Lydia Badia

Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial

To cite this article: Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, van der Meulen FW, Menger DJ, Lehtonen MT, Toppila‐Salmi SK, Vento SI, Hytönen M, Hellings PW, Kalogjera L, Lund VJ, Scadding G, Mullol J, Fokkens WJ. Lack of Efficacy of long‐term, low‐dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy 2011; 66: 1457–1468.

Topical Corticosteroids in Nasal Polyposis

Nasal polyps are the common end-point of a number of conditions characterised by inflammation and are rarely ‘curable’ in its true sense. After consideration of the underlying aetiology and confirmation of the diagnosis, they are normally managed by a combination of medical and surgical interventions. Of these, topical corticosteroids have proved to be the medical treatment of choice.The objectives of the medical management are to eliminate or reduce the size of polyps, re-establish nasal airway and nasal breathing, improve or restore the sense of smell, and prevent recurrence of nasal polyps. The mechanism of action of corticosteroids may be by a multifactorial effect on various aspects of the inflammatory reaction, the effect being initiated by their binding to a specific cytoplasmic glucocorticoid receptor. At a cellular level, there is a reduction in the number of antigen-presenting cells, in the number and activation of T cells, in the number of mast cells, and in the number and activation of eosinophils.When polyps are large (grade 3) topical medication is difficult to instil in a very blocked nose and surgery or short term systemic corticosteroids may be required. Topical corticosteroids are of use in the primary treatment of nasal polyps when they are of a small or medium size (grades 1 and 2) and in the maintenance of any therapeutic improvement.The efficacy of topical corticosteroids such as betamethasone sodium phosphate nose drops, beclomethasone dipropionate, fluticasone propionate and budesonide nasal sprays in reducing polyp size and rhinitis symptoms has been demonstrated in several randomised, placebo-controlled trials. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Placebo-controlled studies of agents that have shown a significant clinical effect in the management of nasal polyposis are reviewed.

The effect of topical amphotericin B on inflammatory markers in patients with chronic rhinosinusitis: A multicenter randomized controlled study

It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis (CRS). Based on this rationale, the use of topical antifungals (amphotericin B) has been advocated. Studies on its clinical effectiveness are, however, contradictory.

Primary spontaneous cerebrospinal fluid rhinorrhea and obesity.

The objective of this paper is to determine whether there is a relationship among obesity, gender, and the risk of development of primary spontaneous cerebrospinal fluid (CSF) rhinorrhea. A retrospective case review of all the patients with CSF rhinorrhea treated at our unit over a 10-year period is presented. From a series of 20 patients, we studied 9 cases of primary spontaneous CSF rhinorrhea; 6 patients were female (mean age 50 ± 10 years) and 3 male (mean age 61 ± 7 years). All the female patients were clinically obese, i.e., they had a body mass index >30 kg/m2. All the male patients had a body mass index within normal parameters. We review the postulated etiologic factors of this uncommon condition and study the pathophysiologic basis for obese patients to have CSF rhinorrhea. This study suggests a relationship between obese females and the risk of developing a primary spontaneous CSF rhinorrhea.

Pyocele of the middle turbinate.

Mucoceles are uncommon and the majority occur in the fronto-ethmoidal complex. We present the first case of a secondarily infected mucocele arising from a concha bullosa of the middle turbinate. It was excised intranasally with complete resolution of symptoms.

Vile bodies: an endoscopic approach to nasal myiasis

Nasal myiasis is the infestation of the nasal cavities by larvae (maggots) of Diptera flies. Several species of flies deposit their ova in the nose and the larvae feed on the hosts tissues. We present a case of nasal myiasis by larvae of Oestrus ovis--Sheep Nasal Bot Fly. The larvae of Oestrus ovis are well known parasites in the nasal cavities and paranasal sinuses of sheep and goat. In Britain very rarely larvae may be deposited in the eye, nostrils or outer ear of man, usually husbandry workers. Reputedly, the larvae never survive beyond the first stage with acute catarrhal symptoms lasting only a few days. This is the first reported case in the UK of an urban-dwelling patient infected by mature, third instar larvae of O. ovis. His nasal infestation resolved after endoscopic removal of the live maggots.

Heterotopic pleomorphic adenoma of the external nose

Pleomorphic adenomas arising from sites other than the major or minor salivary glands are uncommon. We describe a case of pleomorphic adenoma in the subcutaneous tissue of the nasomaxillary crease. An identical tumour was previously excised from the right nasal cavity. The possible aetiology of these heterotopic salivary gland tumours is discussed.

Dilated pupil during endoscopic sinus surgery: what does it mean?

Endoscopic sinus surgery has become the standard of care for the surgical management of chronic sinus disease. Sinus disease and its surgical treatment carry the risk of orbital complications, irrespective of the approach. Orbital complications associated with sinus surgery include nasolacrimal duct damage, extraocular muscle injury, intraorbital hemorrhage/ emphysema, and direct optic nerve damage, resulting in blindness. The finding of an unequal pupil at the end of a procedure would be a cause of considerable concern, but it is most likely due to the topical contamination of the eye with a mydriatic pharmacological agent commonly used in endoscopic sinus surgery.

Primary chordoma of the ethmoid sinus

Primary chordoma of the paranasal sinuses are extremely rare tumours, with only a small number of cases verified and published in the literature. It appears that only five of these cases involved the ethmoid sinuses either as a primary or by local invasion, and of these documented cases only one other has been found to solely involve the ethmoid sinus. We present a case of primary ethmoid sinus chordoma treated by wide local surgical excision and present a review of the literature with regard to prevalence and treatment rationale.