Transcranial management of CSF rhinorrhea
Jyotirmay S. Hegde, Hemanth Vamanshankar in CSF Rhinorrhea, 2020
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.
Bibliography
Arturo Castiglioni in 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).
Swallowing disorders
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
When an otorhinolaryngology surgeon assesses the patient, a history and examination will be performed and should be followed by an endoscopic examination of the larynx and pharynx. Laryngeal motor and sensory function is assessed, particularly vocal fold mobility and glottal closure. Where possible, videostroboscopy should be used if vocal abnormalities are identified and a functional endoscopic evaluation of swallowing (FEES) should be performed (by the otorhinolaryngology surgeon or a trained SLT). FEES is a dynamic real-time assessment of the swallow from a luminal perspective. The mucosa may be assessed along with the mobility and health of the vocal folds. Safety of deglutition, particularly penetration, aspiration and residue, may be evaluated. FEES is performed at the bedside or in the clinic, and requires only a nasopharyngoscope and food to administer. Advantages include: lack of exposure to ionising radiation; ability to assess patients who are unfit for transport to other departments at bedside; direct visualisation of glottic function; ability to test strategies or compensatory manoeuvres; and speed of the study. FEES guides dietary recommendations and may be repeated frequently as the patient’s condition changes. The main disadvantage of FEES is the period of obscuration of view, termed the ‘whiteout’, that occurs with constriction of the luminal space as swallowing occurs. For a brief moment the endoscope tip is enveloped in mucosa and no view of the bolus or glottis is possible. Airway violation occurring at this point cannot be seen. Technical proficiency in passing the endoscope is required and difficult nasal anatomy may make this uncomfortable for the patient or impossible to achieve. There is also a need for appropriate sterilisation of the endoscope and equipment used.
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.
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).
Evaluating tooth extraction as a stand-alone treatment for odontogenic sinusitis
Published in Acta Oto-Laryngologica, 2023
Emi Tsuchiya, Momoko Takeda, Eri Mori, Ikuko Takakura, Ryoto Mitsuyoshi, Nobuyoshi Otori, Katsuhiko Hayashi
The development of an ideal therapy for OS includes the identification and treatment of the causative tooth and the treatment of the maxillary sinusitis. Successful treatment of OS reportedly requires management of the odontogenic cause first, and several studies suggest that removal of the odontogenic infection is necessary as a primary treatment for OS [3,6]. Overlooking the odontogenic aetiology may lead to treatment failure because of future infection exacerbation from the source, which is left untreated [9]. The American Academy of Endodontics published a 2018 position statement on maxillary sinusitis of endodontic origin, recommending that dental treatment for removing the odontogenic infection should be performed first, followed by endoscopic sinus surgery if the disease symptoms persist after the dental procedures [6]. Although there are various treatment methods for OS, minimal procedures should be performed to maintain the patient’s quality of life. However, otorhinolaryngologists and dentists treat the disease independently, to the disadvantage of numerous OS patients. To achieve this, the optimal treatment method should be selected for maxillary sinusitis based on dentistry- and otorhinolaryngology-informed approaches.
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