Sinonasal Disorder Research Articles

Piezoelectric device use in sinus osteotomy for equines is feasible but may extend time to accomplish frontonasal bone flap.

Sinus osteotomy is currently performed in equine surgery with conventional surgical methods, such as trephines and oscillating bone saw, leading to subsequent trauma to the bone during cutting. Piezoelectric devices are now used in maxillofacial surgery in humans as a standard tool as it is less traumatic than the oscillating bone saw and shortens the healing period. The aim of this study was to show that the piezoelectric device can be used for equine sinus surgery, compare its use with the oscillating bone saw, and describe the outcome of cases involving osteotomy performed with a piezoelectric surgical device. 10 horse specimens for cadaveric study and 11 client-owned equines for clinical evaluation. Each cadaveric head underwent a frontonasal bone flap on a randomly assigned side with the piezotome and the oscillating bone saw on the opposite side. Surgical time was recorded for every procedure, and gross examination was performed. A Welch t test was used to compare the surgical time between piezoelectric and oscillating saw use. For the clinical study, animals presented for sinonasal surgery at the hospital from March through October 2023 were included. Osteotomy was possible with the piezotome in all animals. Surgical time was significantly increased when using the piezotome in comparison with the oscillating saw (P < .05). All clinical patients were treated adequately for the sinonasal disorder they were presented for using the piezotome instead of the oscillating saw. No adverse effects nor long-term complications related to its use have been noted, and preservation of the surrounding soft tissues was evident. The use of a piezoelectric device in equine surgery is feasible. However, the cadaveric study showed an increased surgical time to perform a frontonasal bone flap.

The midfacial segment pain: little known disorder in need of scientific evaluation.

Despite its inclusion in the International Classification of Orofacial Pain, tension-type orofacial pain has little support in the scientific literature. However, a similar-in-phenotype orofacial pain perceived in the middle segment of the face has been described by few case series from mostly ear, nose and throat clinics. The authors of these descriptions used the term 'midfacial segment pain'. Patients had no significant sinonasal disorder in these studies, but experienced symmetrical pain perceived mostly over the maxillary and ethmoid sinuses. No aura or autonomic symptoms were present apart from mild nasal congestion or rhinorrhoea in some individuals. This description appears similar to tension-type headache, but with midfacial location. In this viewpoint, we indicate a need to fill this gap in scientific knowledge and propose a multicentre interdisciplinary study that would give a detailed description of this type of orofacial pain.

Exhalation Delivery Systems for Application of Intranasal Corticosteroids.

Chronic rhinosinusitis (CRS) is a common sinonasal disorder which results in significant inflammation in the nasal cavity and paranasal sinuses. Topical nasal steroids play an important role in the treatment of CRS. Exhalation delivery system with fluticasone (EDS-FLU) utilizes a patient's forced exhalation to power the delivery of topical steroids to deeper areas of the nasal cavity and paranasal sinuses most affected by CRS. This review focuses on evidence surrounding the safety and efficacy of the EDS-FLU system. Literature search was conducted of articles investigating the safety and efficacy of EDS-FLU. Relevant efficacy and safety data were examined and summarized from the studies. The efficacy and safety of EDS-FLU in CRS, both with and without polyps, has been established in open-label and placebo-controlled phase 3 trials. There was significant improvement in the cardinal symptoms of CRS and subjective patient-reported outcomes scores. Additionally, there was objective improvement in sinonasal inflammation as measured by polyp grade. Recent studies have also established significant improvement in health status and general quality of life following treatment using EDS-FLU. Emerging data have also examined patients who have previously had endoscopic sinus surgery and on appropriate medical therapy and noted improvement in polyp burden and overall Lund-Kennedy scores after using EDS-FLU. Exhalation delivery system with fluticasone demonstrates significant results in both patient-oriented outcomes and objective measures of sinonasal inflammation in patients with CRS with and without polyps. Further research is needed to investigate the long-term outcomes of EDS-FLU and to compare the effects of EDS-FLU with ESS. Exhalation delivery system with fluticasone provides an additional effective treatment modality for patients suffering from CRS.

A new approach to managing follow-up patients with sino-nasal disorders: the rhinology panel

Background/aims There is a growing backlog of patients with sino-nasal disorders waiting for a follow-up appointment. This study aimed to identify rhinology patients on the outpatient follow-up list who could be removed from the waiting list for a face to face follow-up appointment and instead either given a phone consultation by a clinical nurse specialist or discharged from the service. Methods The clinical records of patients on the waiting list for a follow-up appointment at a nasal disorders clinic were reviewed by a panel comprising a consultant rhinologist, a rhinology fellow, a specialist registrar and two nurse specialists. Results A total of 300 clinical records of patients on the follow-up list of the Rhinology clinic were identified, of which 253 were found to have a sino-nasal disorder. Of these, 137 patients (54%) were discharged from the rhinology face to face follow-up clinics, while 116 patients (46%) were given face to face review appointments. Conclusions A multi-professional rhinology review panel is an effective way of managing the waiting list of an outpatient rhinology clinic and providing nurse-led telephone consultations could decrease the strain on resources while maintaining patient safety.

Wogonin attenuates nasal polyp formation by inducing eosinophil apoptosis through HIF-1\u03b1 and survivin suppression

Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is an inflammatory sinonasal disorder characterized by eosinophilic inflammation and T-helper 2 skewing. Eosinophil accumulation in sinonasal mucosa comprises a major feature of CRSwNP. The study aimed to investigate the effect of the flavone wogonin in nasal polyposis by assessing its ability to induce eosinophil apoptosis in vitro and attenuate eosinophilic CRSwNP in mice. Double immunofluorescence, immunohistochemistry, flow cytometry, and immunoblotting were performed to evaluate hypoxia-inducible factor (HIF)-1α, survivin, and apoptotic markers in the human eosinophilic EoL-1 cell line or sinonasal tissues from patients with CRS with or without NPs. In sinonasal specimens from patients with CRS, HIF-1α and survivin were up-regulated in eosinophils from patients with NPs compared with levels in patients without NPs. Under hypoxia, HIF-1α and survivin expression was up-regulated in EoL-1 cells. Wogonin down-regulated both HIF-1α and survivin in EoL-1 cells. In addition, overexpression of survivin protected EoL-1 cells against apoptosis in response to wogonin. Moreover, wogonin attenuated nasal polyp formation in a murine model. Our findings suggest that wogonin could induce caspase-3 activation by suppressing HIF-1α and survivin expression in EoL-1 cells. Further studies regarding novel therapeutic options for CRSwNP targeting eosinophil apoptosis are needed.

Posttreatment surveillance for sinonasal malignancy.

Sinonasal neoplasms have a high rate of recurrence following treatment, and clinicians utilize a variety of surveillance techniques. Generally, surveillance modality and frequency of follow-up are determined by the guidelines for head and neck cancer as a broad category. However, recent studies have demonstrated that a more tailored approach to follow-up may be necessary. Endoscopy has low sensitivity in recurrence detection, especially in the asymptomatic patient. However, it is able to identify superficial recurrences that may be more amenable to repeat resection. Conversely, imaging [computed tomography (CT), MRI, and F-fluorodeoxyglucose-PET/CT] is useful in ruling out disease, but the inflammatory environment of the posttreatment sinonasal cavity leads to a high number of false positives. This is especially notable in PET/CT, which has worse specificity and positive predictive value in sinonasal malignancy than in head and neck malignancy overall, especially in the early posttreatment period. Little data are available on optimal timing and duration of follow-up, but tumor histology and aggressiveness should be considered when choosing a surveillance approach. Sinonasal malignancy surveillance strategies may warrant modifications of current protocols used for head and neck malignancy. This is due to a number of factors, including a greater diversity of sinonasal disorder and increased duration of posttreatment sinonasal inflammation. Clinicians should be aware of the performance parameters of commonly used surveillance techniques and adjust follow-up regimens based on this information.

A Case of Olfactory Groove Meningioma Presenting Anosmia

The common causes of anosmia include sinonasal disorder, post-upper respiratory infection, trauma and chemicals. Intracranial tumor also frequently cause anosmia, so it is not easy to diagnose an intracranial tumor in patients who present with no definite related symptoms other than anosmia. Therefore, otolaryngologists should focus their attention on these disorders when they see patients with anosmia. We have experienced a case of olfactory groove menigioma presenting with only anosmia. We herein report this case with a brief review of the literature.� Korean J Otorhinolaryngol-Head Neck Surg 2011;54:431-4

Influence of anatomic variations of the middle nasal meathus on sinonasal diseases

The most common anatomic variations of the structures of the middle nasal meatus are variations of agger nasi cells, variations of the middle turbinate, variations of uncinate process, variations of the ethmoidal bulla, deviations and deformations of nasal septum in the region of the middle nasal meatus, Haller's cell (orbitoethmoidal) and Onodi's cell (sphenoethmoidal cell). In 1997, the Otorhinolaryngology-Head Neck Surgery, Task Force on Chronic Rhinosinusitis defined chronic sinusitis and nasal disease initially by including sinusitis and rhinitis with one term-chronic rhinosinusitis. This was done because it was apparent to many that nasal disoders often affected the sinuses, and vice versa. Also they established baseline parameters, major and minor signs and symptoms, for definition of rhinosinusitis. Two major factors or one major factor and two minor factors constitute a strong history for rhinosinusitis. The following methods were used in the study: 1. Anamnestic data processing about: disease symptoms that were recognized by American Academy for ENT as major and minor criteria in diagnosing nosinusitis; the duration of symptoms; the kind of sinonasal disorder and the secondary disorders. 2. Data processing obtained by anterior/posterior rhinoscopy. 3. Data processing obtained by endoscopic examination. 4. Data processing obtained by CT of paranasal cavities and the nose. The data about anatomic variations were statistically processed by Eives's correlation coefficient that indicates the degree of correlation between sinonasal disorders and anatomic variation. By analyzing the obtained data in the examined patients with sinonasal disorders, anatomic variations were present in over 50% of the patients and are defined by percentage. 1. The deviation of nasal septum in 83.33% patients. 2. The variations of the form of the middle nasal chonha in 58.92% patients. 3. The presence of agger nasi cells in 50% patients. 4. Variations of the form of ethomoidal bulla in 50% patients. Eives's correlation coefficient i.e. the degree of correlation between sinonasal disorders and the presence of anatomic variation statistically significantly correlate at r > or = 0.05 of anatomic variation of the middle nasal chonha (r = 0.23) and the presence of deviation/deformation of nasal septum (r = 0.6) with sinonasal disorders. Anatomic variations of the structures of the middle nasal meatus can additionally complicate the anatomy of the lateral nasal wall and the conditions of the ostiomeatal unit. Therefore we must view these variations as factors predisposing to more rapid and frequent appearance and persistence of chronic inflammations. Also, familiary with the variations in sinonasal anatomy is a prerequisite to safe and effective surgical treatment of sinonasal disease. Recognition of this anatomic variation should minimize catastrophic violation of vital structures such as orbit or skull base.

Allergic rhinitis--making the correct diagnosis.

The symptoms of rhinosinusitis occur in a variety of sinonasal conditions, which may be broadly classified as allergic (seasonal, perennial or occupational rhinitis/rhinosinusitis) or non-allergic (caused by infection, or non-infectious, e.g. drug-induced or idiopathic). Correct diagnosis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. Careful examination should reveal obvious alternative causes of symptoms, such as polyps or tumours. If allergy is suspected, this can be confirmed by further tests, particularly the skin-prick test or measurements of serum specific IgE. Imaging techniques, usually X-rays or CT scanning, are of use if a systemic condition or major sinonasal disorder needs to be excluded. Other useful diagnostic aids are measurements of nasal peak flow, rhinomanometry, acoustic rhinometry, olfactory threshold, and measures of mucociliary function (which may include biopsy for electron microscopy).