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Transcranial management of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Harsh Deora, Nishanth Sadashiva, Mohammed Nadeem
Although it seems trivial, the final diagnosis of CSF rhinorrhea may be confusing. Other rhinology pathology, including seasonal allergic rhinitis, perennial nonallergic rhinitis, and vasomotor rhinitis, are relatively common, and may mimic some of the signs and symptoms of CSF rhinorrhea or may occur simultaneously with a CSF leak. Furthermore, CSF rhinorrhea is often intermittent, even after trauma, which may lead to false-negative results on diagnostic testing if testing is performed during the quiescent phase. Lastly, the subarachnoid cistern is a relatively low-pressure system. Thus, leaks may be of low volume, which can lead to false-negative testing or failure to recognize that a leak even exists. In cases of high clinical suspicion and initially negative diagnostic testing, further follow-up with repeat testing is warranted.
Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Management is generally conservative as the majority of leaks cease spontaneously within 10 days. Surgery may be indicated for persistent leaks (transmastoid or middle fossa approach). See the section on CSF rhinorrhoea in the Rhinology chapter for further details.
Bibliography
Published in Arturo Castiglioni, A History of Medicine, 2019
XIII. For the development of otolaryngology and rhinology see G. bilancioni: Per la storia della laringoiatria, R.I.S., 11:25, 117, 1920; also G. D. searle: Medical History of Allergic Rhinitis (Chicago, Searle, 1945). See also: T. H. bryan: The history of Laringology and rhinology and the influence of America (A.H.M., n.s. 5, 151–170: 1933), and D. B. delavan: The origin of Laryngology (Diplomate, 9:1937) and T. wright: A history of Laringology and Rhinology, (2nd ed. Philadelphia, Lea and Febiger, 1914).
Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator
Published in Acta Oto-Laryngologica, 2022
Hirohiko Tachino, Hiromasa Takakura, Hideo Shojaku, Michiro Fujisaka, Shinsuke Ito, Yutaro Oi, Anh Tram Do, Chiharu Fuchizawa, Tatsuya Yunoki, Atsushi Hayashi
One hundred forty consecutive patients operated on with our new modified technique were enrolled from January 2014 to May 2021 at Toyama University Hospital. All patients were diagnosed as having a NLDO, the cause of which was age-related in the majority of them. Those NLDO patients with occlusion of the lacrimal punctum or canaliculus were excluded. All patients preoperatively underwent comprehensive ophthalmologic examinations by ophthalmologic specialists that included a lacrimal irrigation test and the computed tomography imaging (CT) with dacrocystography (CT-dacryocystography). Because CT-dacryocystography is useful to diagnose the location of the NLDO, it was routinely performed before the DCR in our hospital. In addition, the patients underwent an endonasal fiberscopic diagnostic procedure performed by a rhinology specialist. Informed consent was obtained from all patients in accordance with the Declaration of Helsinki. The study was approved by the institutional ethics committee (approval no.: R2020166).
OnabotulinumtoxinA injection towards the SPG for treating symptoms of refractory chronic rhinosinusitis with nasal polyposis: a pilot study
Published in Acta Oto-Laryngologica, 2021
Kent Are Jamtøy, Erling Tronvik, Daniel Fossum Bratbak, Joan Crespi, Lars Jacob Stovner, Irina Aschehoug, Wenche Moe Thorstensen
Another aspect to consider was the discrepancy between the modest improvement of nasal symptoms reported on the rhinology VAS diary (Table 2) and the objective findings (AR, PNIF, modified Lund Kennedy and Meltzer score) (Table 3). There are four plausible explanations for this: (1) end objective measurements (AR, PNIF, modified Lund Kennedy and Meltzer score) were conducted at week 12–13, which in hindsight probably is after the expected peak BTA effect. In a potential later RCT one should consider performing the objective investigations between weeks 8 and 12. (2) The patients may have discontinued their symptomatic medications (decongestants and antihistamines) even though they were instructed to avoid the change of medications during the study period. (3) There were difficulties measuring MCA, NCV, and PNIF due to severe polyposis and the significant loss of volume in the nasal cavity. (4) The reduction of nasal obstruction on VAS can also be a placebo effect. The lack of improvement of hyposmia (Table 3) is in accordance with other studies showing that hyposmia is a difficult symptom to treat [20].
Computational modelling of nasal respiratory flow
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
H. Calmet, K. Inthavong, H. Owen, D. Dosimont, O. Lehmkuhl, G. Houzeaux, M. Vázquez
Nasal resistance is a parameter used in rhinology to quantify the level of nasal obstruction aiding the medical treatment strategy. The resistance is defined as the pressure drop per flow rate and this is shown in Figure 7(a) where the results are similar between the LES and laminar models. The presence of the peak at the transition between the inhalation and the exhalation is due to the zero value of the flow rate. The pressure drop against flow rates during the inhalation phase was compared to in vitro measured data available from (Kelly et al. 2004) and (Weinhold and Mlynski 2004) shown in Figure 7(b). The pressure drop data was taken from Point 1 to Point 4 (labelled in Figure 5) to allow comparison with the literature which measured the pressure drop across the nasal cavity without the nasopharynx section. The results showed acceptable agreement with reported studies in the literature. The similar pressure drop profiles between the LES and laminar approaches suggest that overall trends and results can be achieved with good accuracy with the laminar. This is also the case for local temporal results at breathing periods outside of the peak inhalation and exhalation, where the flow rate is lower and therefore flow characteristics are expected to be laminar dominant.