Eri Mori

Chronic Rhinosinusitis: Risk Factors for the Recurrence of Chronic Rhinosinusitis Based on 5-Year Follow-Up after Endoscopic Sinus Surgery

Background: Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases in the US, and little is understood about its pathogenesis. This study was conducted to characterize, retrospectively, the clinical, objective and immunological parameters that accompany recurrence of CRS during long-term follow-up after surgery. Methods: Fifty-six patients with CRS who had undergone endoscopic sinus surgery were followed up for 5 years after the surgery. The CRS parameters chosen were as follows: history of asthma and/or allergic rhinitis, peripheral eosinophilia of at least 520 cells/µl, peripheral eosinophil count, total IgE, presence of polyps, CT score, presence of fungi (positive fungal culture or stain), mucus or mucosal eosinophilia, mucosal eosinophil count, presence of acute infection after surgery, gender and age. Individual correlations and stepwise regression were performed. Results: Patients with a total peripheral eosinophil count of 520/µl or more and those with asthma were likely to experience recurrence of CRS within 5 years after surgery. Furthermore, patients with mucus or mucosal eosinophilia who were diagnosed as having eosinophilic CRS (ECRS) showed a high incidence of recurrence within 5 years. The parameter of mucus or mucosal eosinophilia (diagnosis of ECRS) had a positive predictive value of 85.7%. Conclusions: Surgeons should always examine the inflammatory infiltrate of nasal polyps or the paranasal mucosa, and patients with ECRS require anti-inflammatory medications, such as steroids, for a long time after surgery. Long-term follow-up is also essential.

Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE Endoscopic sinus surgery (ESS) is a worldwide standard surgical procedure for chronic rhinosinusitis (CRS). Residual ethmoid cells (RECs), which result from failure to completely remove them, have been thought to be a cause of recurrence of CRS. Our objective was to investigate the relationship between the REC score and post ESS recurrence of CRS. METHODS From January 2002 through December 2003, a total of 138 consecutive CRS patients (86 men and 52 women; mean age: 44 years) underwent ESS at the Department of Otorhinolaryngology, Ota General Hospital. CT was performed at 6 or more months post ESS for all patients. The left and right ethmoid sinuses were each divided into superior-anterior, inferior-anterior and posterior parts. The extent of RECs in each part was assessed using a 3-grade scoring system. The outcome of CRS was classified into a satisfactory outcome group and a poor outcome group based on the improvement rate determined from the pre ESS and post ESS CT image findings. The two groups were then compared for the age, gender, presence/absence of nasal polyps, presence/absence of allergic rhinitis, presence/absence of asthma, the peripheral eosinophil count (%) and the total REC score. In addition, the individual correlations between the above variables and the poor outcome group were analyzed by logistic regression analysis. RESULTS The total REC score was 0 in only 35 (25.4%) of the total patients. The most common total REC scores were 1-6 in 85 (61.6%) patients. The superior-anterior part had the largest number of patients with an REC score of 1 or more. The satisfactory outcome group comprised 97 patients (70.3%), while the poor outcome group comprised 41 patients (29.7%). Comparison of these two groups found that the peripheral eosinophil count, the prevalence rate of asthma and the total REC score were each significantly higher in the poor outcome group than in the satisfactory outcome group. Logistic regression analysis identified a peripheral eosinophil count of ≥9.5%, the presence of asthma and a total REC score of ≥4 as factors that correlated significantly with a poor outcome. CONCLUSION The findings of this study indicate that RECs are involved in the recurrence of CRS following ESS. It can be thought that how to achieve full opening of the superior-anterior part of the ethmoid sinus, which includes the frontal recess, will be an issue in the future.

Middle ear adenoma diagnosed by recurrent facial paralysis

Middle ear adenoma is a rare disease derived from the middle ear mucosa. It is usually lack specific findings and easily mistaken for other conditions, delaying a correct diagnosis. In particular, few cases with facial nerve paralysis have been reported. We describe a case of middle ear adenoma that caused hearing loss and recurrent facial paralysis in a 29-year-old woman. In an attempt to treat the facial nerve paralysis, we performed tympanomastoidectomy and facial nerve decompression. By pathological examination, we finally diagnosed it middle ear adenoma with neuroendocrine differentiation. Retrospectively, if we meet the antibiotic resistant mass in the middle ear, we should suspect the tumor. One year after surgery, the adenoma has not recurred but long-term observation is required.

Changes of olfactory processing in childhood and adolescence

OBJECTIVES Olfactory event-related potentials (OERPs) are widely used to study central odor processing. Only a few studies used this method in children and adolescents. Aim of the current study therefore was to measure OERP and the possible influences of age and sex on central odor processing in this age group. METHODS A total of 81 children between 6 and 17 years of age were included in this study. OERP in response to a rose-like odor were measured from three recording positions (Fz, Cz, Pz) according to the 10-20 system. Stimuli were presented by means of a computer-controlled olfactometer. RESULTS Age had a significant influence on the amplitudes of the late positivity with younger children showing larger amplitudes. Although age did not significantly affect the latencies of OERP, interactions of recording positions and latencies between younger and older children and between girls and boys were found. CONCLUSIONS OERP can be used to study central odor processing in children older than 6 years of age. Central odor processing changes from childhood to adolescents possibly reflecting maturation of the brain.

Development of an International Odor Identification Test for Children: The Universal Sniff Test

Objective To assess olfactory function in children and to create and validate an odor identification test to diagnose olfactory dysfunction in children, which we called the Universal Sniff (U‐Sniff) test. Study design This is a multicenter study involving 19 countries. The U‐Sniff test was developed in 3 phases including 1760 children age 5‐7 years. Phase 1: identification of potentially recognizable odors; phase 2: selection of odorants for the odor identification test; and phase 3: evaluation of the test and acquisition of normative data. Test—retest reliability was evaluated in a subgroup of children (n = 27), and the test was validated using children with congenital anosmia (n = 14). Results Twelve odors were familiar to children and, therefore, included in the U‐Sniff test. Children scored a mean ± SD of 9.88 ± 1.80 points out of 12. Normative data was obtained and reported for each country. The U‐Sniff test demonstrated a high test—retest reliability (r27 = 0.83, P < .001) and enabled discrimination between normosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%. Conclusions The U‐Sniff is a valid and reliable method of testing olfaction in children and can be used internationally.

A case of cervical thymic cyst

Object : Cervical thymic cyst is a rare disease accounting for 1% of cervical cystic lesions and is very difficult to diagnose before surgery. Here we report an uncommon case of cervical thymic cyst that was misdiagnosed as lymphangioma before surgery. Patient : A 57-year-old woman had noticed a growing mass on the right side of her neck for the last three months. CT scan and ultrasound examination showed a multilobulated fluid dense mass in the right cervical region, extending from the level of the right mandible to the carotid sheath. After surgical removal was selected as a treatment, microscopically it contained typical thymic tissue with Hassall’s corpuscles and cyst. Finally, it was diagnosed as cervical thymic cyst. Discussion : Thymic cyst is a remnant of the thymus pharyngeal tube that forms in the embryonic period or liquid accumulation of ectopic thymus. It occurs in various positions from the mandibular angle to mediastinum but occurrence in the neck is relatively rare. In this case it was difficult to diagnose preoperatively, because continuity of the mediastinum and tumor, which is a characteristic of thymic cyst, was not recognized in the preoperative image examination. Conclusion : In the diagnosis and treatment of cervical cystic lesions, it is necessary to consider cervical thymus cyst as one of differential diagnoses.