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

Text Box: As revolutionary a change as was brought into rhinology with the introduction of Endoscopic Sinus Surgery (ESS), the issue of what to do with a percentage of cases that have little or no symptoms  reduction following this procedure has prompted a clamour for the need for trainees to be conversant with the older techniques of radical sinus surgeries. In a recent communication with EBM rating of C-4, (Videler et al, Otolaryngology–Head and Neck Surgery (2006) 134, 586-591 ) analyzed the record of 23 patients who underwent Denker's procedure for refractory rhinosinusitis following repeated ESS and observed overall symptomatology score improvement of about 70%, with none of the patients requiring revision surgery after 2 years post op Denker's procedure  Abstract: OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the inflammatory burden and optimization of drainage of the sinuses has been suggested as a last resort for these patients. STUDY DESIGN: A prospective, questionnaire-based study was conducted in a group of 23 patients who underwent Denker’s procedure for refractory chronic rhinosinusitis. Symptoms were evaluated before Denker’s procedure and 12 months and 2 years after surgery. RESULTS: Patients reported improvement of feelings of congestion in 74%, rhinorrhea in 70%, and nasal obstruction in 60% of the cases. The following postoperative improvements were statistically significant: rhinorrhea (P = 0.001), feelings of congestion (P = 0.02), and nasal obstruction (P = 0.03). Reduced olfactory perception and asthma did not improve. CONCLUSION: Radical surgery may be a viable treatment option in case of recurrent ESS failure.

Text Box: Editor's Choice: Failed FESS?...Go Radical! Text Box:  Still on AFRS...

Text Box: Volume 3, No. 3 Text Box:   This study (Rao, Mathers & Ramadan, Otolaryngology–Head and Neck Surgery (2006) 134, 581-585) with an EBM rating of B-3B from West Virginia aimed to throw further light on the significance of detection of fungi in chronic rhinosinusitis (CRS) utilized  PCR to compare fungi in sinus mucosa of individuals with and without CRS observed that fungi were detected only in presence of a combination of inhalant allergies, nasal polyposis and asthma. Abstract: OBJECTIVE: To compare the presence of fungi in the sinus mucosa of patients with and without chronic rhinosinusitis. STUDY DESIGN AND SETTING: Prospective observational study using polymerase chain reaction and conventional culture to detect fungi in the sinus mucosa. Middle meatus mucosal samples were collected from 31 patients with chronic rhinosinusitis and 14 control subjects. RESULTS: Fungi were detected in 6.5% of subjects with chronic rhinosinusitis and in none of the control subjects using polymerase chain reaction. Fungi were detected in 29% of subjects with the combination of inhalant allergies, nasal polyposis, and asthma. Fungi were detected in none of the subjects without the combination of these three comorbidities (P = 0.03). CONCLUSION: Polymerase chain reaction assay appears to be able to detect fungi in chronic rhinosinusitis. SIGNIFICANCE: Fungi may not be implicated in the pathogenesis of most chronic rhinosinusitis. Text Box: April 20, 2006 Text Box: Otorhinolaryngology news

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Text Box: The long observed reduction in measured OAE noticed when  the contralateral ear is acoustically stimulated simultaneously, and hypothesized to be due to medial olivo-cochlear system efferents to the outer hair cells was recently (Clarke et al, Ear Hear, Volume 27(2). April 2006:153-160)  investigated in children with specific language impairment (SLI) in a study that failed to observed any relationship between between TEOAE asymmetry and language impairment. Extract: Given that acoustic signals transmitted to the right ear are integrated by the auditory area located in the left temporal hemisphere, which is thought to play an important role in language, and that connections exist between the auditory cortex and cochlea through MOCS efferents (Huffman & Henson, 1990), Veuillet et al. (1999) suggested that reduced OAE suppression reported in their learning impaired group may reflect a more central dysfunction. It has been suggested that auditory efference is favored in the prevalent ear for language processing. The right ear suppression advantage seems to be absent in neonates with conceptional age less than 36 wks, and gradually appears there after (Morlet et al., 1999). Within this framework, the question arises as to whether any hypothesized differences in MOCS functioning between children with SLI and controls may reflect a difference in auditory efferent asymmetry between the two groups. Accordingly, the present study asks whether a group of children with SLI show a difference in baseline TEOAE amplitude and/ or pattern of right-left asymmetry as compared with a control group with normal language development. Further, it asks whether these children show reduced MOCS efferent activity, compared with a control group, as measured by the contralateral suppression of TEOAE, and if so, whether this reduction is more prominent in either the left or right ear. Additionally, it asks whether any relationships exist between contralateral TEOAE suppression measures and severity and/or pattern of language impairment as measured on standardized language tests. Children with SLI represent a heterogeneous group, therefore, a range of language measures is incorporated to determine whether any particular profile of language impairment is consistently associated with reduced MOCS function ....   Text Box: What link between MOCS AND Language Impairment...?

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 journal's 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-i, 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

An 11-year old female was referred on account of 3 weeks history of progressive right sided neck swelling not responsive to conventional antibiotics. she had associated fever, odynophagia and dysphagia, but no preceding dental or throat symptoms. Examination revealed high fever,   (T=39.80Celsius), pallor, tinge of jaundice, dry coated tongue with thick adherent whitish plaque on the dorsum,  trismus and the neck sign  demonstrated in this picture. Her ESR was markedly elevated, Her PCV was 20, Only anomaly on E/U/Cr was hypokalemia (K+ = 2.5 mEq/L).  Her retroviral screen was negative