Bicanalicular silicone tubes versus otologic T-tubes in endonasal dacryocystorhinostomy

OBJECTIVE

We compared the efficacy of T-tubes and bicanalicular silicone tubes in endonasal dacryocystorhinostomy (DCR).

METHOD

We retrospectively reviewed 54 eyes of 49 patients who had experienced nasolacrimal duct obstruction and undergone endoscopic DCR. Group one had bicanalicular silicone tube stents implanted (24 eyes), and group two consisted of patients who had otologic T-tubes (30 eyes). The duration of stent placement, follow-up time, and the subjective and objective success of the procedures were evaluated. Cases were grouped as failure or success according to improvement in epiphora complaint.

RESULTS

An endoscopic DCR procedure was successful in 19 (79.2%) cases in the silicone group and in 23 (76.7%) cases in the T-tube group. The success rate did not differ significantly between the groups (p = 0.83). The most common cause of failure was granuloma formation in the bicanalicular silicone tube group and spontaneous tube loss in the otologic T-tube group.

CONCLUSIONS

The findings revealed that both the otologic T-tube and the bicanalicular silicone tube had similar success rates (76.7% and 79.2%, respectively). We believe that otologic T-tubes, which are less expensive and more easily acquired, might be offered as an alternative to bicanalicular silicone tubes in patients with nasolacrimal duct obstruction.

Surgical approaches for antrochoanal polyp: a comparative analysis

OBJECTIVE

The aim of this study was to evaluate the clinical and histopathological characteristics of antrochoanal polyps (ACPs) and to perform a comparative analysis of surgical techniques in terms of recurrence.

METHODS

The clinical, radiological and histopathological features of 42 patients with a diagnosis of ACP who underwent surgery in a period of 6 years (January 2000 - January 2006) were investigated retrospectively. Histopathological examinations were present for all patients and were re-examined for histological analysis.

RESULTS

Endoscopic sinus surgery (ESS) was performed in all patients. Transcanine sinoscopy (TS) and the Caldwell-Luc approach (CL) were used in addition to ESS in 14 and 13 patients respectively. The attachment site was detected in 21 patients (50%) and the most frequent site was found to be the lateral wall in 15 patients (71.4%). There was no relationship between the choice of surgery, the attachment site or accessory ostium, or any sinusitis with ACP. Histological examination showed prominent eosinophilia in 29 patients (69%). The follow-up time was a minimum of 12 months with a mean of 28.9 months. Three recurrences were seen after ESS. However, there was no recurrence after ESS+TS and ESS+CL.

CONCLUSION

Our study showed that the most important factors affecting the choice of surgical approaches are the preference of the surgeon, the age of the patient and the presence of recurrent disease. Combined approaches with either TS or CL should be considered, particularly when the attachment site of the antral part of ACP is undetected, in order to prevent incomplete excision and recurrences.

Percutaneous dilational tracheotomy in solid-organ transplant recipients

Pulmonary complications, such as pneumonia and respiratory failure, are important contributors to posttransplantation morbidity and mortality among solid-organ transplant recipients. Percutaneous dilational tracheotomy (PDT) is cost-effective in critically ill patients who require prolonged mechanical ventilation; however, the literature lacks reports about the effectiveness of this procedure in organ transplant recipients. Between August 2001 and February 2003, five recipients underwent PDT in our intensive care unit: two kidney, two liver, and one heart transplant recipient. The respective mean values for age, weight and APACHE II score were 41 +/- 7 yrs (range, 33-51 years), 63 +/- 14 kg (range, 40-80 kg), and 23 +/- 9 (range, 15-35). All PDTs were performed at the bedside by an experienced staff anesthesiologist under endoscopic guidance using the Griggs forceps dilational technique. The mean interval from transplantation to PDT was 58 +/- 56 months (range, 8 days to 132 months). In all cases, the indication for PDT was prolonged mechanical ventilation due to acute respiratory failure. The mean duration of endotracheal intubation before PDT was 4 +/- 3 days (range, 1-8 days). Transient hypoxemia (n = 1) and mild extratracheal bleeding (n = 1) were the only early complications. There were no late complications (including peristomal infection) or deaths associated with the procedures. Among the two patients who survived their stay in the intensive care unit, the functional and cosmetic outcomes of PDT were excellent. We recommend this technique for prolonged airway management in solid-organ transplant recipients.

Sudden cortical hearing loss for speech: a case report

A 35-yr-old male patient experienced a sudden loss of speech understanding due to a bilateral cerebrovascular disease. A detailed summary of audiological and neurological findings was presented. Findings indicated that the presence of Pa waves of the Middle Latency Response (MLR) may be a positive prognosis for improvement in hearing thresholds and speech understanding.

Mucous cyst of the nasal dorsum

The case of a 47-year-old patient with a nasal dorsum cyst excised via external rhinoplasty is described. The lesion was diagnosed as a mucous cyst. Only ten cases of mucous cysts on the nasal dorsum have been published to date, all having developed post rhinoplasty. To our knowledge, ours is the first case that is not associated with rhinoplasty. The external rhinoplasty approach permits better exposure and complete excision of the nasal dorsum masses, and offers good esthetic results.

[Evaluation of nasolacrimal duct function in chronic paranasal sinus infections with 99mTc dacryoscintigraphy]

BACKGROUND

Paranasal sinus infections and nasolacrimal duct obstructions are commonly encountered problems. However the relationship between these two conditions is not yet clear. Trauma, surgery, tumors, and systemic diseases are among the causes of acquired nasolacrimal duct obstructions but most of the cases are idiopathic. In this study patients diagnosed with chronic paranasal sinus infection were examined with 99mTc lacrimal dacryoscintigraphy to assess their nasolacrimal duct function.

METHODS

Twenty-four patients diagnosed with chronic paranasal sinus infection are included in the study. These patients were observed for at least three months awaiting surgical treatment following unsuccessful medical treatment. The control group included 16 persons admitted to the ophthalmology department without any nasolacrimal duct disease. Nasal endoscopy and paranasal sinus CT revealed normal findings. The age of the patients with chronic paranasal sinus infection and examined in regard to nasolacrimal duct function was between 15 to 17 with a mean age of 34.2 years. Fourteen patients were male and 10 patients were female. The control group included 9 male and 7 female patients between 18 to 60 years with a mean of 30.5 years.

RESULTS

The dacryoscintigraphic examination of 48 nasolacrimal ducts in 24 patients with chronic paranasal sinus infection revealed 7 complete and 18 partial obstructions of the duct, and 23 normal findings. In the control group with 32 nasolacrimal ducts of 16 patients, there was no complete obstruction. Partial obstruction (10.6, 12.0, 14.7 minutes) was be observed in three cases. The statistical workup resulted in a significant difference between paranasal sinus patients and control group (x2 = 15,840 p < 0.001). The paranasal sinus CTs of the patients with paranasal sinus disease were staged using the Lund-Mackay staging system: There is no correlation between the staging score of the paranasal sinus infection and the degree of the obstruction the nasolacrimal duct.

CONCLUSION

This study shows that chronic paranasal sinus disease plays an important role in the pathogenesis of nasolacrimal duct obstructions. The presence of infection has an influence on the nasolacrimal drainage system, but the distribution (staging) of the infection does not appear to correlate with the degree of nasolacrimal duct obstruction. Partial obstruction cases that may progress to complete obstruction may be detected by dacryoscintigraphy, and the treatment of chronic paranasal sinus disease may help to overcome the lacrimal drainage problems in these cases.