Grant S. Gillman

Bell's palsy in pregnancy: A study of recovery outcomes

OBJECTIVE : To study facial nerve recovery in patients with Bells palsy of pregnancy compared with that of the nonpregnant population. METHODS : A retrospective chart analysis was conducted of all patients seen within 6 weeks of the onset of Bells palsy of pregnancy, with a minimum of 1-year follow-up. Recovery outcomes were compared with similarly chosen randomly selected groups of nonpregnant females 15 to 40 years old (group 1), nonpregnant females of all ages (group 2), males 15 to 40 years old (group 3), and males of all ages (group 4), all of whom were also seen within 6 weeks of onset. Recovery was categorized as satisfactory (House-Brackmann grade I to II) or unsatisfactory (House-Brackmann grade III or IV). The 2-tailed Fisher exact test was used to statistically analyze differences between groups. RESULTS : Fifty-two percent of women with Bells palsy of pregnancy whose facial palsy progressed to complete paralysis within 10 days of onset recovered to a satisfactory level compared with 77% to 88% of comparison patients. These differences were statistically significant in all cases. Recovery for those with an incomplete palsy was satisfactory in virtually 100% of all patients studied. CONCLUSION : The prognosis for a satisfactory recovery for women who develop a complete facial paralysis with Bells palsy while pregnant is significantly worse than for that for the general population. This information should be taken into consideration by all physicians involved in the counseling of these patients.

Asymptomatic enophthalmos: the silent sinus syndrome.

Although uncommon, enophthalmos may be a presenting symptom of chronic maxillary sinusitis with secondary attentuation of the orbital floor. As such, an awareness of this entity, known as the “silent sinus syndrome,” is important to all practising otolaryngologists. Two such cases are presented herein, together with a discussion of the pathophysiology, management, and current literature.

Clinical Consensus Statement Appropriate Use of Computed Tomography for Paranasal Sinus Disease

Objective To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease. Subjects and Methods A modified Delphi method was used to refine expert opinion and reach consensus by the panel. Results After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories. Conclusions For children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology.

Revision septoplasty: A prospective disease‐specific outcome study

1) Study outcomes of revision septoplasty using a validated disease‐specific questionnaire and a patient satisfaction survey; 2) assess the effect of surgery on the use of medication to treat nasal congestion; and 3) report on sites of persistent septal deviation identified at revision septoplasty.

Case reportsSinonasal hemangiopericytoma

l emangipericytoma (HPC), a tumor of vascular oriin, is rarely seen in the nose and paranasal sinuses. hat makes these tumors particularly perplexing is ow little is known about their natural history, and, as atsakis put it, “the lack of uniformity in appearance, rowth, and biological behavior.” This case report conerns a patient with an HPC who presented with a onfounding biopsy report. A discussion of the diagnois, management, and issues related to long-term sureillance relevant of these uncommon tumors follows.

Evaluating the safety of frontal sinus trephination

The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline.

The impact of nasal surgery on sleep quality: a prospective outcomes study.

Objective (1) Evaluate the impact of nasal airway surgery on sleep quality using validated outcome measurements, (2) compare the utility of Epworth Sleepiness Scale (ESS) versus Pittsburgh Sleep Quality Index (PSQI) as a reflection of sleep quality, and (3) identify perioperative variables that might correlate with a beneficial effect of nasal surgery on sleep quality. Study Design Prospective outcome study of patients with symptomatic nasal obstruction undergoing nasal airway surgery. Setting Academic medical center. Methods Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, ESS, PSQI, and Ease-of-Breathing and Sleep Quality Likert scales preoperatively and 3 months postoperatively. A nonparametric analysis compared pre- and postoperative values, and associations were examined using Spearman correlations. Results Sixty-one patients completed the study. Mean NOSE scores decreased significantly from 68.2 preoperatively to 17.5 three months after surgery. Mean ESS scores and PSQI scores improved (P < .0001) over that same interval (7.5 to 5.3 and 7.8 to 4.6, respectively). There was a correlation seen between the degree of change in both NOSE scores and Ease-of-Breathing scores and the change in sleep quality measured using the PSQI or Sleep Quality Likert scores. The PSQI correlated better with Sleep Quality Likert scores than the ESS. Overall, 86.9% of subjects reported subjective improvement in sleep quality postoperatively. Conclusion In patients undergoing nasal airway surgery there may be a secondary improvement in subjective sleep quality. The degree of change in sleep quality correlates with the severity of nasal obstruction preoperatively and the degree of improvement in obstruction with surgery.

Postauricular epithelioid sarcoma.

o i p l c u s n t i w F p n pithelioid sarcoma, first described by Enzinger in 970, is an uncommon, histologically distinct, soft tisue sarcoma with cutaneous manifestation. It is usully found in the extremities, including the hands, forerms, and lower limbs of young adults. In a review of 02 cases over 40 years by the Armed Forces Institute f Pathology, only 3 cases were identified in the head nd neck region (2 cases in the scalp and 1 involving he ear). We report a case of an 80-year-old male eferred to the Otolaryngology clinic with a suspected ight postauricular basal cell carcinoma. Subsequent athology revealed an epithelioid sarcoma.

Prospective Outcomes Study of the Impact of Nasal Surgery on Sleep Quality

Objectives: Evaluate the impact of functional nasal airway surgery on the quality of sleep in patients using validated outcomes measurements. Study Design: Prospective, single center, outcome study of sleep quality before and after functional nasal surgery in patients with nasal airway obstruction treated from August 1, 2011, to August 1, 2013. Patients >18 years old with symptomatic structural nasal airway obstruction treated surgically at an academic otolaryngology practice. Intervention: Primary septoplasty, revision septoplasty, functional septorhinoplasty. Methods: Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale (0-100 scale), Epworth Sleepiness Scale (ESS) (0-21 scale), the Pittsburgh Sleep Quality index (PSQI) (0-21 scale), and Likert scales pre-operatively and at 3 months post-operatively. The impact of nasal surgery outcome on sleep quality was analyzed. Linear regression analyses were carried out to identify independent variables affecting sleep outcomes in nasal surgery patients. Results: 48 patients enrolled, and 7 were lost to follow-up. 41 patients for preliminary analysis: 19 septoplasty, 4 revision, and 18 functional septorhinoplasty. Mean NOSE scores decreased from 67 pre-op to 17 at 3 month follow-up. ESS scores decreased from 7.8 to 5.8. PSQI decreased from 7.9 pre-op to 5.0 post-op. Additional analyses are ongoing. Conclusions: Nasal airway surgery does have an effect on sleep quality when evaluated using validated outcomes measurements. The NOSE score showed the most significant improvement in symptomatology. The ESS and PSQI also showed improved sleep quality after nasal surgery.

11:24 AM: A CT Study of Frontal Sinus Trephine

delayed spontaneous CSF rhinorrhoea and thereby establishing that transnasal endoscopic repair is a minimally invasive and efficient approach. METHODS: This is a retrospective study conducted at a 1,800 bed tertiary university hospital where approximately 200 patients visit the ENT outpatient department daily. RESULTS: Between 1999 and 2005, 76 patients (34 traumatic immediate onset, 28 spontaneous delayed onset) with CSF rhinorrhoea were treated. Fourteen patients had undergone neurosurgical intervention for an anterior skull base lesion. A remote history of head and nose trauma was illustrated in 57.1% of patients with late onset leaks; 14.2% of patients had varying episodes of meningitis before diagnosis of CSF rhinorrhoea. Investigations included CT, MRI, and immunofixation of beta 2 transferrin. Transnasal endoscopic repair using fat as a plugging material, fascia lata as an overlay graft, and finally fibrin glue was used in all cases. 92.8% of patients had no further episodes of CSF leak. Two patients underwent revision external surgery for closure. There were no major complications, though olfaction was lost in all patients except those with sphenoid leaks. CONCLUSIONS: The results of transnasal endoscopic repair now make it the treatment of choice for most anterior cranial and sphenoid CSF leaks, with the exception of some defects in the frontal sinus. We lay down an algorithm for managing CSF rhinorrhoea in which endoscopic repair should be the initial surgical treatment in the majority of cases. A neurosurgical approach should be reserved for revision cases.