Lars Andréasson

Effects of phenylpropanolamine on ostial and nasal patency in patients treated for chronic maxillary sinusitis.

Ostial and nasal patency were measured in different body positions and after phenylpropanolamine (Ppa) treatment in 12 patients earlier treated for chronic unilateral maxillary sinusitis of varying severity. Six of the sinuses were of normal appearance on sinoscopy. Phenylpropanolamine in a single dose of 100 mg was found to increase the equivalent ostial diameter significantly in the sitting and recumbent positions. The drug also reduced the nasal airway resistance. The Ppa effect might be of benefit in patients treated for chronic maxillary sinusitis.

Pressure-dependent variation in volume of mucosal lining of the middle ear

A method is described for studying pressure-dependent variation in the volume of the mucosa of the middle ear. Studies were performed at different pressures in the middle ear as well as at different ambient pressures. It was found that the pressure-dependent volumetric changes of the mucosa were the same whether the pressure in the middle ear was changed directly by altering the intratympanic or indirectly by altering the ambient pressure. With the method described it is also possible to determine the middle ear volume without artefacts due to the middle ear mucosa. The volume-pressure relationship of the middle ear mucosa varied from 0.6 to 1.7 mul/cm H2O and linearly with the volume of the middle ear. Comparisons between determinations of the middle ear volume with and without consideration of the mucosal compliance showed differences, especially in small middle ears. The effect on the volume of the mucosa caused by variation of posture was also studied. The physiological middle ear pressure depends on the functional state of the Eustachian tube, the middle ear volume, the tympanic membrane and the middle ear mucosa. Thus, knowledge of the mucosa compliance is important for calculating middle ear pressure as well as for determining the volume of the air-filled middle ear space. The method might also prove a useful tool in the elucidation of the vascular bed both in health and in disease as well as the reaction of the mucosal vessels to drugs.

Middle ear disease and hearing impairment in northern Tanzania. A prevalence study of schoolchildren in the Moshi and Monduli districts

A total of 854 schoolchildren from one urban and one rural district in northern Tanzania were examined for the presence of middle ear pathology and hearing loss by means of pneumotoscopy and screening audiometry (air conduction). The prevalence of chronic otitis media (COM) was 1.6%, with no difference between urban and rural children. Scarred and sclerotic tympanic membranes were found in 10.9% of urban children and in 15.1% of rural children, the difference being significant. Hearing loss within the speech frequency range in all the children studied was found in 37% of the urban children and in 18% of the rural children. However, the prevalence of hearing loss above 30 dB HL was 3% in both districts. High frequency loss was significantly more common among urban than among rural children. Undetected severe hearing impairment/deafness was found in three children in the rural district, while none was found in the urban district.

Carcinoma of the oral cavity in relation to aryl hydrocarbon hydroxylase inducibility, smoking and dental status

The authors investigated the smoking patterns in a consecutive series of 20 patients with oral cancer and at the same time assessed the aryl hydrocarbon hydroxylase (AHH) inducibility distribution and dental status. The AHH level proved high in 8 patients, intermediate in 7 and low in 5. High AHH inducibility was more common (p = less than 0.001) and low AHH inducibility less common (p = less than 0.001) than in the controls. Dental status was poor in only 2 patients. It is concluded that smoking is a prominent exogenous factor associated with the occurrence of cancer in the oral cavity. Poor dental status seems to be of minor importance.

Metastases in the oral cavity. Case reports.

4 cases of metastases in the oral cavity are described. They were seen in patients with carcinoma of the renal pelvis, renal carcinoma, breast carcinoma and malignant melanoma. In 3 of the cases, the metastases were situated distally to the canines in the mandible, where Roentgen examination had revealed a radiolucent area, and in the 4th case, in the soft tissue in the upper jaw. The initial symptoms in all 4 cases were swelling, pain or decreased sensitivity. The metastases were diagnosed, on average, 7 years after diagnosis of the primary tumour.

Caldwell—Luc Operation: Long Term Results and Sequelaes

Out of 65 patients with sinusitis, treated with Caldwell-Luc operation 58 (43%) had more or less pronounced postoperative complaints at the follow-up 4-7 years postoperatively. The patients could be divided into group A 47/65 where all were satisfied with the result of the operation and group B 18/65 with more pronounced complaints, such as facial and dental par/hyperesthesia or neuralgia of nervus infraorbitalis. Persisting antrostomy was found in 82% in group A and in 37% in group B indicating that an open antrostomy is of importance for the long time result.

Short and Long-term Treatment Results in Chronic Maxillary Sinusitis

The diagnostic criteria and the length of the observation period are essential factors influencing the results of treatment of maxillary sinusitis. In 198 patients (244 sinuses) with chronic maxillary sinusitis of either rhinogenous or dental etiology all patients were judged as cured or improved at the short-term control 1-3 months after completion of therapy. The long-term observation (mean 3.5 years) revealed different figures of healing. Satisfactory results after conservative therapy were seen in only 34% while the Caldwell-Luc operation gave good results in 80%. In sinusitis of dental origin, dental treatment combined with local sinus surgery was successful in 90%. In 78 sinuses investigated by sinoscopy, discrepancy between the symptoms and the endoscopic findings was seen in 14 cases (18%). Information obtained by questionnaire is therefore unreliable. In 30 sinuses operated upon with the Caldwell-Luc procedure, discrepancy between radiographic and endoscopic findings was seen in 3 cases (10%). Contributory factors, e.g. nasal polyps, dental infections and nasal allergy were found in 48 out of 84 sinuses not completely healed at the long-term control. Patients treated for chronic maxillary sinusitis must be followed up over a long period. A clinical control after 1-2 years, including sinoscopy or sinus radiographs, is recommended even in patients free from symptoms of sinusitis. Sinoscopy seems to be more reliable than sinus radiography and should be performed if the sinus radiographs show any pathology. The patients are also recommended to visit their dentists regularly, due to the close relationship between dental infections and chronic maxillary sinus diseases.

Acute sinusitis in children--symptoms, clinical findings and bacteriology related to initial radiologic appearance.

In a series of 175 children with suspected sinusitis the symptoms and clinical signs were compared with the radiologic and bacteriologic findings. URI, purulent nasal secretion and pain were the main symptoms predicting radiologic changes. In 75% of the patients the presence of two or three of these symptoms was co-existent with major radiological changes. As assessed by nasopharyngeal culture Haemophilus influenzae seemed to be the major pathogen.

A Comparison Between Different Ultrasonic Display Techniques, Radiography and Invasive Control For Different Disorders Of The Paranasal Sinuses

Three pieces of simplified ultrasound equipment adapted for investigation of the paranasal sinuses have been tested in a clinical investigation of 148 sinuses in comparison with radiography and invasive control. An oscilloscope (OSC), one single row of light emitting diodes (LED) and a gas discharge (GD) display were used as display units. No statistically significant difference was found between the different displays or radiography in their screening capacity. It was found that the OSC-display was significantly more reliable than the other displays and radiography in separating different pathological conditions.

Middle Ear Mechanics and Eustachian Tube Function in Tympanoplasty

In 100 patients with chronic otitis media, tubal function and volume was tested before operation. In a postoperative study on hearing and healing there was no positive correlation between these findings and the preoperative results. In 50 patients with healed ear drums, tubal function was retested in a pressure chamber with a flow volume technique. An improvement in Eustachian tube function could be demonstrated. These findings indicate that poor tubal function in chronic otitis media might be secondary to other factors responsible for the disease.