[Concurrent Endoscopic Sinus Surgery (FESS) with Septorhinoplasty - Indication, Risks and Chances]

BACKGROUND

Patients with a chronic rhinosinusitis (CRS) and a concurrent deformity of the outer nose often require a septorhinoplasty (SRP) for functional or aesthetic reasons, combined with functional endoscopic sinus surgery (FESS). Aim of this study was to rule out the benefit of this combined approach.

PATIENTS AND METHODS

In a prospective study of 55 patients (30 m, 25 f, age 16-77 years) with a chronic rhinosinusitis with or without polyps combined with a deformity of the outer nose we performed a FESS together with a SRP using a closed or open approach. The control group included 55 patients (18 m, 37 w, age 18-62 years) with SRP alone. All patients got the same type of anestesia and an antibiotic prophylaxis with clindamycin. We compared the rates of inflammation and other complications of surgery.

RESULTS

The only difference between study group and control group was the period of time for surgery. There was neither a relevant inflammation in both groups nor any other significant complication (bleeding, edema, etc). Also the rate of minor revisions after SRP was almost the same in both groups.

CONCLUSIONS

The combined FESS and SRP is a safe and effective method without an increased risk of complications compared with SRP alone.

[Ability of smell after medialization of the middle nasal turbinate in endoscopic sinus surgery]

BACKGROUND

Endoscopic sinus surgery usually requires a move of the middle nasal turbinate into the midline to achieve a better sight into the ethmoidal sinuses. In this procedure damages of the turbinate are possible, which later can lead to a scarred fixation of the turbinate. Fixing of the turbinate to the septum can avoid this effect, but could reduce smell ability by blocking of the upper nasal duct.

MATERIAL

In a prospective study with 83 patients with chronic sinusitis (55% CRS with polyps, 45% CRS without polyps) at the end of the operation the middle nasal turbinates were fixed at the nasal septum with a 4 × 0 stitch. Before the operation and 6 weeks, 3 and 5 months after operation the smell was tested using the "sniffin'sticks" threshold test.

RESULTS

After operation the ethmoidal area remained open without developing of relevant synechiae or scars. The smell ability decreased after surgery due to the obstruction of the upper nasal duct, but improved again later. After 5 months the average threshold of smell was better than before operation. Testing of the threshold values with the t-test showed a significant difference (p<0.001) between the pre- and postoperative status.

CONCLUSION

The method of medialization and temporary septal fixation of the middle nasal turbinate allows a sufficient ventilation and drainage of the paranasal sinuses after sinus surgery. Due to only temporary fixation of the turbinate at the septum, a permanent obstruction of the upper nasal duct and the olfactory area is prevented. Thus the threshold of smell is not reduced.

[Model project of hearing screening in new-born in Hanover (preliminary results)]

In Germany, congenital hearing disorders are usually detected too late resulting in insufficient therapy of the disorder. To investigate these problems, the Federal Ministry of Health and the principal associations of statutory health insurance commissioned a pre-operative study. The study's aim is to verify whether introduction of a universal new-born hearing screening results in earlier diagnosis of hearing disorders and thus improves medical care for children with impaired hearing. Feasibility, effectiveness and economic tenability of this hearing screening programme will be investigated. The study is realised in the Hanover region and aims at carrying out a hearing test in all new-born during the first days of life. The tests will be performed in all 10 birth clinics and 2 paediatric clinics in the relevant region and in 24 otolaryngological practices. Hearing ability is controlled via an automated screening device measuring otoacoustic emissions. Sensitivity and specificity of the test is more than 95%. Economical feasibility is investigated by cost-effectiveness analyses. During a 6-month period the screening has been implemented in all clinics in every day routine. The mean coverage rate in the clinics has been stabilised to 97% of the total number. 4.7% of the children were presumed to suffer from unilateral hearing disorders and 2.3% from bilateral. In 13 cases the diagnosis of hearing disorder was confirmed. The mean age of diagnosis in these children was 3.7 months. The average age of therapy onset was 4.4 months. According to the present experience, area-wide implementation of hearing screening seems feasible in existing health care structures. The intention to advance the time of diagnosis and the therapy onset can be achieved by this method. Systematic training, introduction and quality assurance measures of screening are mandatory. Tracking of suspicious cases is necessary, even if it challenges data privacy regulations.

[Results of clinical and epidemiologic studies of the nitrate problem]

Small differences in nitrate intake with the drinking water are not reflected in nitrate contents of saliva and urine of test persons. A correlation of nitrate concentration in body fluids and cancer incidence can be expected hardly. Inflammatory diseases of the gut are frequently accompanied by enhanced endogenous nitrate synthesis and have an essential influence on total nitrate load of the human organism. Nitrate contents in saliva and/or urine are not general indicators of inflammatory processes. As the role of the nitrate ion in humans is not yet understood, the claim remains for a nitrate intake being as low as possible.