Acoustic Rhinometry and Paranasal Sinuses: A Systematic Study in Models, Anatomic Specimens, and In Vivo

Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure

BACKGROUND

Postoperative irrigation after endoscopic sinus surgery and endoscopic modified Lothrop procedure is used to remove nasal crusts and to improve wound healing. To evaluate the optimal application protocol for irrigation of the frontal sinus, a prospective cadaver study was performed.

METHODS

An endoscopic modified Lothrop procedure and complete sphenoethmoidectomy were performed in 19 heads. Each was irrigated with a 1.5% solution of water and different colors using nasal spray and a squeeze bottle filled with 50, 100, and 200 mL. Intensity of local staining and percentage of area were documented using standardized videoendoscopy after irrigation in "bending over the sink" or "vertex to floor" position. Grading was performed by two independent observers for 23 anatomic regions, including the stained circumference of maxillary and frontal ostia. To evaluate the influence of the anatomy, acoustic rhinometry was performed. ANOVA was used to evaluate effects of application methods and head positions using GenStat 8.2 (Lawes Agricultural Trust, Rothamsted Experimental Station, Harpenden, U.K.) using an appropriate block structure.

RESULTS

With regard to the frontal sinus, we were able to show clear superiority of the squeeze bottle technique filled with 200 mL and applied in the "vertex to floor position."

CONCLUSION

In a relatively fit and flexible patient the vertex to floor position using a squeeze bottle technique is advocated. There may be some patients, however, for whom this position is not feasible. In these patients "bending over the sink," while inferior to the "vertex to floor" position, still ensures some irrigation of the frontal sinus.

Acoustic rhinometry in healthy humans: accuracy of area estimates and ability to quantify certain anatomic structures in the nasal cavity

OBJECTIVES

We evaluated the accuracy of acoustic rhinometry (AR) measurements in healthy humans and assessed the ability of AR in quantifying the dimensions of the paranasal sinuses and certain anatomic structures in the nasal cavity.

METHODS

Twenty nasal passages of 10 healthy adults were examined by AR and computed tomography (CT) before and after decongestion. Actual cross-sectional areas of the nasal cavity and actual locations of the nasal valve, the head of the inferior turbinate, the head of the middle turbinate, the ostia of the frontal and maxillary sinuses, and the choana were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage.

RESULTS

The AR-measured cross-sectional areas in the anterior nasal cavity were in reasonable agreement with the corresponding areas determined from CT, whereas AR consistently overestimated the passage areas at locations posterior to the paranasal sinus ostia. The nasal valve was identified as a pronounced minimum on the AR area-distance curve. However, AR did not discretely identify the head of the inferior turbinate, the head of the middle turbinate, or the choana.

CONCLUSIONS

The local minima on the AR area-distance curve beyond the nasal valve are caused by acoustic resonances in the nasal cavity, and do not correspond to any anatomic structure. The AR area overestimation beyond the paranasal sinus ostia is due to the interaction between the nasal cavity and the paranasal sinuses, rather than to sound loss into the sinuses. Acoustic rhinometry provides no quantitative information on ostium size or sinus volume in either non-decongested or decongested nasal cavities.

Bibliography. Current world literature. Nose and paranasal sinuses

PURPOSE OF REVIEW

Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed.

RECENT FINDINGS

There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death.

SUMMARY

Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.