nasal Functions in Patients who Underwent Total Laryngectomy Surgery.

Introduction There is a common opinion that losing airway functions in total laryngectomy patients cause changes in nasal physiological rates. Studies conducted to review the subject present gaps, especially in terms of objective measurements. Objective We evaluated late-term effects of surgery on nasal functions in patients who underwent total laryngectomy surgery more than two years ago. Methods We included in the study 22 patients who had undergone total laryngectomy, as well as 24 healthy subjects with similar demographic characteristics as the control group. We performed acoustic rhinometry for intranasal volume and cross-sectional area measurements, saccharin test for measurement of nasal mucociliary clearance, and smell identification test for evaluation of olfactory function in the patient and control groups. We compared and statistically analyzed the data obtained from the groups. Results In our study, although late-term (>2 years) measurements were not statistically significant, we detected more nasal passage patency in the patient group than in the control group. In smell identification test, lower scores were obtained in the patient group. The difference between measurements in both groups was statistically significant. Conclusion We believe that since the upper respiratory tract is disabled due to tracheostomy in patients with total laryngectomy, atrophy occurs in the late term and, consequently, nasal mucociliary clearance is impaired. We also see diminished olfactory function in total laryngectomy patients.

Polysomnographic evaluation of sleep apnea in patientswith unilateral or bilateral impaired nasal patency.

The aim of this work was to describe the polysomnographic evaluation of sleep apnea in patients suffering from unilateral or bilateral impaired nasal passage patency. The study covered 60 adult, including 23 women and 37 men aged 19-69, admitted to the Hospital Department. The subjects were divided into 3 groups: I - 20 patients with unilateral impaired nasal patency, II - 20 patients with bilateral impaired nasal patency, III - 20 controls with correct nasal passage patency. The methodology of the study included: a subjective examination, a questionnaire with questions about main night symptoms, e.g. dyspnea, noisy snoring, polynuria, an objective examination, blood tests (morphology, CRP, fibrinogen, IL-6, glucose level), imaging tests (RTG, CT and MRI of the head/paranasal sinuses) to determine the cause and site of respiratory obturation, physiological tests as a part of polysomnogram. The analysis described: the level of sleep disorders, causes associated with impaired nasal patency and the Mladina's classification of the nasal septum deviation. Due to the conducted polysomnogram and analysis of the additional tests, sleep apnea was diagnosed in the studied patients with impaired nasal patency: shallow breathing u 19 patients (47,5%) with unilateral impaired patency and 9 patients (22,5%) with bilateral impaired patency, whereas apnea in 21 patients (52,5%) with unilateral impaired patency and 11 patients (27,5%) with bilateral impaired patency. In both groups I and II, the impaired nasal passage patency was caused by nasal septum deviation in 18 cases (34%) and in 15 cases (28,3%), respectively. The control group did not show any sleep disorders in polysomnographic tests. Each patient from group I and II was referred for surgery to improve the nasal patency due to its cause. The conducted tests revealed shallow breathing in 47,5% of the studied patients whereas sleep apnea in 52,5% cases. The most frequent cause of impaired nasal patency was nasal septum deviation, which was found in 82,5% of the patients, including 45% with unilateral impaired patency and 37,5% with bilateral nasal patency.

Effects of medication methods after simple and effective probing of lacrimal passage.

To evaluate the effect of reducing the use of antibiotics in the treatment of infant bacterial dacryocystitis after probing of the lacrimal duct. A total of 542 cases of children under one year old and accepting nasolacrimal duct probing treatment were divided into two groups, which were treated with topical and oral antibiotics, respectively. Conjunctival sac secretions were used as a control index of bacterial infection, whereas the disappearance of epiphora symptoms and lacrimal passage patency were used as cure indexes. The χ (2) test was used to compare enumeration and measurement data, and a statistical significance was set at P<0.05. The therapeutic effect on the two groups of postoperative patients was investigated. In the two study groups, no significant differences in gender, age and postoperative control of lacrimal sac infection were observed. The cure rates after three probing operations also showed no significant difference. After probing of the lacrimal passage, results of this study confirmed that postoperative medication without oral antibiotics but an ophthalmic dosage of antibiotics was a simple and effective treatment method.

English

The objective of present study was to compare the results of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. It was a prospective study. Forty two consecutive patients having complaints of epiphora, swelling near medial canthus, angular conjunctival congestion, with naso lacrimal duct obstruction were selected for the study. Selection of type of operation was left to the patient's choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty two patients underwent endonasal dacryocystorhinostomy and twenty had external dacryocystorhinostomy .The follow-up was done at 7 th , 21, st & 3 months after surgery. The patency of lacrimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocystorhinostomy techniques are acceptable alternative. Success of external DCR & endonasal DCR based on patency of passage on 3 rd month was 85% & 81.8% respectively.

Transcanalicular laser dacryocystorhinostomy using low energy 810 nm diode laser

Background:Hypertrophic scarring may be a cause of failure after transcanalicular laser dacryocystorhinostomy (DCR) surgery. This hypertrophic scarring results from tissue charring and excessive coagulation, which may be caused by the high laser energy. We have evaluated the use of low energy settings to prevent hypertrophic scarring, for a successful outcome.Aims:To perform and evaluate transcanalicular laser DCR using low energy 810 nm diode laser.Design:Interventional, non-comparative, case series.Materials and Methods:Patients with nasolacrimal duct obstruction and chronic dacryocystitis, who needed DCR, and were fit for surgery under local anesthesia, were recruited to undergo transcanalicular laser DCR using a 810 nm diode laser. The outcome was measured by the patency of the lacrimal passage, as indicated by the relief in the symptoms and the patency on syringing at the last follow-up. The surgical time and surgical complications were noted.Statistical Analysis Used:Descriptive analysis.Results:The study included 94 patients. The average age was 30.1 years (range 15 - 69 years). Seventy (74.4%) patients were female. Eight patients had failed external DCR. Per-operative patency of the passage was obtained in all the patients. Average surgical time was seven minutes (5 – 18 minutes). At the end of the study period of one year, a successful outcome was seen in 85 patients (90.5%). There were eight patients of previous failed DCR surgeries, and six of them achieved a cure at the end of follow-up.Conclusions:Transcanalicular Laser DCR can be safely performed using a low power 810 nm diode laser. The surgery is elegant, minimally invasive, allows fast rehabilitation, and has an excellent success rate.

Endonasal Laser Dacryocystorhinostomy and External Dacryocystorhinostomy Outcome Profile in a General Ophthalmic Service Unit: A Comparative Retrospective Study

To evaluate the outcome profile of endonasal laser dacryocystorhinostomy (ENL-DCR) in comparison with external dacryocystorhinostomy (ENL-DCR) carried out as part of general ophthalmic service within the same center. Patients who have undergone external or endonasal laser DCR in the authors institute with a minimum follow-up of 9 months and at least 3 months after removal of the tubes were invited to participate in this research. We used a questionnaire and a systematic clinical examination for detecting lacrimal passage patency and function. Patients were classified into categories: complete anatomical and physiological success; anatomical success with partial relief of symptoms; anatomical success with no relief of symptoms; anatomical failure. The endoscopic view of the ostium vertical location has been classified into four levels. One hundred and ten external-DCR and 53 Endonasal-DCR procedures were evaluated. Free communication (anatomical success) was achieved in 82% undergoing Ext-DCR and in 58% undergoing ENL-DCR. A significant number of patients continued to have symptoms in spite of a patent fistula (54% for Ext-DCR and 39% for ENL-DCR). The site of the opening of the internal ostium was significantly related to the persistence of symptoms in spite of free communication (P < 0.001, chi-square test). In this series of patients undergoing DCR in a general ophthalmic unit, the standard Ext-DCR technique has a higher anatomical success rate than the endoscopic laser DCR but not necessarily with equivalent rate of relief of symptoms. An inferiorly placed ostium is more likely to result in complete relief of symptoms.

Nasal passage patency in patients with allergic rhinitis measured by acoustic rhinometry: nasal responses after allergen and histamine provocation

We investigated nasal passage patency after allergen and histamine provocation in patients with allergic rhinitis by acoustic rhinometry. In total, 75 outpatients with allergic rhinitis were studied. The threshold of nasal hypersensitivity to histamine was measured by the 10 μl instillation of serial 10-fold dilution in the ipsilateral nasal cavity. Nasal provocation testing to specific antigen was applied to the anterior part of inferior turbinate in bilateral sides in sitting position. Measurement of nasal patency by acoustic rhinometry was repeated three times in each nasal cavity. The minimal cross-sectional area and total volume of nasal cavity were measured in an individual subject. The minimal cross-sectional area and total volume in the histamine challenged-side significantly decreased on the 10 −2, 10 −1, 10 −0 of end point, and up to 30 min after challenge with the threshold dose, but not in the unchallenged side. This means acoustic reflection technique is sensitive at least 100-fold in comparison with classical method like findings by anterior rhinoscopy and symptom scores. Nasal passage patency after bilateral allergen provocation showed predominant in the unilateral side, suggesting the cross over-reflex effects.It was concluded that acoustic rhinometry is one of the highly quantitative and sensitive method which can observe the change of nasal congestion.

鼻腔開存度へのエメダスチンの効果

The effect of emedastine difumarate after antigen challenge was investigated on nasal passage patency and the number of inflammatory cells in the nasal secretion of allergic rhinitis patients. The results showed that the change in nasal passage patency after 8 weeks of emedastine difumarate administration was significantly inhibited 30 minutes after the antigen challenge. No significant changes in the number of inflammatory cells in nasal secretion was observed during the acute or late phases.

Evaluation of nasal passage patency after antigen and histamine challenge in guinea pigs by acoustic rhinometry.

We investigated the effects of antigen and histamine on the nasal passage patency in guinea pigs with or without nasal allergy. The change of nasal patency was measured by acoustic rhinometry and nasal airway resistance. Acoustic reflections have been used in adult humans to determine nasal cavity dimensions in terms of cross-sectional areas as a function of the distance from the nostril. In order to measure nasal cavity dimensions in guinea pigs, we modified equipment for use in humans by decreasing sound tube dimensions, increasing sampling frequency, and applying a special nosepiece. The percent change of volume, minimum cross-sectional area, and nasal airway resistance showed the largest changes at 10 minutes after antigen challenge in sensitized guinea pigs. There was a significant correlation between the individual percent change of nasal airway resistance and volume or minimum cross-sectional area. Histamine, 10(2) to 10(5) micrograms/mL, caused a dose-dependent reduction in percent change of volume in the challenged side of nonsensitized guinea pigs, but not in the opposite side. These results indicate that the noninvasive acoustic reflections technique is useful in small experimental animals, especially to assess the effect of nasal cavity dimensions after the challenge of antigen or nonspecific stimuli.

Clinical and physiologic ?significance? of drug-induced changes in nasal flow/resistance

Although nasal airways flow/resistance (R n) measurements distinguish drug-induced changes in nasal patency better than investigator observations, it has not been shown that these alterations reflect useful clinical effects. Forty-eight patients with elevatedR n values from colds were studied for their responses to 10.0, 15.0 and 25.0 mg single doses of phenylephrine, and to placebo, given orally in a double-blind crossover protocol. Nasal flow/resistance was determined by electronic posterior rhinometry, and subjective estimates of nasal congestion using a five-ranked scale, before and over 120 min after, therapy each day. The meanR n changes observed for all three drug doses were significantly better than those following placebo at 14 of 15 time periods, with like significance for the mean subjective scores. Mean per cent changes inR n separated the effects of 25.0 mg from 10.0 and 15.0 mg doses of phenylephrine, and distinguished all three active tablet doses from placebo, whereas the subjective estimates could only differentiate the three phenylephrine doses from placebo, but not from one another. While these data confirm the sharp ranking of nasal decongestant potency possible withR n recording, contrasted with more blurred patient impressions, they suggest that statistically valid changes in nasal airways flow/resistance commonly imply favorable clinical activity as well as increased nasal passage patency.