Gustavo Eisenberg

Balloon dilation of the frontal recess: a randomized clinical trial.

Objectives: We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus. Methods: We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months. Results: Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed. Conclusions: Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.

Aumento de expresión y actividad de MMP-9 en rinosinusitis crónica con poliposis nasal

Introduccion Las metaloproteinasas de matriz (MMP) son un conjunto de endopeptidasas implicadas en la degradacion de la matriz extracelular, que podrian explicar los cambios histologicos caracteristicos de la poliposis nasal. El objetivo de este estudio consiste en determinar la implicacion de MMP-2 y MMP-9 en la rinosinusitis cronica con poliposis nasal. Material y metodo Para ello, se tomaron muestras de 15 pacientes afectados de poliposis nasal y muestras de 15 controles intervenidos de turbinoplastia. Las muestras se procesaron para analisis de la expresion de ambas MMP mediante Western blot, y para determinacion de su actividad enzimatica mediante cimografia. Resultados Los resultados mostraron un incremento de la actividad y de la expresion de MMP-9, pero no de MMP-2, en las muestras procedentes de pacientes afectados de poliposis nasal en comparacion con los controles. Conclusiones Estos resultados apoyarian la implicacion de la MMP-9 en la remodelacion tisular caracteristica de esta enfermedad.

Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria

Introduccion La cirugia endoscopica nasosinusal (CENS) es una tecnica quirurgica muy extendida que permite el tratamiento de multiples enfermedades del area nasosinusal. Por otro lado, aunque muchas intervenciones otorrinolaringologicas se realizan ambulatoriamente, la CENS todavia se aplica con al menos un dia de ingreso en la mayoria de los hospitales. Objetivos Evaluar nuestra experiencia en CENS como cirugia mayor ambulatoria, analizar las causas que causaron el ingreso inesperado e identificar algun factor de riesgo para no cumplir con el alta precoz. Material y metodo Se estudia a 145 pacientes intervenidos ambulatoriamente mediante CENS por rinosinusitis cronica, polipos antrocoanales y dacriocistorrinostomias desde agosto de 2004 a junio de 2007. Se analizaron las variables: sexo, edad, antecedentes personales (hipertension arterial, asma, sindrome de Widal), enfermedad intervenida, septoplastia asociada, extension de la cirugia y cirugia de revision. Resultados El indice de sustitucion fue del 13,1 %; las causas mas frecuentes fueron las hemorragias (31,6 %), de las que mas de la mitad solo precisaron observacion sin recambio de taponamiento, y mareo/debilidad tras cirugia (36,8 %). De todas las variables estudiadas, solo la cirugia de revision se asocio a un incremento en la tasa de reingreso ( odds ratio =3,5; intervalo de confianza del 95 %, 1,2-10,1). Conclusiones Nuestra experiencia en CENS como cirugia mayor ambulatoria muestra un indice de sustitucion del 13,1 %, si bien la mayoria de los casos correspondieron a pacientes con complicaciones leves. La cirugia de revision supuso en nuestra serie un factor que aumento la tasa de ingreso.

Surgical management of salivary gland tumours

Abstract Introduction and objectives Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. Material and methods This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions, and cervicotomies), final pathology findings, and course with at least 1 year follow-up. Results Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 submandibular tumours (6%), 1 palatal tumour (2%), and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were review parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomies complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Freys syndrome (2%). Conclusions Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthins tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.

Nasosinusal Endoscopic Surgery as Major Out-Patient Surgery

INTRODUCTION Functional endoscopic sinus surgery (FESS) is a useful and widespread technique that allows the treatment of a large number of nasal pathologies. Nevertheless, although many ENT operations are carried out on an out-patient basis, FESS procedures commonly require at least 1 day of hospital admission in many centres. OBJECTIVES To evaluate our experience in FESS as day-case, to study causes of unexpected overnight admission, and to identify any risk factors for failing to comply with early discharge. MATERIAL AND METHOD We studied 145 patients consecutively subjected to out-patient FESS procedures for chronic rhinosinusitis, antrochoanal polyps, and dacryocystorhinostomy from August 2004 to June 2007. We analyzed sex, age, medical history (arterial hypertension, asthma, Widal syndrome), pathology, associated septoplasty, extent of the surgery, and revision surgery. RESULTS The re-admission rate was 13.1% with the following as the most frequent causes: bleeding (31.6%), requiring only observation in over half the cases (ie, without changing the nasal packing), and dizziness/weakness (36.8%). Only revision surgery was associated with an increase in the re-admission rate (odds ratio, 3.5; 95% CI, 1.2-10.1). CONCLUSIONS Our experience in FESS for out-patient surgery shows a readmission rate of 13.1 %, although most cases were related to minor complications. The revision surgery was the only variable that could be associated with an increase in re-admission rate.

Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática

INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. MATERIAL AND METHOD An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegels criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. RESULTS The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13dB and 66.11dB in the treatment group (P<.01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13dB in the control group, a significant difference (P<.0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. CONCLUSION Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegels criteria in most cases.

Ethmoid Drug-Eluting Catheter for Nasosinusal Polyposis: Results after a Randomized Controlled Trial:

Objectives: Assess the safety and efficacy of a drug-eluting catheter to be inserted into the ethmoid sinuses during endoscopic sinus surgery to elute triamcinolone in patients with CRSwP (nasosinusal polyposis). Methods: Prospective, randomized, controlled, double-blind, clinical trial using intrapatient control design. The study enrolled 40 patients with CRSwP undergoing endoscopic sinus surgery. In every case, after polypectomy was done to expose the ethmoid bulla, a drug-eluting catheter to elute triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional total ethmoidectomy. Outcome measures were visual analogue scales, Rhinosinusitis Disability Index, endoscopy, and olfactometry assessment at baseline, 3, 6, and 12 months. Safety assessments included ocular examinations at baseline and 30 days. All CT imaging was done after more than 12 months of follow-up. Results: After randomization was performed, unilateral devices were successfully placed in all patients and easily removed after 4 weeks. When comparing both nasal fossae in postoperative endoscopies at 6 and 12 months, the prevalence of edema, adhesions, and recurrent polyposis were statistically similar. Changes from baseline in patient-reported outcomes were statistically relevant in both sides. No clinically important changes in intraocular pressure occurred. CT resolution of pathology was achieved in both sides, improving Lund-Mackay scale, without significant differences. Conclusions: This trial provides clinical evidence on the safety and efficacy of a drug-eluting catheter for use in patients with CRSwP. It achieves similar results compared to complete ethmoidectomy, without any major complications.

Postviral Anosmia: Lack of Response to Corticosteroids

Objectives: (1) Describe the clinical caracteristics of postviral anosmia, comparing with anosmia related to chronic rhinosinusitis (CRS). (2) Analyze its response to corticosteroid treatment. Methods: A retrospective study was performed on 66 patients with olfactory loss. Olfactory function was assessed at baseline using the Connecticut Chemosensorial Clinical Research Center test. Clinical records were reviewed to discharge CRS, post-traumatic and other certain etiologies. Computed tomography and magnetic resonance imaging were reviewed. Topical, oral corticosteroids, or both were used on postviral cases for at least 6 months. Results: Patients were evaluated after 6 and 12 months of follow-up. The mean age at diagnosis was 53.8 (standard deviation 12.92). There were 74.2% females (49/66) and 25.8% males. The most frequent etiology was postviral anosmia, 51.5% of cases (34/66). At the time of diagnosis, the mean combined olfactometry (threshold test + identification test/2) was 2.75 (standard deviation 2.36). After 12 months, the mean was 4.70 (standard deviation 3.21), a significant improvement compared to baseline. No significant differences between the improvement obtained with topical corticosteroid therapy and/or oral were found. No differences were found comparing to treatment response of anosmia related to CRS. Conclusions: Postviral anosmia occurs most often in women. Olfactory recovery is uncommon, and topical or systemic corticosteroids were similarly ineffective.

Drug-Eluting Catheter as Treatment of Sinonasal Polyposis

Objective: Chronic rhinosinusitis with polyposis is currently treated with intranasal steroids. The study objective was to assess the safety and effectiveness of a drug-eluting catheter to be inserted into the ethmoid sinuses to release triamcinolone during FESS in patients with sinonasal polyposis. Methods: Preliminary results from a prospective, randomized, double blinded, clinical trial enrolling 40 patients. In every case, after polypectomy was done to expose the ethmoid bulla, a drug-eluting catheter to deliver triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional functional endoscopic sinus surgery. Outcome measures were visual analogue scales, RSDI, endoscopy, and olfactometry assessment at baseline and 3 months. Safety assessment included ocular exams at baseline and 30 days. Results: After randomization was performed, unilateral devices were successfully placed in all patients, and they were also easily removed after 4 weeks. When comparing both nasal fossae, mean inflammation scores were minimal at all time points. At 3 months, the prevalence of polypoid edema, adhesions and rhinorrhea was statistically similar in both sides. Changes from baseline in patient-reported outcomes were statistically significant (P < .0001). No clinically significant changes from baseline in intraocular pressure occurred. CT imaging will be done after 12 months of follow-up. Conclusion: This randomized controlled trial provides clinical evidence of the safety, effectiveness, and clinical utility of a drug-eluting catheter in patients with nasal polyposis.

Increased Expression and Activity of MMP-9in Chronic Rhinosinusitis With Nasal Polyposis

INTRODUCTION Matrix metalloproteinases (MMP) are a family of endopeptidases involved in extracellular matrix degradation and which could potentially explain specific histological changes in nasal polyposis. The aim of this study is to determine whether MMP-2 and 9 are involved in chronic rhinosinusitis with polyposis. MATERIAL AND METHOD Specimens were collected from 15 patients affected by nasal polyposis and 15 control patients (with turbinoplasty performed). Specimens were processed for determination of protein expression levels by Western-blot and for determination of their enzymatic activity by zymography for both MMPs. RESULTS Results showed a higher expression and activity of MMP-9 but not of MMP-2 in specimens from patients with polyposis when compared with controls. CONCLUSIONS These results support the involvement of MMP-9 in the tissue remodelling characteristic of this disease.