SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases

BACKGROUND

Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD).

METHODOLOGY

Literature review using Medline and Em base databases (search terms 'chronic rhinosinusitis'; "chronic sinusitis" or"Severe Chronic Upper Airway Disease") limited to articles published in the English language.

RESULTS

Complex pathophysiological mechanisms characterize various forms of chronic rhinitis and rhinosinusitis (CRS), where inflammation persists in spite of adequate medical treatment. In these cases, a multifactorial etiology often underlies the development of sino-nasal inflammation. The interaction between chronic upper and lower airway inflammation via neurogenic and systemic pathways may complicate the therapy of these patients, and lead to insufficient symptom control.

CONCLUSION

The recently introduced definition of"Severe Chronic Upper Airway Disease" (SCUAD) increases awareness of those patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment. The concept of SCUAD may prove helpful in directing research towards clarifying the definition, diagnosis and pathophysiology of rhinitis and rhinosinusitis,their limits and overlap. In this review, a hypothesis on SCUAD immunopathology is also presented.

The golden ratio in facial symmetry

Symmetry is believed to be a hallmark of appealing faces. However, this does not imply that the most aesthetically pleasing proportions are necessary those that arise from the simple division of the face into thirds or fifths. Based on the etymology of the word symmetry, as well as on specific examples and theories of beauty, we conclude that φ-value, a ratio also known as the golden ratio or the divine proportion, can also characterize symmetrical forms. Therefore, we propose the utilization of this ratio in facial aesthetics.

Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo

BACKGROUND

Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV.

METHODS

Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995-2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals.

RESULTS

Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients' mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p<0.001).

CONCLUSIONS

This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

Dietary habits of preschool aged children with tonsillar hypertrophy, pre- and post-operatively

BACKGROUND AND OBJECTIVES

Tonsillectomy has been reported to have a positive effect on weight gain of children with tonsillar hypertrophy. This effect may be related to better respiration or/and feeding, immunological or metabolic factors. In this study we analyse the effect of tonsillectomy on the dietary habits of children.

SUBJECTS AND METHODS

Dietary habits of thirty 4-6 years old children were assessed before the operation and six months after it, using 24 hours dietary-recalls. In parallel, dietary habits of eighteen healthy children of the same age were assessed using the same method.

RESULTS

Children with tonsillar hypertrophy were receiving greater amounts of daily calories overall from sugar products, soft drinks and edible fats (p = 0.01, t = 2.673). Post-operatively, they increased the calories they were consuming daily and consumed even greater amounts of these food (p < 0.001, t = 3.527) in relation to the control group, gaining weight significantly (p = 0.043).

DISCUSSION

Parents should be aware of a possible weight increase after tonsillectomy which can be related to an over-consumption of products like candies and soft drinks.

Acute mastoiditis complicated with bezold abscess, sigmoid sinus thrombosis and occipital osteomyelitis in a child

Acute otitis media complications are relative rare since the introduction of antibiotics. Still many controversies exist on the diagnosis and treatment of some of them. In this report we describe a pediatric case of upper cervical abscess (bezold abscess), sigmoid sinus thrombosis and occipital osteomyelitis following mastoiditis, presenting with persistent fever and otorrhea. The patient responded well to intravenous antibiotics and wall-intact mastoidectomy. We discuss methods of early diagnosis and appropriate treatment options.

Outpatient cold knife tonsillectomy in toddlers with sleep disordered breathing

PROBLEM

Tonsillectomy performed as day surgery has become popular over the last fifteen years. However, there are conflicting opinions regarding the safety of this practice, especially in children of very young age. We sought to determine the safety of outpatient tonsillectomy in children aged three years old and younger.

METHODOLOGY

A retrospective study of all tonsillectomies performed in a major pediatric hospital during a two-year period was conducted. Age, gender, indication for tonsillectomy, other procedures performed simultaneously, seniority of operating surgeon, and reasons for hospital admissions during the first post-operative week were recorded. Patients with inappropriate records for the analysis were excluded. A total of 1058 patients were studied. Tonsillectomized children were divided into two age groups: greater than 3 years old (n = 951) and 3 years old or younger (n = 107).

RESULTS

Male gender, obstructed sleep disordered breathing as indication for surgery, seniority of the operating surgeon, and age of 3 years old or younger were not associated with post-operative complications.

CONCLUSIONS

Outpatient tonsillectomy can be managed safely regardless of age, as long as specific factors, such as good recovery room supervision, exist.

Otitis media with effusion: what parents want to know

Introduction:

Otitis media with effusion is a common condition of childhood. The development of an information leaflet for parents of children with the condition, and its impact on clinical management, have not previously been examined.

Patients and methods:

Eighteen doctors and 38 parents assessed the content of an information leaflet on otitis media with effusion, by applying two rounds of the modified Delphi technique. A qualitative assessment of content items was also performed.

Results:

From the 23-item list used in the first assessment round, four items had a low doctor–parent agreement and seven were excluded. Differences were also noticed in comments on the value of such leaflets, with parents being more positive about the value of leaflet distribution.

Conclusion:

During the consultation, doctors may not tell parents what they want to know, especially regarding daily care of their child. An information leaflet, developed using the Delphi technique, can help reduce this discrepancy and increase parents' satisfaction.