Heinz R. Stammberger

Paranasal sinuses:anatomic terminology and nomenclature.

A consensus on the preferred modem usage of potentially confusing or ambiguous terms in sinus anatomy and nomenclature is described. These terms are intended to provide clear communication among otorhinolaryngologists and serve as a basis for discussion among anatomists. Terminology is in English and based on Latin nomenclature. An attempt has been made to reconcile or eliminate duplication, redundancy, and overlap in terminology that have arisen over the past century. A key concept is that the ethmoid complex is divided into anterior and posterior sections by the basal lamella of the middle turbinate.

Endoscopic Surgery for Mycotic and Chronic Recurring Sinusitis

Chronic sinusitis and its complications are often caused or perpetuated by fungi. In Europe and North America Aspergillus species are the most common contaminants of the sinuses, with relatively few cases of mycoses caused by Mucor, Candida, Penicillium, Cladosporium and Fusarium reported in the literature. Although Aspergillus and Mucor are mainly saprophytic, they may cause severe potentially lethal complications. Consequently, therapy should include complete removal of the mycotic masses and prevention of reinfection In nearly all cases in our experience, fungal diseases of the maxillary sinuses are secondary diseases, the pathologic conditions for which are created by chronic recurring sinusitis. Nasal endoscopy has shown that in most cases of recurring sinusitis, infection spreads from the nose into the larger sinuses, mostly from an infected anterior ethmoid. Maxillary and frontal sinuses are fully dependent on the pathophysiologic conditions in the anterior ethmoid because their ventilation and drainage pass through its complicated system of fissures and clefts into the middle nasal meatus. Endoscopic endonasal surgery of the diseased ethmoid is therefore an important element in our treatment schedule. Stenotic and/or chronically infected areas of the anterior ethmoid are identified by conventional or computed tomography. These areas then undergo endonasal operation under the guidance of rigid endoscopes. Diseased mucosa is removed, narrow or stenotic areas are widened, and the natural maxillary sinus ostium is enlarged. In many cases it is possible to remove all mycotic masses through this new window. Fenestration into the inferior nasal meatus is unnecessary with this method, and the sinus mucosa is usually left untouched. For follow-up treatment, instillations of antimycotic or antibiotic ointments are used. Even in cases of massive mucosal changes, the dependent sinuses, such as the frontal or maxillary sinuses, usually heal spontaneously after this procedure without having been treated directly. More than 140 patients with mycotic sinusitis, 48 of whom were studied and followed up for this paper, were treated by us during the last 8 years. The endoscopic surgical technique we have developed is described in detail.

Sinusitis and frontal brain abscess in a diabetic patient caused by the basidiomycete Schizophyllum commune: case report and review of the literature.

Martin Hoenigl, Engelbert Aspeck, Thomas Valentin, Bettina Heiling, Katharina Seeber, Robert Krause, Heinz Stammberger, Alfred Beham and Walter Buzina Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria, Department of Neurology, Medical University of Graz, Graz, Austria, Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria and Institute of Pathology, Medical University of Graz, Graz, Austria

Der BasidiomyzetSchizophyllum communein den Nasennebenhöhlen

In der medizinischen Literatur der vergangenen 50 Jahre findet man nur 22 Fälle, in denen der weltweit vorkommende Basidiomyzet Schizophyllum commune beschrieben wurde. In einem Zeitraum von drei Jahren haben wir 270 Patienten untersucht, die entweder unter einer chronischen Sinusitis oder unter einer Nasennebenhöhlen‐mykose litten. Dazu wurde entweder Nasenschleim oder Operationsmaterial aus den Nasennebenhöhlen (NNH) kultiviert und die entstandenen Pilzkulturen mikroskopisch identifiziert. Konnten die Pilze nicht eindeutig bestimmt werden, wurde deren DNA zur molekularbiologischen Untersuchung isoliert. Die Internal Transcribed Spacer (ITS) Region des ribosomalen Gen‐Clusters wurde mit pilzspezifischen Primern amplifiziert und das entstandene PCR‐Produkt sequenziert. Zusätzlich wurden alle sterilen, mit weißem Myzel wachsenden Pilze mit dem Primerpaar scom1/scom2r, welches spezifisch für S. commune ist, amplifiziert. Insgesamt konnten wir im Untersuchungszeitraum von drei Jahren in zwölf Fällen S. commune aus unserem Patientengut isolieren. Die präsentierten Methoden zeigen, dass dieser Basidiomyzet in Patienten mit Erkrankungen der NNH viel häufiger vorkommt, als man bisher angenommen hat.

Transnasal Endoscopic Removal of an Extensive Immature Teratoma in a Three-Month-Old Child

The use of endoscopy in the paranasal sinuses has grown and diversified in the past few years. We present a case of an immature malignant teratoma originating from the sinuses, with intracranial extension to the middle and posterior fossae, that was managed and removed endoscopically. At the age of 2 months, the patient was hospitalized for respiratory instability. Diagnosis was made with biopsy, and chemotherapy was introduced. After 4 weeks, an endonasal endoscopic approach was performed, and a complete macroscopic removal of the tumor was achieved without complications. Follow-up for 10 months with magnetic resonance imaging and endoscopic examination has not revealed recurrence. In selected cases, the endonasal endoscopic technique may be a good alternative to the external approach, reducing the operative trauma and mortality.

Does insulin‐like growth factor 1 receptor (IGF‐1R) targeting provide new treatment options for chordomas? A retrospective clinical and immunohistochemical study

Scheipl S, Froehlich E V, Leithner A, Beham A, Quehenberger F, Mokry M, Stammberger H, Varga P P, Lazáry A, Windhager R, Gattenloehner S & Liegl B 
(2012) Histopathology 60, 999–1003

Released intranasal eosinophilic major basic protein as a diagnostic marker for polypoid chronic rhinosinusitis

OBJECTIVE: To investigate the hypothesis that eosinophil major basic protein is released in high concentrations in the nasal mucus of patients with polypoid chronic rhinosinusitis. STUDY DESIGN: Single center, open, prospective trial. SETTING: Medical University of Graz, Austria. SUBJECTS AND METHODS: Patients with polypoid chronic rhinosinusitis (n = 23) were compared to three different control groups: patients with chronic rhinosinusitis-like symptoms but without general mucosal thickening, patients who underwent functional endoscopic sinus surgery for reasons other than chronic rhinosinusitis, and patients without sinus disease (total n = 21). Mucus was harvested from each patient using a standardized technique and analyzed for eosinophil major basic protein with an enzyme-linked immunosorbent assay. RESULTS: In the patient group with polypoid chronic rhinosinusitis, 20 of 23 (87%) were positive for eosinophil major basic protein. In contrast, only one control patient was positive, whereas the remainder had no detectable amount of eosinophil major basic protein in the mucus (P = 0.001 vs chronic rhinosinusitis). CONCLUSION: Toxic eosinophil major basic protein levels are elevated in polypoid chronic rhinosinusitis patients compared to control groups that have similar clinical presentations but upon closer examination turn out not to have chronic rhinosinusitis. In the future, the detection of eosinophil major basic protein in nasal mucus may become a sensitive and specific marker for chronic rhinosinusitis and a helpful diagnostic tool.

Transnasal Endoscopic Treatment of Orbital Complications of Acute Sinusitis The Graz Concept

Objective: Orbital complications of acute sinusitis can be severe. Nowadays, surgical drainage of intraorbital abscess formations is performed endoscopically in the majority of cases. This study aims to illustrate the Graz experience in the endoscopic treatment of orbital complications and to present our treatment algorithm. Methods: In a retrospective study, 53 patients were examined who were referred to the Department of General Otorhinolaryngology of the ENT-University Hospital Graz from 2000 to 2011. Results: Of 53 patients, men were affected more frequently than women (n = 37, 69.81% vs n = 16, 30.19%). The following diagnoses were obtained: 9 preseptal cellulitis, 7 orbital cellulitis, 14 subperiosteal abscesses, and 23 orbital abscesses. In 16 patients, a conservative therapy was administered; 37 patients underwent surgery, most of them purely endoscopically (n = 31, 83.78%). Two of the patients who underwent conservative treatment and 7 of those who underwent surgery experienced a recurrence (n = 9, 16.98%). Conclusion: Based on analysis of our recurrences, we have tried to create the optimal treatment algorithm as a point of reference in the management of orbital complications of acute sinusitis. In this way, 7 of 9 recurrences could have been avoided, equaling a hypothetical recurrence rate of 3.77% instead of 16.98% (hypothetical success rate 96.23%).

Are stents beneficial in endoscopic choanal atresia repair of newborns and children? Case series of 11 patients.

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Balloon Dilation in Rhinology: Reviewing the Evidence

Program Description: Balloon catheter technology was introduced in 2005 for management of paranasal sinus inflammatory disease. This miniseminar will objectively evaluate the currently available operative suite and office-based balloon devices. Rhinologists with considerable experience without commercial conflicts on balloons will assess the frank advantages and limitations of the current balloon devices. Evidence-based review will be incorporated to assess the strengths and weaknesses of the existing peer-review literature. The recent large European clinical trial will be reviewed. The potential complications unique to balloon catheters will be discussed. An update on CPT coding, RUC values, and socioeconomic implications will also be addressed. Educational Objectives: 1) Review the currently available operative suite and office-based balloon catheter technologies and explore implications on the Functional Endoscopic Sinus Surgery (FESS) paradigm. 2) Critically appraise the existing peer-review literature and address potential complications of balloon dilation. 3) Assess socioeconomic implications and CPT coding issues related to balloons.