Nechama Uri

Classification of fungal sinusitis in immunocompetent patients

OBJECTIVE The objective of this study was to review the subgroup classification of fungal sinusitis in immunocompetent patients. METHODS The study design included 19 immunocompetent patients with fungal sinusitis who were operated on between 1993 and 1998. RESULTS Ten of 19 patients showed a fungus ball. They underwent a limited surgical endoscopic procedure, and no further treatment was needed. Four patients had allergic fungal sinusitis and were treated postoperatively with irrigation, topical steroids, and oral steroids in 2 patients as well. Five patients had chronic sinusitis with significant bone erosion. All 5 underwent an extensive endoscopic procedure and were treated postoperatively by repeated irrigation, endoscopic cleaning, and no antifungal preparation. Two patients of this group are reported broadly. CONCLUSIONS Fungal sinusitis in immunocompetent patients is not a rare condition and can be divided into 3 categories: 1) fungus ball, 2) chronic erosive (noninvasive) fungal sinusitis, and 3) allergic fungal sinusitis. The symptomatology, treatment, and prognosis varied significantly among the 3 different categories.

Indications for the Caldwell-Luc approach in the endoscopic era:

OBJECTIVE: Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis. STUDY DESIGN AND SETTING: Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications. RESULTS: Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications. CONCLUSIONS: The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.

Acyclovir in the treatment of idiopathic sudden sensorineural hearing loss

BACKGROUND Idiopathic sudden sensorineural hearing loss (ISSNHL) is a vexing problem that continues to pose a diagnostic and therapeutic enigma for the otologist. The aim of the study, adopting the viral theory, was to discover whether patients with ISSNHL would benefit from early treatment with acyclovir and hydrocortisone compared with patients treated by hydrocortisone alone. METHODS Sixty patients with ISSNHL were treated in a prospective controlled randomized manner. Patients were seen within 7 days of onset and were divided randomly into 2 groups. The study group patients were treated with acyclovir and hydrocortisone, whereas those in the control group were treated with hydrocortisone alone. RESULTS We compared the 2 groups before and after treatment regarding SRT, mean hearing level at each frequency, speech reception threshold improvement, gender, age, tinnitus, and balance complaints. The overall improvement was 78%. CONCLUSION We conclude that there probably is no benefit from the addition of acyclovir in the treatment of ISSNHL.

Acyclovir in the treatment of Ramsay Hunt syndrome.

Ramsay Hunt syndrome is an herpetic disease with ominous prognosis regarding the facial nerve. Treatment with acyclovir, a well-known virostatic agent, has been given in a small number of patients in recent years with excellent results. We report on the administration of acyclovir intravenously for 7 days in 31 patients with Ramsay Hunt syndrome, with overall recovery rate of 82.6%. There were no side effects regarding this treatment.

Herpes Zoster Oticus: Treatment with Acyclovir

Herpes zoster oticus produces facial paralysis with a low recovery rate. Acyclovir, a specific virostatic drug, was given intravenously in five herpes zoster oticus patients, and in three of them was followed by oral therapy. In follow-ups of 1 to 24 months, one patient had grade I recovery, three patients grade II, and one grade III. These good results encourage the use of acyclovir in herpes zoster oticus patients.

Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria

BACKGROUND Chronic sinusitis is one of the most common otolaryngological diagnoses. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis can easily be misdiagnosed and treated as chronic sinusitis, causing continuing harm. AIM To better identify and characterise these two subgroups of patients, who may suffer from a systemic disease requiring multidisciplinary treatment and prolonged follow up. METHODS A retrospective, longitudinal study of all patients diagnosed with allergic fungal sinusitis or eosinophilic mucin rhinosinusitis within one otolaryngology department over a 15-year period. RESULTS Thirty-four patients were identified, 26 with eosinophilic mucin rhinosinusitis and 8 with allergic fungal sinusitis. Orbital involvement at diagnosis was commoner in allergic fungal sinusitis patients (50 per cent) than eosinophilic mucin rhinosinusitis patients (7.7 per cent; p < 0.05). Asthma was diagnosed in 73 per cent of eosinophilic mucin rhinosinusitis patients and 37 per cent of allergic fungal sinusitis patients. CONCLUSION Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis have the same clinical presentation but different clinical courses. The role of fungus and the ability to confirm its presence are still problematic issues, and additional studies are required.

Clinical utility of a polymerase chain reaction assay in culture-negative necrotizing otitis externa.

Objective This study describes a subset of necrotizing otitis externa (NOE) patients with a refractory disease and negative cultures. In these cases, we decided to use a polymerase chain reaction (PCR) assay from surgically obtained tissue under sterile conditions to improve pathogen detection sensitivity. Study Design Retrospective case review. Setting Academic medical center. Patients Nineteen consecutive patients diagnosed with NOE between January 2008 and January 2014 inclusive. Three patients of this cohort presented a culture-negative disease. Interventions Diagnostic. Main Outcome Measures Positive detection of pathogens using a PCR assay in cases with a complicated course of NOE and clinical resolution of the disease after targeted therapy according to PCR results. Results Surgical samples were obtained under sterile conditions from three patients with negative cultures and a refractory disease course of NOE. PCR assays were performed using pan-bacteria and pan-fungi protocols. In all three samples, a positive result for a fungal pathogen was recorded and followed by successful empirical targeted therapy. Conclusion Patients who present with a refractory culture-negative NOE should be suspected as suffering from a fungal disease. The PCR assay may be an important laboratory adjunct in detecting pathogens responsible for NOE and can aid to promote therapy and disease resolution.

Resection Bed Margins following Laser Cordectomy

Objective: 1) To evaluate our experience with transoral CO2 laser microsurgery (TLM) in patients with early glottic cancer. 2) To evaluate the effect of positive additional biopsies taken from the resection bed on the outcome of patients. Method: Retrospective study of patients with early glottic cancer who were treated by TLM, between January 2001 and December 2009 at Carmel Medical Center. Resection bed margins (RBM) using cold instruments were taken from all patients. Local control rate, overall survival, and organ preservation rate were compared between patients with positive vs negative RBM. Results: Sixty-four (24 Tis; 23 T1a; 10 T1b; 7 T2) patients were included in the study. Mean follow-up was 50 months ± 34 (12-130). Overall local control rate (LCR) was 81%. Only 10/64 (15%) patients had local failure and were referred to radiotherapy, after which 3 underwent salvage laryngectomy. Twenty-nine patients had positive RBM, and 35 had negative margins. Patients with positive RBM had poorer LCR (59% vs 100%, P = .0001) and lower organ preservation rate (84% vs 100%, P = .09) compared to patients with negative margins. However, overall survival was not different between the 2 groups. Conclusion: TLM is an effective treatment modality in early glottic cancer. Positive RBM may indicate a residual disease and hence a poorer outcome. We recommend that patients with positive RBM should be treated with re-resection or radiation and should have close follow-up.