Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients

OBJECTIVE

Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated disease-specific questionnaire for the assessment of Nasal Obstruction (NO). The aim of this study was to validate the Greek-NOSE questionnaire.

STUDY DESIGN

Prospective instrument validation study.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

NOSE questionnaire was translated into Greek and then translated back into English. A prospective study was conducted on adult patients with NO due to septal deviation (SD). Test-retest evaluation of SD patients was carried out. Internal consistency was assessed with Cronbach's alpha test and test-retest reliability with Pearson's test (correlation), kappa (reproducibility), and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores of a control group of volunteers without NO to preoperative scores of SD patients undergoing septoplasty with Mann-Whitney test. Responsiveness was assessed by comparing preoperative to 3 months postoperative scores of SD patients with paired t test and evaluating the magnitude of surgery effect.

RESULTS

Test-retest evaluation was accepted on 109 patients. The Greek-NOSE had good internal consistency (Cronbach's alpha 0.74 for test and 0.76 for retest). All its items were significantly correlated between test and retest evaluation. NOSE showed high reproducibility (mean kappa: 0.75), and almost all differences in Bland-Altman plot were between agreement thresholds. Controls (123 volunteers) had significant lower score. Postoperative scores were significantly lower than preoperative, and magnitude of surgery effect was high, both indicating good responsiveness.

CONCLUSION

The Greek-NOSE questionnaire is a valid instrument with satisfactory internal consistency, reliability, reproducibility, validity, and responsiveness.

Reversible facial nerve palsy due to parotid abscess

INTRODUCTION

A facial nerve palsy combined with parotid enlargement usually suggests malignancy. It is highly unusual for facial nerve palsy to result from a benign situation such as inflammation or infection of the gland.

PRESENTATION OF CASE

We present a rare case of facial nerve palsy due to parotid abscess.

DISCUSSION

A literature search retrieved thirty-two cases of facial nerve palsy due to benign parotid lesions since 1969. Only nine reported the presence of a parotid abscess. The etiology of paralysis remains unknown although certain factors such as the virulence of the offending organisms or perineuritis, have been suggested. Best diagnostic evaluation and management are discussed.

CONCLUSION

In clinical practice, exclusion of malignancy is mandatory, as it represents the most common cause of facial palsy in the presence of a parotid lump.

An inflammatory pseudotumour of the larynx: a case report and literature review of an unusual tumour

Background:

Inflammatory pseudotumour (IPT) is a rare benign pseudoneoplastic proliferation of unknown etiology, often showing locally aggressive behaviour. Conflicting theories about exaggerated response to injury versus true neoplastic origin have been suggested.

Methods:

We report a case of laryngeal pseudotumour in a 73-year-old man presenting with hoarseness and slowly progressive dyspnea and a short review of the English language literature on the subject.

Results:

Management consisted of midline vertical thyrotomy, excision of the tumour, and a temporary tracheotomy. No recurrence observed eight months postoperatively.

Conclusions:

Laryngeal IPT is extremely rare, and it may easily be misinterpreted as a malignant tumour. Conservative excision and anti-inflammatory therapy are advocated, since its general behaviour is benign.

Clarithromycin induced reversible sensorineural hearing loss

OBJECTIVE

We present a rare case of reversible sensorineural hearing loss caused by clarithromycin.

METHODS

We present a case report of hearing loss following clarithromycin administration; we also review the current literature and case reports concerning macrolides and, in particular, clarithromycin induced hearing loss.

RESULTS

A young pregnant woman presented with sensorineural hearing loss after clarithromycin intake. The subject's hearing returned to normal limits after drug discontinuation and short-term treatment with low dose steroids.

CONCLUSION

Newer macrolides are considered to be safer regarding ototoxic effects, and a few cases have been previously described. The present case adds to the body of knowledge concerning clarithromycin ototoxicity. Clinicians should be aware of this rare complication and a thorough otologic history should be established prior to macrolide administration. A baseline audiogram and close observation for patients at higher risk is suggested to identify patients with prior hearing loss and serve as baseline for future reference.

Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants

AIM

The aim of this study was to investigate the frequency of rhinitis medicamentosa (RM) in patients attending the ENT outpatient clinic of the General Hospital of Rethymnon (Crete, Greece) before and after the launch of an intensive nasal decongestant advertising campaign in Greece.

METHODS

We reviewed the medical records of the patients with RM seen at the ENT outpatient clinic in May, June and July of 2003 and 2006. We analyzed and recorded the gender, age, and related clinical information of the patients with RM.

RESULTS

In May, June and July of 2003, 41 patients out of a total of 1780 patients attending the ENT outpatient clinic were diagnosed with RM (2.3%). In the same months in 2006, 161 patients out a total of 1898 patients were diagnosed with RM (8.5%). The frequency of RM in these groups was therefore found to have increased significantly between 2003 and 2006. In 2006, 8 out of 10 patients with RM reported that they had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist.

CONCLUSION

We suggest that the intensive media advertising campaign for nasal topical decongestants (particularly on TV) which started in 2004 is probably the main reason for this "endemic" RM.

Cavernous haemangioma of the left nasal cavity

Cavernous haemangioma of the nose is a rare lesion but it has to be added to the differential diagnosis of an intra-nasal bleeding mass. A high index of suspicion, upon computed tomography delineation of the extent of the mass, including the presence of bone remodelling plus histological evaluation can be usefully employed to define an accurate diagnosis. In the present case of an adult female with a huge cavernous haemangioma arising from the mucosa of the left middle nasal meatus, the two most interesting points were the rarity as a site of occurrence of this tumour and the successful extirpation of this lesion with the minimally invasive trans-nasal endoscopic technique. We recommend the minimal invasive trans-nasal endoscopic technique for adequate exposure, sufficient control of bleeding and for complete removal of a nasal haemangioma reaching the nasopharynx and paranasal sinuses.

Intraparotid lymph node tuberculosis

PROBLEM

Parotid gland Mycobacterial infection is a rare disease that causes parotid swelling without disease-specific manifestations.

CASE REPORT

We present a case of intraparotid lymph node tuberculosis that mimicked a tumour. Computed tomography of the head and neck indicated a left parotid enlargement involving two intraparotid lymph nodes. The cervical lymph nodes of the ipsilateral posterior triangle and the submandibular and jugulodigastric areas were also enlarged. Contrast enhancement indicated homogenous tissue with no necrotic areas. A biopsy revealed a caseating granuloma most likely due to tuberculosis. A purified protein derivative test gave strong positive results (35 mm). After one month of antituberculous treatment, the cervical lymphadenopathy and left parotid lumpiness disappeared.

CONCLUSIONS

Tuberculous parotitis and neoplasms have similar clinical manifestations. In patients with a mass in the parotid gland, a high clinical suspicion of underlying tuberculosis is crucial for establishing an accurate diagnosis and the proper management.

Cocaine versus tetracaine in septoplasty: a prospective, randomized, controlled trial

BACKGROUND

Successful local anaesthesia is of critical importance for the success of septoplasty, and many surgeons prefer to use cocaine for this purpose. The aim of this study was to evaluate the efficacy of cocaine 4 per cent solution, compared with tetracaine 2 per cent plus adrenaline, as a local anaesthetic for patients undergoing septoplasty.

METHODS

From December 2002 to February 2005, a prospective, randomized, controlled trial was conducted. One hundred and eight patients underwent septoplasty under local anaesthesia. Patients were randomly classified into group A and group B, in which was used respectively cocaine 4 per cent solution and tetracaine 2 per cent solution plus adrenaline. A visual analogue scale was used to evaluate the severity of patients' pain during their procedure.

RESULTS

Group B (tetracaine; mean rank=43.77) reported significantly less pain (p<0.001) compared with group A (cocaine; mean rank=65.23).

CONCLUSIONS

On the basis of these findings, we recommend tetracaine as the first choice anaesthetic for nasal septoplasty; the use of cocaine should be limited.

Optimal time for nasal packing removal after septoplasty. A comparative study

OBJECTIVE

The objective of this study was to evaluate the efficacy and subjective discomfort of one-day internal dressing compared to that of two-day in patients undergoing nasal septal surgery.

STUDY DESIGN/METHODS

Prospective, randomized, clinical trial conducted on 75 patients undergoing septoplasty in a tertiary ENT clinic. Discomfort caused by nasal dressings was evaluated by means of a visual analog scale. Postoperative complications were also compared.

RESULTS

Mean discomfort score for group A (nasal packing for 48 hours) was 3.5 (SD 1.15) vs. 2.7 (SD 1.52) for group B (nasal packing for 24 hours). Significant lower discomfort is reported when the nasal packing is removed the first day instead of after two or more days. No increase in complication rate was noticed.

CONCLUSION

Our results point out that one-day internal nasal dressing is preferable to that of two or more days, because of less patient discomfort and increased cost-effectiveness without increasing immediate complications.

In vitro enzymatic treatment and carbon dioxide laser beam irradiation of morphologic cartilage specimens

OBJECTIVES

To determine the role of the main cartilage components in the internal system of interlocked stresses and to clarify the effect of laser beam irradiation on cartilage.

DESIGN

Control and experimental series.

SUBJECTS

Rabbit ear cartilage.

INTERVENTION

Rabbit ear cartilage strips incubated in collagenase and hyaluronidase enzyme solutions for specific periods were examined, and the observed changes in shape, strength, and elasticity were recorded, as well as the effect of carbon dioxide laser irradiation. Laser-pretreated cartilage strips were also incubated in the enzyme solutions to determine whether the laser-provoked changes were susceptible to enzymatic action. All cartilage pieces were examined by light and electron microscopy.

RESULTS

Collagenase-treated cartilage strips gradually lost their interlocked stresses, while hyaluronidase-treated strips mostly maintained their shape and their physical characteristics. Hyaluronidase-incubated cartilage strips altered their shape when they were laser treated. Collagenase-treated cartilages did not modify their shape when they were laser treated. Laser-pretreated cartilage pieces lost their new form in collagenase solutions but kept their laser-evoked shape when put in hyaluronidase solutions.

CONCLUSION

The macroscopic observations combined with light and electron microscopy findings argue for the distinct role of the collagen network in morphologic cartilage shape and tensile strength preservation and provide a probable mechanism of cartilage transformation owing to carbon dioxide laser irradiation.

Osteoid osteoma of the ethmoid bone associated with dacryocystitis

Background

Osteoid osteomas (OO) are small, benign osteoblastic lesions. Ethmoid bone OO has been very rarely reported so far.

Case presentation

We report a case of a 16-year-old boy suffering from persistent epiphora and a mild pain in the area of median canthus, due to a bone density mass within the right ethmoid air cells extending to the ipsilateral right orbit. The mass was removed via an external ethmoidectomy approach. Histopathologic examination of the specimen set the diagnosis of OO. One year after the operation the patient is free of symptoms, while no recurrence occurred.

Conclusion

A case of ethmoid bone OO associated with dacryocystitis is reported. Although benign and rare, OO should be considered in differential diagnosis of the ethmoid bone osteoblastic lesions.

Primary nasal non-Hodgkin lymphomas presented initially as benign disease

BACKGROUND

Primary non-Hodgkin lymphomas (NHLs) of the sinonasal tract comprise a rare entity that constitutes 1.5% of all NHLs and 2.2% of extranodal lymphomas in the whites. Clinical diagnosis may be very challenging because of the variety and low specificity of the presenting symptoms and signs.

METHODS-RESULTS

We present three cases of NHLs, initially diagnosed as benign diseases. All three cases have been eventually correctly diagnosed and treated in our hospital between January 2000 and December 2003. The patients have been under close follow-up from 11 to 36 months after the initial treatment. One of them remains without clinical or radiological evidence of recurrence, whereas the two others died 11 and 16 months after the initial diagnosis.

CONCLUSION

It is important to underline that atypical or persistent symptoms of rhinosinusitis may represent the initial expression of a more serious condition such as deep fungal infection, vasculitis, lymphoma, or other malignancy.

Canal Wall Down Mastoidectomy for Cholesteatoma: Experience at the University of Crete

OBJECTIVE

To evaluate clinical and audiologic data as well as operative findings and postoperative follow-up in the management of chronic cholesteatomatous otitis media with canal wall down mastoidectomy (CWDM).

STUDY DESIGN

A retrospective review of cases followed up between 1990 and 2002.

SETTING

Tertiary referral centre.

METHOD

Two hundred one patients with chronic otitis media with cholesteatoma underwent CWDM.

MAIN OUTCOME MEASURES

Clinical presentation, surgical findings, and audiologic evaluation were assessed.

RESULTS

Preoperatively, eight patients suffered from vertigo and four presented with facial nerve paralysis. In 40 patients (20%), erosion of the lateral semicircular canal was found, and in 31 patients (15%), there was dehiscence of the facial nerve canal. Dural plate erosion and sinus plate dehiscence were found in 13 and 17 patients, respectively. Nine patients experienced serious endocranial complications at their admission. The malleus was noted to be intact in the majority of patients in all age groups. The incus was eroded or absent in most of the cases in all age groups. On postoperative evaluation 3 months after surgery, 195 audiograms were performed, with a mean pure-tone average of 55 dB HL and a mean air-bone gap of 30 dB HL.

CONCLUSION

Although CWDM has the disadvantages of the necessity to avoid water insertion in the external auditory canal and lifelong mastoid care, it is an effective treatment in a single-step procedure for patients with advanced disease and for those who refuse to submit to postoperative follow-up.

The combined endoscopic CO2 laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis

Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO(2) arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long-term results in the management of 18 patients treated in our department during the last 8 years.

Bilateral sudden sensorineural hearing loss caused by Charcot-Marie-Tooth disease

Charcot-Marie-Tooth (CMT) disease or hereditary motor and sensory neuropathy (HMSN) is a relatively common neurological syndrome, which has seldom been associated with hearing dysfunction, particularly sudden sensorineural hearing loss (SNHL). Families with autosomal dominant, autosomal recessive and X-linked forms of inheritance have been described. Sudden sensorineural hearing loss is a frustrating and frightening condition, especially if the hearing loss is bilateral. Regarding the site of the lesion, the evidence from the literature on HMSN suggests that either the VIIIth nerve or central auditory pathways are primarily involved in patients with hearing loss. We report the first case in the English literature of a patient with Charcot-Marie-Tooth type II disease presenting bilateral SNHL in the course of his disease. The patient was hospitalized for 15 days, and undergoing treatment without any audiological improvement. Detailed clinical, audiological and laboratory examination was performed. The aetiology and prognostic indicators of bilateral SNHL are discussed, as well as, the incidence of hearing loss in CMT patients.

The role of laser assisted tympanostomy (LAT) in treating allergic children with chronic serous otitis media

OBJECTIVES

To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure.

METHOD

Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters.

RESULTS

Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome (P < 0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome (P < 0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome.

CONCLUSION

A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail.

Palate ulcer due to mucormycosis

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence. A case of deep hard palate ulcer due to sinonasal mucormycosis in a 79-year-old man is reported. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks. By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers.