Text Box: Abreast of Ear, Nose, Throat, Head & Neck Advances

Text Box: Since its first description in early 1980s, allergic fungal sinusitis has consistently been associated with higher incidence of skull base and/or orbital erosion. To clear the air on the gross variation reported by studies on the incidence of bony (skull base and / or orbital) erosion in allergic fungal rhinosinusitis (AFRS), a recent study ( Ghegan et al, Otolaryngology–Head and Neck Surgery (2006) 134, 592-595) with an EBM rating of C-4 investigated the incidence of bony erosion in both AFRS and non-AFRS population and observed that the incidence of radiologically evident bony erosion is much higher in AFRS (56%) compared to non-AFRS (5%) population, and that such erosion tends to occur commonly in African-Americans males! Abstract: OBJECTIVE: To compare the incidence of bony erosion associated with allergic fungal rhinosinusitis (AFRS) with the incidence of bony erosion seen in other types of inflammatory sinusitis. STUDY DESIGN: Retrospective review. RESULTS: AFRS was diagnosed in 27 patients, and 15/27 (56%) had bony skull base or orbital erosion. Non-AFRS chronic sinusitis required surgery in 158 patients, but only 8 (5%) had bony skull base or orbital erosion (P 0.01). AFRS patients were 12.6 times (P 0.01) more likely to have bony erosion than non-AFRS patients. African American males were 15.0 times (P 0.01) more likely to have bony erosion than whites and African American females combined. CONCLUSION: Bony erosion with intracranial and intraorbital extension is much more common in AFRS than all other types of inflammatory sinusitis combined. African American males have a higher incidence of AFRS, as well as intracranial and intraorbital extension.

Text Box: Editor's Choice: Skull Base /orbit Invasion, AFRS & Pigmentation? Text Box:  HSP-70 & Idiopathic Tinnitus

Text Box: Volume 3, No. 2 Text Box:   A recent attempt to find some way around the perplexing issue of idiopathic tinnitus  got a boost recently with this study from Italy (Savastano et al,  Ann Otol Rhinol Laryngol. 2006 Mar;115(3):243-6.) that  investigated the issue of heat shock protein 70 antibodies in cases of idiopathic tinnitus and observed that a portion of such cases might have underlying autoimmune inner ear disorders. Abstract: OBJECTIVES: Our preliminary study investigated the role of nonspecific immunologic tests and immunoassay for heat shock protein 70 (HSP-70) in supporting the possibility of an autoimmune inner ear process determining idiopathic tinnitus. METHODS: Thirty-six consecutive patients with idiopathic tinnitus without other otologic or autoimmune diseases and 20 healthy blood donor subjects underwent determinations of circulating immune complexes (CICs) and other nonspecific immunologic factors and immunoassay for HSP-70. RESULTS: The mean CIC values were 4.2 microg/mL in the tinnitus patients and 0.9 microg/mL in the control group (p = .012). Thirteen of the 36 tinnitus patients and none of the control group were HSP-70-positive. Ten of the 13 HSP-70-positive patients had CIC values higher than normal. In the tinnitus group, the mean CIC values were 6.9 microg/mL and 2.6 microg/mL in the HSP-70-positive and -negative subgroups, respectively (p = .024). CONCLUSIONS: It may be hypothesized that in a significant number of cases, idiopathic tinnitus could be induced by immune response to inner ear-specific HSP-70. Text Box: April 13, 2006 Text Box: Otorhinolaryngology news

Text Box:     Links & Hyperlinks >> Text Box: Biodun Olusesi Newsletter Editor Text Box: Top Picks

Text Box: In order to find a rational approach to management of paediatric patients with epistaxis, Damrose & Maddalozzo () retrospectively reviewed 90 cases and concluded that evaluation should include routine screening for anaemia and coagulopathy. Abstract: OBJECTIVES/HYPOTHESIS: Otolaryngologists are frequently consulted for the evaluation and treatment of pediatric epistaxis. There is a lack of consensus as to the optimal approach to this problem. This study evaluated an approach used to evaluate and treat patients referred on an outpatient basis. STUDY DESIGN: Retrospective study. METHODS: Charts from 90 patients referred for the treatment of epistaxis were reviewed. RESULTS: Anemia was identified in 22% of patients. An abnormal coagulation study was identified in 7.8% of patients. Computed tomography (CT) imaging of the sinuses was obtained in nearly 90% of patients and revealed no suspicious masses. Opacification of the sinuses consistent with sinusitis was commonly seen. The majority of cases were resolved by the first follow-up visit with a topical nasal emollient. CONCLUSIONS: The outpatient evaluation of epistaxis should include a screen for anemia and coagulopathy. Routine CT imaging of the sinuses is unhelpful and is not recommended. The majority of cases are easily treated with rehydration of the nasal mucosa. Consideration should be given to rhinosinusitis as a co-existing factor in patients with epistaxis.   Text Box: What Approach to Paediatric Epistaxis?

Text Box: 1. 8th International Otology Course of the Jean Causse Ear Clinic June 22-24, 2006; Béziers, France 2. 110th American Academy of ORL,Head & Neck Surgery Annual Meeting & OTO EXPO, September 17-20, 2006; Toronto, Canada. 3. 42nd South African ENT Congress joint meeting with the British Association of Otolaryngology - Head & Neck Surgery, October 29-November 1, 2006; Cape Town, South Africa.          For more Worldwide otolaryngological events and conferences....Click Here

Text Box: Coming Events of Importance to Otolaryngologists in Africa...

Text Box: What is the diagnosis

Text Box: · Reviewers wanted for otolaryngology news journals watch page. If you are an Otolaryngologist in Africa and will like to be our journal reviewer, please feel free to email orl-mailer@otolaryngologyinafrica.net · DODA 2006, capable of advanced hearing measure, and also paediatric hearing assessment is being developed. If you requested for and got a free copy of DODA, you may also look out for this latest version dubbed DODA 2006, as well as for an additional page on outcome of hearing assessment using DODA. Watch out for otolaryngologyinafrica.net Journal Club Page! Till Next Week, Biodun

Text Box: This is a free email newsletter circulating to Otolaryngologists in Africa, and interested Otolaryngologists elsewhere. If you know anyone interested in receiving this free newsletter, feel free to forward a copy to such person or encourage them to email orl-mailer@otolaryngologyinafrica.net for subscription                                                      © Copyright Dr 'Biodun Olusesi,  2005 - 2006

 

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Case Review

Clinical Photo of The Week

A 30-year old male was referred on account of 11 months history of right sided epistaxis, 3 months history of  twisting of the face to the left side, and drooping of upper right eyelid. He had always done clerical jobs. Examination revealed right ptosis, right complete lower motor neuron facial nerve palsy, right soft palatal paralysis and the tongue sign demonstrated in this picture. EUA postnasal space revealed scanty soft tissue mass admixed with old blood clots. You may want to view his MRI of sinuses / brain findings for more detail.