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Hosokawa Y, Omura K, Aoki S, Miyashita K, Akutsu M, Tsunemi Y, Kashiwagi T, Haruna S, Otori N, Tanaka Y. Predictors of Visual Acuity and Usefulness of a Treatment Algorithm in Rhinogenous Optic Neuritis. EAR, NOSE & THROAT JOURNAL 2019; 100:162-166. [PMID: 31550936 DOI: 10.1177/0145561319865490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rhinogenous optic neuritis, which causes neuropathy associated with visual dysfunction, greatly reduces patient quality of life and requires suitable early treatment. This study aimed to analyze visual outcome predictors in patients with rhinogenous optic neuritis and to develop and investigate the usefulness of an algorithm to facilitate early treatment. Prospective and retrospective investigations were conducted at the Department of Otorhinolaryngology. The visual outcomes after sinus surgery of 24 of 53 patients suspected of having rhinogenous optic neuritis were analyzed. Furthermore, the usefulness of the treatment algorithm was evaluated in 27 of these 53 patients. Data from 24 patients who underwent surgery were included in a multiple regression analysis to investigate the associations between visual outcomes and concomitant symptoms and the time from symptom onset to surgery. The mean time from the initial examination to a request for otorhinolaryngological examination to assess the usefulness of the treatment algorithm was compared in 27 patients who did not undergo an initial otorhinolaryngological examination. Visual acuity improved in 23 participants who underwent surgery. Multivariate analysis identified the time from onset to surgery and headache as significant predictors of postoperative visual acuity. The mean time from the initial examination to a request for otorhinolaryngological examination was significantly shorter after the algorithm was introduced (1.13 days, 8 patients; P = .008). Early surgical treatment is essential to avoid further postoperative visual acuity decreases in patients with rhinogenous optic neuritis. Patients who experience headache may have poorer postoperative outcomes.
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Affiliation(s)
- Yu Hosokawa
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan.,Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan.,Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Aoki
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Keisuke Miyashita
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Makoto Akutsu
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Takashi Kashiwagi
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Shinichi Haruna
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Flügel W. [Inflammatory diseases of the paranasal sinuses: orbital and periorbital complications]. HNO 2010; 58:24-30. [PMID: 20033118 DOI: 10.1007/s00106-009-2045-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In most cases bacterial infections of orbital and periorbital structures constitute inflammatory processes transmitted from the paranasal sinus system. The anatomical continuity of the paranasal sinuses to the orbit and also to the brain is the main reason for the occurrence of serious or even life-threatening complications. MATERIAL AND METHODS Under consideration of the literature and selected clinical cases, the pathogenesis, diagnostic standards and therapy strategies are discussed with respect to the stage of the disease and the clinical course. CONCLUSIONS Inflammatory periorbital and orbital complications require immediate otorhinolaryngological diagnosis and therapy and therefore, interdisciplinary cooperation with ophthalmologists and radiologists is indispensable. In particular the infrequent, but still seriously life-threatening processes associated with a 5-10% fatality rate must be diagnosed and treated as early as possible. In these cases the inclusion of neurosurgery and intensive care into a complex treatment management is necessary in order to prevent severe progression with endocrinal complications or even fatal outcome.
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Affiliation(s)
- W Flügel
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie und Kommunikationsstörungen, HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
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Suzuki N, Suzuki M, Araki S, Sato H. A case of multiple cranial nerve palsy due to sphenoid sinusitis complicated by cerebral aneurysm. Auris Nasus Larynx 2005; 32:415-9. [PMID: 16139977 DOI: 10.1016/j.anl.2005.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 05/19/2005] [Accepted: 05/27/2005] [Indexed: 10/25/2022]
Abstract
A case of sphenoid sinusitis and internal carotid aneurysm presenting with multiple cranial nerve palsy is reported. A 46-year-old man with high fever and neck rigidity developed progressive visual loss and ophthalmoplegia on both sides, and ptosis, mydriasis and facial numbness on the right side. CT scan and MRI revealed abnormal shadow of the sphenoid sinus and the cavernous sinus. Sphenoidectomy and antibiotic therapy improved left visual acuity, but the right visual disturbance remained. Cerebral angiography performed 20 days after the operation, showed an aneurysm of the cavernous portion of the right internal carotid artery. This aneurysm could be called "bacterial aneurysm" due to sphenoid sinusitis and cavernous sinusitis. However, there is another possibility that the enlargement of an idiopathic and asymptomatic intracavernous aneurysm due to rapid and severe parasinusitis induced bilateral cavernous sinus syndrome with the right side dominance. After endovascular coil placement, his right visual disturbance partially recovered.
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Affiliation(s)
- Nobuhiro Suzuki
- Department of Otolaryngology, Tokyo Medical University, Shinjyuku-ku, Nishishinjyuku, 6-7-1, Tokyo 160-0023, Japan.
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Peytral C, Chevalier E. Complications ophtalmologiques en pathologie oto-rhino-laryngologique. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcorl.2004.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Attallah M, Hashash M, al-Muhaimeed H, Dousary S, al Rabah A, Kharashi S. Reversible neuropraxic visual loss induced by allergic Aspergillus flavus sinomycosis. AMERICAN JOURNAL OF RHINOLOGY 1999; 13:295-8. [PMID: 10485016 DOI: 10.2500/105065899782102863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This work reports a patient with visual loss treated successfully with surgical removal of the Aspergillus flavus sinomycosis. Vision was partially reversed within hours after surgery before starting planned corticosteroid therapy. The patient's visual acuity continued to improve steadily until it became equal to that of the other eye. The immediate gain in vision and continued improvement without corticosteroid therapy suggest a new hypothesis for visual loss induced by allergic sinonasal Aspergillosis. Simple mechanical pressure alone of the aspergillus mass over the nerve can produce visual loss, and this loss is reversed by removing the mass without corticosteroid therapy.
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Affiliation(s)
- M Attallah
- King Abdulaziz University Hospital, Riyadh, Saudi Arabia
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Marple BF, Gibbs SR, Newcomer MT, Mabry RL. Allergic fungal sinusitis-induced visual loss. AMERICAN JOURNAL OF RHINOLOGY 1999; 13:191-5. [PMID: 10392237 DOI: 10.2500/105065899781389740] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.
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Affiliation(s)
- B F Marple
- Department of Otolaryngology, University of Texas Southwestern Medical Center at Dallas 75235, USA
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Intravenous antibiotics in sinusitis. Curr Opin Otolaryngol Head Neck Surg 1999. [DOI: 10.1097/00020840-199902000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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