[The combination of recurrent otitis media and adenotomy in early childhood as diagnostic marker of mucopolysaccharidosis type II (Hunter syndrome)]

Mucopolysaccharidoses are a group of rare lysosomal accumulation diseases caused by a deficiency of the lysosomal enzyme and the accumulation of mucopolysaccharides in various organs and tissues. Children with mucopolysaccharidosis type II (Hunter syndrome) develop multisystem dysfunction, including severe airway obstruction. At the same time, 34% of patients already at an early age (2-3 years) undergo surgical manipulations related to ENT organs (tonsillectomy, adenotomy). The article describes a clinical case of diagnosis of type II mucopolysaccharidosis by a pediatric otorhinolaryngologist. The main manifestations of the disease are discussed in detail, including the presence of indications for adenotomy at the age of 2 years, episodes of otitis media, which served as diagnostic markers for suspected orphan disease mucopolysaccharidosis type II. The leading role of the pediatric otorhinolaryngologist in the early diagnosis of the rare disease mucopolysaccharidosis type II is substantiated.

Impact of Treatment for Nasal Cavity Disorders on Sleep Quality: Systematic Review and Meta-analysis

OBJECTIVE

To determine the impact of treatment for patients with nasal obstruction secondary to allergic rhinitis (AR) and nasal septal deviation (NSD) on sleep quality.

DATA SOURCES

Primary studies were identified though PubMed, Scopus, Cochrane Library, and Web of Science.

REVIEW METHODS

A systematic review was performed by querying databases for articles published through August 2020. Studies were included that reported on objective sleep parameters (apnea-hypopnea index) and sinonasal and sleep-specific patient-reported outcome measures: Rhinoconjunctivitis Quality of Life Questionnaire, Nasal Obstruction Symptom Evaluation, Epworth Sleepiness Scale (EpSS), and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The database search yielded 1414 unique articles, of which 28 AR and 7 NSD studies were utilized for meta-analysis. A total of 9037 patients (8515 with AR, 522 with NSD) were identified with a mean age of 35.0 years (35.3 for AR, 34.0 for NSD). Treatment for AR and NSD significantly improved subjective sleep quality. For AR, the EpSS mean difference was -1.5 (95% CI, -2.4 to -0.5; P = .002) and for the PSQI, -1.7 (95% CI, -2.1 to -1.2; P < .00001). For NSD, the EpSS mean difference was -3.2 (95% CI, -4.2 to -2.2; P < .00001) and for the PSQI, -3.4 (95% CI, -6.1 to -0.6; P = .02).

CONCLUSION

Subjective sleep quality significantly improved following treatment for AR and NSD. There were insufficient data to demonstrate that objective metrics of sleep quality similarly improved.

Use of facial vein graft with vascularized composite auricular helical rim flap for alar rim defects

Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.

Rhinologic disease and its impact on sleep: a systematic review

BACKGROUND

Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA).

METHODS

A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included.

RESULTS

The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001).

CONCLUSION

Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.

Radiofrequency ablation of turbinates after septoplasty has no effect on allergic rhinitis symptoms other than nasal obstruction

BACKGROUND

In this study we evaluated the effects of inferior turbinate radiofrequency ablation (RFA), performed after septoplasty, on patients with allergic rhinitis (AR) symptoms.

METHODS

This was a prospective, randomized, controlled study involving 60 patients with both a deviated nasal septum (DNS) and AR. Those who underwent septoplasty/sham surgery constituted the Septo-Sham group and those who underwent septoplasty/RFA formed the Septo-RFA group. Demographic factors, pre- and postoperative symptom scores for allergic rhinitis (SFARs), and Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) scores were calculated. We subdivided the total SFAR (tSFAR) scores into scores for nasal obstruction (SFAR-NO) and scores for symptoms other than nasal obstruction (SFAR-SONO); the latter included rhinorrhea, itching, and sneezing.

RESULTS

The baseline characteristics were similar between the groups. The 2 types of surgery improved both the NOSE and SFAR scores. In subgroup analysis according to the type of symptoms, both types of surgery showed improvement in SFAR-NO and SFAR-SONO scores. However, the extent of improvement did not differ between the groups, regardless of the type of symptoms.

CONCLUSION

For patients with both DNS and AR, both types of surgery afford postoperative symptomatic improvement. Both types of surgery yielded improvement in both nasal obstruction and symptoms other than nasal obstruction. However, performing RFA after septoplasty did not afford further short-term symptomatic improvements. Thus, septoplasty without RFA may be optimal for patients with both DNS and AR.

The Efficacy of Yogic Breathing Exercise Bhramari Pranayama in Relieving Symptoms of Chronic Rhinosinusitis

INTRODUCTION

A multitude of modalities are available for the treatment of chronic rhinosinusitis, however, each has its side effects and compliance issues. Bhramari pranayama, which is a breathing exercise in the practice of yoga, offers an inexpensive and free from side effect modality in this regard.

OBJECTIVE

The objective of this study was to evaluate the efficacy of Bhramari pranayama in relieving the symptoms of chronic sinusitis.

METHODOLOGY

A total of 60 patients with chronic sinusitis were randomly divided into two groups, one received conventional treatment of chronic sinusitis and the other group was in addition taught to practice yogic breathing exercise Bhramari pranayama. The patients were advised to practice this breathing exercise twice a day and were followed up at 1, 4, and 12 weeks using the Sino-Nasal Outcome Test (SNOT-22 score).

RESULTS

The mean SNOT-22 score in the group following the Bhramari pranayama breathing exercise using the ANOVA test improved from 39.13 ± 9.10 to 24.79 ± 8.31 (P = 0.0002), this improvement was seen by the end of 4 weeks itself and continued until the 12th week of assessment.

CONCLUSION

Integrating regular practice of Bhramari pranayama along with the conventional management of chronic rhinosinusitis is more effective than conventional management alone.

Rhinocerebral mucormycosis after functional endoscopic sinus surgery: A case report

RATIONALE

Mucormycosis is a rare fungal infection which mainly develops in compromised hosts and the associated mortality rate is high.

PATIENT CONCERNS

We report a case of mucormycosis in a 59-year-old woman following routine endoscopic sinus surgery. The patient had a history of diabetes mellitus (DM) and bronchial asthma.

DIAGNOSES

On follow-up 4 weeks after the first functional endoscopic sinus surgery (FESS), she complained of a severe headache and was readmitted for a second period. Endoscopic examination revealed bony erosion and a whitish discharge on the left middle turbinate, which was confirmed as mucormycosis by endoscopic biopsy.

INTERVENTIONS

Endoscopic debridement of the necrotic tissue and middle turbinectomy were performed and the patient was treated with intravenous amphotericin B for 3 months (3.5 mg/kg/day).

OUTCOMES

About 1 month into the second period of hospitalization, left Bell's palsy had occurred. The facial palsy improved naturally after 2 months of hospitalization. One year after endoscopic debridement, follow-up endoscopy showed that there was no residual lesion.

CONCLUSION

This is the first report of mucormycosis after routine endoscopic sinus surgery. We did not miss headache symptom after FESS surgery, and diagnosed mucormycosis through early endoscopic biopsy, which played an important role in curing the patient. In addition to the importance of medical therapy such as DM control for patients, emotional support and psychiatric treatment are also important factors as these patients require hospitalization for a long period, 3 months in the case of this patient.

[The analysis of the misdiagnosis big data of the otolaryngology during 2004 to 2013 in China]

Objective:The aim of this study is to explore the misdiagnosis status of the otolaryngology in China as well as to provide evidence to reduce misdiagnosis and improve the diagnostic level.Method:The retrieval and management system of the misdiagnosed diseases database developed by Chen Xiaohong was used for searching the literature of the misdiagnosis in otolaryngology.The 10 year' smisdiagnosis literature data of the otolaryngology(from 2004 to 2013) were analyzed including the literature sources, sample size, misdiagnosis rate,misdiagnosis consequences and misdiagnosis reasons.Result:A total of 369 articles were found,including 4211 cases.The average misdiagnosis rate was 25.43% in 51 diagnosed diseases.The top misdiagnosed diseases were nasopharyngeal tuberculosis(84.76%),tuberculous otitis media (75%) and congenital laryngeal cyst(75%).The lowest misdiagnosed disease was nasosinusitis(5.92%).The top three misdiagnosed diseases were tuberculosis of otolaryngology(1216 cases),nasosinusitis(710 cases) and BPPV(697 cases).After statistical analysis,we found that 97.22% of the misdiagnosed patients were grade Ⅲ consequences (that is the misdiagnosis and mistreatment does not cause adverse consequences),but there were still 10 cases caused gradeⅠconsequences(death or sequela).The main causes of the misdiagnosis were lack of diagnosis experience, non detailed interrogation and physical examination and non targeted examinations.Conclusion:The big data of the 10 years reflects the misdiagnosis phenomenon in otolaryngology to some extent.Neurologist, stomatologist and ophthalmologist should be familiar to the main points of the differential diagnosis diseases of the otolaryngology and strive to reduce the clinical misdiagnosis and mistreatment.

Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China

Mycobacterium gordonae is often regarded as a weak pathogen that only occasionally causes overt disease. We report a case of M. gordonae infection in the facial skin, nasal mucosa, and paranasal sinus in an immunocompetent patient and review previous cases. The T-SPOT.TB test might be useful in diagnosing such cases.

Impact of nasal conditions on chronic otitis media: a cross-sectional study in Koreans

OBJECTIVES

We evaluated the relationship between pathological nasal conditions and pathological middle ear conditions on a large-scale epidemiological basis, conducted as a cross-sectional study at the population level using Korean National Health and Nutrition Examination Survey (KNHANES) data.

STUDY DESIGN

A cross-sectional study.

METHODS

In a retrospective cohort study, we analyzed data from the KNHANES (2008-2012), which used a stratified, multi-stage, probability-cluster sampling method in a rolling sampling survey of South Korean citizens.

RESULTS

The prevalences of nasal and middle ear pathologies were evaluated. Chronic postnasal drip, chronic hypertrophic rhinitis, and nasal polyps were correlated with the presence of middle ear pathologies; allergic rhinitis was negatively correlated. The prevalences of chronic otitis media and septal deviation showed no relationship. Only nasal polyps showed a tendency to be associated with cholesteatomatous otitis media in patients with COM.

CONCLUSIONS

Our results indicate the need for a nasal assessment when evaluating COM. Additionally, correction of nasal pathologies may be useful with the surgical treatment of COM to improve patient success rates and satisfaction.

Retrospective study of a series of choanal atresia patients

Introduction Although it has been more than 250 years since the first description of choanal atresia (CA), there are still doubts about this abnormality. The differences between unilateral and bilateral forms are seldom discussed.

Objectives Aggregate data from patients diagnosed with CA, grouping patients with unilateral and bilateral forms.

Methods Retrospective study.

Results Eighteen patients were included: 12 (66.6%) presented bilateral atresia, of which 77.8% were mixed bony-membranous type and 22.2% were pure bony type. From the 12 patients with bilateral atresia, 10 presented related malformations, 3 of whom had CHARGE syndrome (coloboma, heart defects, choanal atresia, retardation of growth and development, genitourinary problems, ear abnormalities). From the remaining 6 patients with unilateral atresia, only 2 showed malformations, 1 renal and 1 cardiac. All patients with unilateral atresia needed only 1 surgical procedure, and patients with the bilateral form needed a median of 2.85 interventions (p = 0.003). The median age of surgical procedure in the unilateral group was 6 years, ranging from 6 months to 18 years, and in the bilateral group was 25 days, ranging from 6 days to 6 years (p = 0.003). The median interval between diagnosis and surgery was 9 months in the unilateral group, ranging from 1 month to 18 years, and in the bilateral group was 1 day, ranging from 1 day to 2 months (p = 0.001).

Discussion and Conclusions Success rates with the endoscopic approach vary from 62 to 100%. Nonetheless, most of these reports present results without considering the number of compromised sides. In our opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis.

Removing nasal packing in epistaxis: what to do in the case of an undeflatable foley catheter balloon

Introduction Undeflatable Foley catheter balloons adapted for use as nasal packing in epistaxis represent a possible complication.

Case Reports We report on three cases in which Foley catheter balloons adapted for use as posterior nasal packing in epistaxis failed to deflate. In one patient, deflation was achieved by simply using the fingertips to massage the segment of the catheter collapsed by the fixation device. In the second case, the Foley balloon was removed by the oral route after sectioning the catheter. In the third patient, the Foley catheter was successfully deflated after sectioning.

Discussion The probable causes of the undeflatable balloons in these cases were a blockage or lumen collapse of the balloon or a malfunction in the valve system. Although no definitive method has been established for dealing with this complication, the options proposed are the following: manipulation to restore the permeability of the segment of the catheter collapsed by the fixation device, if this is the case; sectioning the catheter or inserting a stiletto catheter; bursting the balloon; or removing it by the oral route. The latter option is apparently the most appropriate for the otolaryngologist in cases unrelated to simple collapse caused by the fixation device.