Péter Móricz

Extracorporal septal reconstruction with polydioxanone foil

•  Conventional septoplasty cannot be the answer to all types of septal deviation. •  Indications of extracorporal septal reconstruction with polydioxanone (PDS) foil: (i) selected cases of very high septal deviations, (ii) post‐traumatic and (iii) extremely pronounced congenital septal deviations and/or aesthetic deformities. •  Polydioxanone foil facilitates the incorporation of a newly implanted septal graft without significant postoperative complications and is absorbed within 25 weeks. •  The surgical technique is described in detail, and the early postoperative functional and aesthetic results (mean follow‐up: 11 months) on 16 patients (mean age: 42 years) are reported. Overall, 88% of the patients responded positively to the question of whether they would choose to undergo the same procedure again, knowing the postoperative result. •  The procedure is easy to learn and has already proved to be an excellent combination of modern functional and aesthetic nasal surgery.

Radiosurgical Excision of Rhinophyma

&NA; The authors have indicated no significant interest with commercial supporters.

Effects of cytochrome P450 1A1 and uridine-diphosphate-glucuronosyltransferase 1A1 allelic polymorphisms on the risk of development and the prognosis of head and neck cancers.

We studied the effect of allelic polymorphisms of cytochrome P450 1A1 (CYP1A1) and uridine-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) on the risk of development of head and neck cancers and overall survival. One hundred and forty-two head and neck cancer patients (48 with laryngeal, 42 with hypopharyngeal and 52 with mesopharyngeal tumours) were included in the study. The control group (150 individuals) included volunteers without malignant tumours. There was no statistically significant difference in age, sex distribution, or smoking habits between the two groups. The participants were genotyped for the CYP1A1 isoleucine/valine (Ile/Val) polymorphism in exon 7 and for the UGT1A1 thymine–adenine-repeat polymorphism (*1 and *28 alleles) in the promoter region of the gene. The effect of the allelic variants on survival was studied using the log-rank test, whereas the &khgr;2-test and odds ratios (OR) with 95% confidence intervals (CI) were used to compare the allelic frequencies between patients and controls. Our study revealed a significant link between the occurrence of the CYP1A1 Ile/Val, Val/Val (OR: 1.72, 95% CI: 1.02–2.96, P=0.044) and UGT1A1*28 alleles (OR: 2.74, 95% CI: 1.45–5.18, P=0.002) and an increased risk of head and neck cancers. These alleles decreased the duration of survival significantly (P=0.018 and 0.006). The survival was significantly more strongly reduced when the two high-risk alleles were carried simultaneously (OR: 2.149, 95% CI: 1.111–4.157, P=0.001). Our results suggest that the use of the CYP1A1 Ile/Val and Val/Val variants and UGT1A1*28 as biomarkers can aid risk assessment while their prognostic value can aid planning of individual therapy.

Laser stapedotomy – the up-to-date solution of otosclerotic stapes fixation

A vezeteses hallascsokkenest okozo otoscleroticus stapesfixatio műteti megoldasanak folyamatos fejlődese az elmult fel evszazad egyik fulsebeszeti sikertortenete. A stapedectomia, illetve parcialis stapedectomia mellett manapsag a stapedotomia is elterjedt műteti megoldasnak tekinthető. Cel: A minimalisan invaziv lezerstapedotomia hazai bevezetese, tapasztalatok szerzese, valamint a műteti hallaseredmenyek es a posztoperativ komplikaciok elemzese. Modszer: A szerzők kozlemenyukben KTP-lezerrel asszisztalt, Nitinol-pisztonnal vegzett 14 esetuk kapcsan ismertetik lezerstapedotomiakkal szerzett első tapasztalataikat. 2006 marciusa es 2007 aprilisa kozott 11 nőbeteget es 3 ferfi beteget operaltak. A betegek atlageletkora 42,2 ev volt, 6 esetben bal, 8 esetben jobb fulon tortent a műtet. A betegek atlagos kovetesi ideje 9 honap volt. Eredmenyek: A posztoperativ audiogramok ertekelesekor az 500–1000–2000–3000 Hz frekvenciakat figyelembe veve a legvezetes atlagos javulasa 21,5 dB volt. Ugyanezen frekvenciakon a ...

Radiofrequency Transoral Microsurgical Procedures in Benign and Malignant Laryngeal and Hypopharyngeal Lesions (Institutional Experiences)

Besides cold-steel and laser instruments, the use of radiofrequency (RF) devices in transoral microsurgery is getting increasing popularity mainly due to its minimal thermal effect on the collateral soft tissue. Authors summarize their surgical technique, results, and experience gained with RF applied during laryngeal interventions at the Department of Otorhinolaryngology, Head and Neck Surgery at Medical School, University of Pécs. Transoral microsurgery using radiofrequency was carried out in 23 cases in total between 1 January 2011 and 1 March 2013. Fourteen histopathologically different benign lesions and 9 malignant planocellular carcinomas of the larynx were removed using different Micro-Larynx RF Probes powered by Surgitron Dual 4.0 MHz Frequency RF (Ellman International, Oceanside, NY, USA) device. No major bleeding event occurred during or after the procedures and neither laryngeal oedema nor significant postoperative pain was recorded. Authors also reviewed the international literature in this topic while detailing some of their most interesting cases.

Objective assessment of olfactory rehabilitation after laryngectomy.

WebMD and its ‘smart symptom checker’ as a medical site ‘to trust’. We report the findings of a study that examined the accuracy of Boots WebMD symptom checker in diagnosing ENT complaints. Data was collected prospectively from patients seen by the first author (a specialist registrar in ENT) over 1 month. Patient information was entered into the Boots WebMD symptom checker and the diagnoses provided were compared with the clinical diagnosis and assessed for appropriateness. The study included 61 patients. The median number of differential diagnoses provided per patient was 13 (range 1–20). The symptom checker correctly diagnosed 70% of patients (Fig. 1). However, the clinical diagnosis only matched the first diagnosis on the list of differentials for 16% of patients. Boots WebMD symptom checker provided a total of 801 differential diagnoses. 73% of all diagnoses were deemed to be appropriate, although they were not necessarily the same as the clinical diagnosis. Of the inappropriate diagnoses, 10% were a symptom not a diagnosis e.g. hearing loss. 17% of diagnoses were inappropriate based on the combination of symptoms e.g. ear ache and hearing loss diagnosed as thyroid cancer. There was a median of three inappropriate diagnoses provided per patient. Only 11% of patients received no inappropriate differential diagnoses. Internet self-diagnosis can provide a correct clinical diagnosis but is likely to also provide a large number of differential diagnoses. A considerable proportion of diagnoses may be inappropriate. Doctors need to be aware that patients are turning to the Internet as a diagnostic aid, and have some appreciation of the accuracy and limitations of self-diagnosis websites. Self-diagnosis has implications for clinical practice and can alter the dynamics of the consultation. The main limitation of this study is the use of a single ENT surgeons’ diagnosis as the standard because of the issue of diagnostic accuracy.

Coexistent Acquired Hearing Loss and Right Fronto-Parietal Meningioma as Causes of Musical Hallucinations

Although etiological theories on musical hallucinations tend to focus on single factors, this article reports the case of a patient with coexistent factors that might be relevant in aberrant musical listening. A 61-year-old woman with symptoms of anxiety was examined in an outpatient psychiatric center. During the examination, musical hallucinations were explored. Severe hearing loss, including loss in her right ear and mild loss in her left ear, was found. The magnetic resonance scan exhibited a right-sided fronto-parietal meningioma. In lieu of the presenting clinical picture, where the presence of simple partial seizures was considered a possibility, carbamazepine treatment and later a low- dose risperidone add-on medication were introduced. This report emphasizes the importance of assessing the interactive potential of coexistent pathogenetic factors. Such factors might take an active presence, especially when considered in the context of evaluating musical hallucinations. Keywords: musical hallucinations; meningioma; hearing loss; epilepsy

Morphological and Histological Effects of Radiofrequency and Laser (KTP and Nd:YAG) Treatment of the Inferior Turbinates in Animals A Comparative Pilot Study

The aim of this study was to evaluate the short and medium-term effects of radiofrequency (RF) and potassium titanyl phosphate (KTP) and neodymium-yttrium-aluminum garnet (Nd:YAG) laser treatment on the inferior turbinate mucosa in a porcine model. Following randomization, the inferior turbinates were treated either with RF submucosally or with the KTP or the Nd:YAG laser on the surface under videoendoscopic control. Tissue samples were taken at the end of postoperative weeks 1 and 6, and were evaluated macroscopically and histopathologically. Scanning electron microscopy was implemented to demonstrate the morphological changes in the respiratory epithelium. Six weeks following the RF procedure, the mucosa was intact in all cases, and the volume of the inferior turbinates was reduced in the majority of the cases. Although a volume reduction occurred in both laser groups, more complications associated with the healing procedure were noted. With hematoxylin and eosin and periodic acid–Schiff staining, intact epithelium, and submucosal glands remained after the RF procedures at the end of postoperative week 6. Following the KTP-laser intervention, necrotizing sialometaplasia and cartilage destruction occurred, and squamous metaplasia was also apparent in the Nd:YAG group. In both laser groups, dilated glands with excess mucus were seen. The scanning electron microscopic findings demonstrated that cilia were present in all cases. In conclusion, the medium-term macroscopic results were similar in all 3 groups, but the postoperative complications were less following the RF procedure. RF procedure is minimally invasive due to the submucosal intervention that leads to a painless, function preserving recovery.

Laser Stapedotomy – an Up-To-Date Solution in Otosclerotic Stapes Fixation

Introduction: Development of surgical treatment of otosclerotic stapes fixation is one of the success stories of otology during the past five decades. Nowadays not only stapedectomy and partial stapedectomy but stapedotomy can also be considered a well-established otological procedure. Aim: To introduce this minimally invasive surgical technique into the Hungarian otolaryngology practice, to gain useful experiences, and to analyze the hearing improvements and postoperative complications. Methods: The authors give account of their first clinical experiences with 14 patients with KTP laser assisted stapedotomies using the self-crimping Nitinol piston. A total of 14 patients (11 females, 3 males) who have undergone the procedure between March 2006 and April 2007 were reviewed. The average age of the patients was 42.2 years, 6 procedures were carried out on left ears and 8 on right ones. The average length of follow-up was 9 months (ranging from 6 weeks to 1 year). Results: Pure tone audiograms documented a h...