Kaori Kase

Endoscopy-assisted transoral resection of the styloid process in Eagle's syndrome. Case report

Eagles syndrome is often associated with elongated styloid process or ossified stylohyoid or stylomandibular ligament. Patients with this syndrome present with recurrent cervicofacial pain. Surgical removal of the elongated styloid process is a standard treatment and can be accomplished through either a transoral or extraoral approach. Both approaches have advantages and disadvantages, and the best surgical approach remains controversial. In our case, the elongated styloid process was removed by transoral approach assisted by endoscopy. Endoscopy provides clear surgical view thus lessen the chance of neurovascular injury and other intraoperative complications. Endoscopy-assisted transoral resection is an optional alternative surgical procedure for Eagles syndrome.

Bacteriology of recurrent exacerbation of postoperative course in chronic rhinosinusitis in relation to asthma.

OBJECTIVES Co-mobidity of asthma is known to result in a poor prognosis of post-endoscopic sinus surgery (post-ESS). Bacterial infection may play a key role in recurrent pathophysiology of sinusitis in post-ESS. METHODS Forty-two patients with CRS associated with asthma undergoing ESS were enrolled. Bacterial culture was performed from the sinus cavity at the time of acute infectious episodes. Recurrence of sinonasal disease was analyzed in terms of steroid responsiveness and peak expiratory flow (PEF). RESULTS Totally 75 aspirates were obtained during post-ESS; 2 repeat aspirates from 10 patients, 3 from 5 patients, and 4 from 2 patients. Only 6 specimens (8.0%) obtained from 5 patients (11.9%) showed no growth whereas 83 isolates were recovered from 69 specimens. Sixteen patients had at least one episode of a significant decline of PEF. All except one patient complained of symptoms and signs of upper respiratory infections prior to a depression of PEF. Positive culture was obtained in 10 out of 11 patients examined at the time of acute exacerbation of CRS. CONCLUSION Bacterial infection may play a critical role of recurrent polyps and refractory symptoms during post-ESS follow-up. Moreover, worsening of sinusitis accompanies asthma exacerbation.

Comparison of bacterial examinations between eosinophilic and neutrophilic chronic rhinosinusitis with nasal polyps

Abstract Conclusion: We found no significant differences in the bacterial features of the maxillary sinuses between eosinophilic and neutrophilic chronic rhinosinusitis (CRS) with nasal polyps. Objectives: Since neutrophilic CRS is often influenced by a predisposition to bacterial infection, and eosinophilic CRS is likely to be developed by allergic antigens, differences in the microbiology between the two pathologies of CRS can be expected. The present study was designed to investigate the bacterial findings from the maxillary sinus in eosinophilic and neutrophilic CRS. Methods: Seventy patients with CRS with nasal polyps were divided into eosinophilic and neutrophilic types based on histopathological observations of the nasal polyps. The specimens for bacterial culture were obtained from the maxillary sinus during endoscopic sinus surgery. Results: In all, 29 and 41 patients were classified as having eosinophilic and neutrophilic CRS with nasal polyps, respectively. The isolation rate of bacteria showed no significant difference between eosinophilic (90%) and neutrophilic CRS (98%). Aerobic bacteria were found in 25 patients (86%) with eosinophilic CRS, which was not significantly different from that in neutrophilic CRS (40 patients, 98%). The isolation rate for aerobic and anaerobic bacteria showed no significant differences.

A case of orbital apex syndrome due to Pseudomonas aeruginosa infection

Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.

Maxillary sinus infundibulum narrowing influences sinus abnormalities in spite of the presence or absence of allergy

Abstract Conclusion. Maxillary sinus abnormalities were demonstrated to be associated with maxillary sinus infundibulum narrowing as well as nasal airflow resistance secondary to nonspecific nasal inflammation. Objectives. There is no consensus regarding the pathogenetic roles of allergy and anatomic variations in sinus mucosa abnormalities. We investigated the correlation between allergy and anatomic variations in sinus abnormalities in chronic rhinitis patients in the presence or absence of allergy. Methods: In all, 148 adult patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were enrolled. Opacification of sinuses, the size of the maxillary sinus infundibulum, Haller cells, and concha bullosa were evaluated based on computed tomography (CT) images. Simultaneously, nasal airflow resistance was measured. Results: The AR group comprising 105 patients showed maxillary sinus opacification in 45 patients. In the NAR group including 43 patients, soft tissue opacification was observed in 13 patients. There was no significant difference in the incidence of sinus opacification between the AR and NAR groups. Both nasal resistance and the infundibulum size in both the AR and NAR groups with sinus opacification showed significant differences from those without sinus abnormalities. The presence of concha bullosa influenced the sinus opacification in both the AR and NAR groups.

Effectiveness of Glucocorticosteroidfor PostoperativeRecurrence of Nasal Polyps inChronic Rhinosinusitis associatedwith Asthma

Backgrounds: Asthma co-mobidity is known to be associated with a poor prognosis for chronic rhinosinusitis with nasal polyps (CRSwNP). Systemic and topical glucocorticosteroid has been proved to be effective for recurrent nasal polyps after surgery. Methods: We evaluated the steroid responsiveness and bacterial culture in 42 patients with CRSwNP associated with asthma during postoperative follow-up. Results: Seventeen patients controlled by topical glucocorticosteroid therapy did not require systemic glucocorticosteroids (non-users). The remaining 25 patients showed recurrence of nasal polyps in spite of basal medication of topical corticosteroids and required oral corticosteroids. Eight patients were considered to be steroid non-responders. On the other hand, 17 patients responded to a short-term intake of oral corticosteroids (steroid responders). There was a statistically significant difference in the detection rate of pathogens from the sinus during acute exacerbations between steroid responders and non-users of steroids. There was a significant difference in symptomatic scores only between steroid non-responders and non-users of steroids, whereas the other parameters showed no significant differences. Conclusion: Bacterial infection plays a critical role in recurrent polyps and refractory symptoms as well as in the poor response to glucocorticosteroids during postoperative followup. Keywords: Chronic

A Case Report of an Ethmoid Osteoma Associated with Gardner’s Syndrome

Background: Osteomas of the nose and paranasal sinus are commonly known as benign neoplasms. Many cases with osteomas show generally asymptomatic findings. On the other hand, some cases with manifest symptoms may require surgical treatment. The most common of these are osteomas in the paranasal sinuses, which can cause recurrent infections and headaches. It has been reported that ethmoid and frontal osteomas could extend to the orbita and cause cosmetic deformity or mucocele formation. Gardner’s syndrome is an autosomal dominant hereditary disorder characterized by clinical triad of intestinal polyposis, osteomas, and cutaneous or soft tissue tumors. Case presentation: A 33-year-old man withan ethmoid osteoma had a past history of familial adenomatous polyposis (FAP) and a family history of FAP. The patient underwent a total colectomy due to FAP when 31 years old. His complaint was right-sided exophthalmus at the age of 33. A computed tomography demonstrated an osteoma on the roof of the anterior ethmoid region with an extension to the orbit and opacification of both maxillary and ethmoid sinuses. The osteoma could be successfully and completely removed using an endoscopic endonasal approach. Conclusion: Suspected cases of Gardner’s syndrome in patients with paranasal sinus osteomas should have a complete workup for Gardner’s syndrome, including lower gastrointestinal tract endoscopy, barium enema imaging and genetic testing, because early recognition and diagnosis of Gardner’s syndrome will help prevent the development of colon cancer.

Bacteriologic Evaluation of Sinus Aspirates Taken by Balloon Catheter Devices in Chronic Rhinosinusitis: Preliminary Study

Purpose: Chronic rhinosinusitis (CRS) is known to be a polymicrobial infection involving both aerobes and Gram-positive and Gram-negative anaerobes. Accurate bacterial evaluation by adequate culture methods can justify subsequent antimicrobial strategies. Methods: Two specimens were obtained from each of 10 patients undergoing catheter-based Balloon Sinuplasty™, one from the middle meatus (endoscopic approach) and the other from the sinus (catheter-based approach). Results: The bacterial culture from the middle meatus was positive in 9 of 10 patients, including 6 different aerobes without anaerobes. The bacterial culture of aspirates from the sinuses were positive in 8 out of 10 patients, with 4 different aerobic bacteria and 4 different anaerobic bacteria. Anaerobes were isolated in 0% of middle meatus samples, which was significantly lower than the 62.5% (5/8) detected in the sinus samples. Conclusions: Bacterial culture of sinus aspirates using a catheter-based technique improves the recovery of bacterial pathogens from CRS patients.