Archives of oto-rhino-laryngology

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent disease which can be classified as eosinophilic or neutrophilic based on dominant inflammatory cell type at tissue. The aim of this study was to evaluate the clinical relevance of classifying nasal polyps as eosinophilic or neutrophilic on treatment outcomes. The study was conducted with 40 patients who underwent either surgical or medical treatment with the diagnosis of CRSwNP. The patients were classified into two groups for further assessment up to eosinophil intensity at polyp tissue. All patients were examined by nasal endoscopy and paranasal computed tomography (CT). Before treatment, subjective symptom score, nasal endoscopy score, and CT score were measured. Subsequently, they were reevaluated by similar diagnostic tests after either medical or surgical treatment at sixth month. The preoperative subjective symptom score, endoscopy score, and paranasal CT score were compared between chronic rhinosinusitis (CRS) with eosinophilic nasal polyps (E-NP) (CRSwE-NP) group and CRS with neutrophilic nasal polyps group and there was no difference between the two groups (p = 0.369, p = 0.310 and p = 0.494 respectively). Although after treatment in both groups symptom score and endoscopy score were significantly improved but not the CT score, we found no difference in between the groups at sixth month. In most of the previous studies, patients with CRSwE-NP were assumed to have poor prognosis and high recurrence rate despite surgical or medical treatment. However, we did not find any association between eosinophilic or neutrophilic nature of nasal polyp tissue and disease severity.

The most popular approaches for vestibular schwannoma (VS) removal are retrosigmoid, middle cranial fossa and translabyrinthine (TL). All require a certain degree of invasivity, bone removal, or brain manipulation. Recently, the authors described the transcanal transpromontorial approaches (TTA), which allow the inner ear to be accessed directly through the external auditory canal (EAC), either with a microscopic (Expanded TTA, or ExpTTA) or even an exclusive endoscopic technique (Endoscopic TTA, or EndoTTA). The advantages compared to traditional approaches are a direct view of the internal auditory canal (IAC) from lateral to medial, very little or no superficial tissue dissection and very little petrous bone drilling. In summary, from an anatomical point of view, they could be considered to be minimally invasive approaches. The radiologic outcome and the anatomical correspondence of these new approaches are described so as to share with the readers the possible radiologic findings and to compare and differentiate them from classic transpetrous approaches such as the TL approach. 4.

Đánh giá sự khác biệt giới tính trong các tác nhân gây bệnh liên quan đến bệnh lý đường mũi xoang ở những bệnh nhân phẫu thuật mũi do viêm xoang mãn tính và tái phát (C/R RS). Phân tích hồi cứu 164 mẫu cấy dịch mũi xoang dương tính được lấy trong quá trình phẫu thuật nội soi đường mũi xoang từ năm 2006 đến năm 2013. Đối tượng nghiên cứu bao gồm 79 bệnh nhân nữ (48,8%) và 84 bệnh nhân nam (51,2%) với độ tuổi trung bình 47,3 (13–88) năm. Tăng trưởng Staphylococcus dương tính được phát hiện ở 38 (23,2%) bệnh nhân, tăng trưởng kị khí dương tính ở 25 (15,2%) bệnh nhân và 67 (40,9%) bệnh nhân có tăng trưởng đa vi khuẩn. Sự tăng trưởng Staphylococcus ở nam giới cao hơn một cách có ý nghĩa so với nữ giới (p = 0,04). Tỷ lệ Odds cho một nhiễm trùng đa vi khuẩn ở nam giới trên 60 tuổi so với nữ giới là 2,17 (CI 0,63–8,08, 95%). Các vi khuẩn kị khí xuất hiện thường xuyên hơn ở nam giới (17,9%) so với nữ giới (12,5%). Các loài Streptococcus không cho thấy sự khác biệt giữa các nhóm giới tính và độ tuổi. Kết quả thu được cho thấy sự khác biệt giữa các tác nhân gây bệnh trong C/R RS giữa nữ và nam. Ở nhóm nam giới, các loài Staphylococcus được tìm thấy là phổ biến hơn với xu hướng mạnh mẽ hơn đối với các tác nhân đa vi khuẩn và tỷ lệ kị khí cao hơn. Những kết quả này có thể gợi ý về các quy trình quản lý khác nhau trong phẫu thuật cho nam và nữ.

During cochlear implantation surgery, a range of complications may occur such as tip fold-over. We recently developed a method to estimate the insertion orientation of the electrode array. The aim of the study was to determine the optimal angle of orientation in a cohort of cochlear implanted patients. On eighty-five CT scans (80 uncomplicated insertions and 5 cases with tip fold-over), location of the electrode array’s Insertion Guide (IG), Orientation marker (OM) and two easily identifiable landmarks (the round window (RW) and the incus short process (ISP)) were manually marked. The angle enclosed by ISP-RW line and the Cochlear™ Slim Modiolar electrode array’s OM line determined the electrode array insertion angle. The average insertion angle was 45.0–47.2° ± 10.4–12° SD and was validated with 98% confidence interval. Based on the measurements obtained, patients’ sex and age had no impact on the size of this angle. Although the angles of the tip fold-over cases (44.9°, 46.9°, 34.2°, 54.3°, 55.9°) fell within this average range, the further it diverted from the average it increased the likelihood for tip fold-over. Electrode array insertion in the individually calculated angle relative to the visible incus short process provides a useful guide for the surgeon when aiming for the optimal angle, and potentially enhances good surgical outcomes. Our results show that factors other than the orientation angle may additionally contribute to failures in implantation when the Slim Modiolar electrode is used.