Yoriko Yukitatsu

Novel endoscopic scoring system after sinus surgery.

OBJECTIVE To propose a simple post-operative endoscopic scoring system for use after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS), and to demonstrate the usefulness of this approach. METHODS Subjects comprised 116 patients (84 men, 32 women; mean age, 54 years) with CRS who were analyzed endoscopically and radiologically after ESS between 2006 and 2012. The study was designed as a case series with planned data collection in the setting of university medical centers. Patients were followed-up for ≥ 6 months after ESS (mean, 13.1 months). Both pre- and post-operative computed tomography (CT) findings of each sinus and olfactory cleft (OC) were scored according to the Lund-Mackay scoring system: 0, normal; 1, partially; or 2, completely occupied. CT score represents the total score expressed as a percentage of the maximum possible score (12 points per side). Post-operative endoscopic score (E score, %) was calculated as the maximum score according to physical findings on each operated sinus and OC: 0, normal; 1, partially diseased; or 2, completely closed. Post-operative course using E score was verified by comparison with the Lund-Kennedy (L-K) scoring system. RESULTS E score was easily and quickly determined. Interclass correlation coefficient among 10 otolaryngologists indicated high-level inter-rater reliability (0.922). E score correlated strongly with both CT score (n=116, p<0.0001, rs=0.755) and L-K score (n=79, p<0.0001, rs=0.723). CONCLUSION Endoscopic evaluation using E score for sinuses and OCs after ESS is a useful method, together with L-K score for the nasal cavity and radiological study.

Correlation between olfactory acuity and sinonasal radiological findings in adult patients with chronic rhinosinusitis

OBJECTIVE This study aimed to clarify the correlation between olfactory disorder severity and radiological findings in patients with chronic rhinosinusitis (CRS) in the preoperative stage. METHODS From 2007 to 2014, 272 adult patients (163 men, 109 women; age range 22-80 years) with olfactory disorder due to bilateral CRS who were scheduled to undergo primary endoscopic sinus surgery (ESS) were enrolled. Two groups were studied: eosinophilic CRS (ECRS, n=193); and non-ECRS (n=79). T&T olfactometer recognition and intravenous olfaction tests were used. Computed tomography (CT) scores for sinuses and olfactory clefts (OC) were applied. Correlations between olfactory acuity and CT score were statistically analysed. RESULTS In both groups, recognition threshold correlated significantly with CT score. Recognition threshold and CT score were significantly more severe in ECRS than in non-ECRS. CT score at OC showed the strongest correlation with recognition threshold. CT scores for total sinuses and OC in patients showing a positive response to the intravenous olfaction test (239 patients) were significantly milder than those in the negative group (29 patients), but ethmoid CT score was not. CONCLUSION Olfactory disorder severity correlated significantly with CT opacification. Olfactory disorder and CT findings were more severe in patients with ECRS than in those with non-ECRS.

Clinical Features of Patients Treated with Endoscopic Sinus Surgery for Posttraumatic Paranasal Sinus Mucocele

Aim: The purpose of this study was to analyze the clinical features of patients with posttraumatic paranasal sinus mucocele (PSM). Subjects and Methods: Between 2009 and 2013, we performed endoscopic sinus surgery (ESS) on 68 patients with PSM at the Department of Otolaryngology - Head and Neck Surgery at Hyogo College of Medicine. Five male patients (age range, 45-76 years) with posttraumatic PSM were analyzed retrospectively. Diagnosis was based on the history of injury and radiological findings. Results: Posttraumatic PSM was found in 7% (5/68) of patients. The mean interval from injury to diagnosis was 28.4 years. All patients had frontal sinus mucocele. Four patients had symptoms of headache, diplopia, visual field defect, and forehead swelling, and 1 patient was asymptomatic. ESS was performed under general anesthesia in all cases, and the symptoms improved postoperatively. Reoperation was required in 1 patient (20%) because headache developed with obstruction of the frontal drainage route 7 months after ESS. Conclusions: Posttraumatic PSM was the least frequent form of PSM and was located predominantly in the frontal sinus, causing symptoms long after the forehead injury. The important lessons to be learned for treating posttraumatic PSM are to obtain a detailed history and to enlarge the route to the cyst to avoid its recurrence.

Decreased expression of VE-cadherin and claudin-5 and increased phosphorylation of VE-cadherin in vascular endothelium in nasal polyps.

VE-cadherin and claudin-5 are major components of adherens and tight junctions of vascular endothelial cells and a decrease in their expression and an increase in the tyrosine-phosphorylation of VE-cadherin are associated with an increase in endothelial paracellular permeability. To clarify the mechanism underlying the development of edema in nasal polyps, we studied these molecules in polyp microvessels. Normal inferior turbinate mucosal tissues and nasal polyps from patients treated with or without glucocorticoid were stained for VE-cadherin or claudin-5 and CD31 by a double-immunofluorescence method and the immunofluorescence intensities were graded 1–3 with increasing intensity. To correct for differences in fluorescence intensity attributable to a different endothelial area being exposed in a section or to the thickness of a section, the relative immunofluorescence intensity was estimated by dividing the grade of VE-cadherin or claudin-5 by that of CD31 in each microvessel. Tyrosine-phosphorylation of VE-cadherin was examined by Western blot analysis. The relative intensities of VE-cadherin and claudin-5 in the CD31-positive microvessels significantly decreased in the following order; inferior turbinate mucosa, treated polyps and untreated polyps. The ratio of tyrosine-phosphorylated VE-cadherin to VE-cadherin was significantly higher in untreated polyps than in the inferior turbinate mucosa and treated polyps, between which no significant difference in the ratio was seen. Thus, in nasal polyps, the barrier function of endothelial adherens and tight junctions is weakened, although glucocorticoid treatment improves this weakened barrier function.

Clinical Study of 1,515 Patients Presenting with Epistaxis Over the Last 6 Years

Aim: This study reviews our clinical experience of patients with epistaxis and discusses proper management. Patients and Methods: We retrospectively investigated 1,515 patients with epistaxis treated in our department between 2005 and 2010. Results: Men over 50 years old predominated. More than half of the patients (n = 828) first visited after consultation hours, and 40% (n = 606) were brought by ambulance. The most common underlying diseases were circulatory diseases (69%, n = 1,047). Antithrombotics were being administered to 23% (n = 345). Kiesselbachs plexus was the most commonly observed bleeding site (51%, n = 769). In 20% (n = 297), no bleeding point was confirmed because hemostasis had been achieved on arrival. Anterior packing was the most common primary treatment, followed by electrocauterization. Hospitalization was required in 2% (n = 30). Re-bleeding occurred within 14 days after primary treatment in 14% (n = 206). Surgical treatment was performed for 5% (n = 11). Conclusions: Patients showing repeated pulsatile arterial bleeding require hospitalization for surgical therapy, although outpatient therapy is sufficient in most cases. A risk of re-bleeding should be considered if patients show unclarified bleeding points and circulatory diseases.

Clinical Study of 1304 Patients with Epistaxis for Recent 5 Years

Objective: Epistaxis is one of the most common symptoms encountered in the ENT clinic. In this study, we reviewed our recent clinical experience of patients with epistaxis and discussed important lessons for the management of cases of epistaxis. Method: Between 2005 and 2009, 1304 patients with epistaxis were treated at our department. There were 795 men and 509 women. Mean age was 57 years (range, 0-99 years). Clinical features: situations at the first visit; pathogenesis; bleeding points; methods of treatments; and clinical courses were retrospectively investigated. Results: The 700 patients (54%) first visited in the nighttime. The most common condition was hypertension in 388 patients (30%) followed by cardiovascular disease in 262 patients (20%). The 630 patients (48%) were on medication with hypotensors and/or antithrombotic drugs. Kiesselbach’s plexus was the mostly observed, as it was observed in 679 patients (52%). In 225 patients (17%), bleeding point was not confirmed. The 424 patients (33%) were primarily treated by anterior packing, followed by electrocauterization in 365 patients (28%). Re-bleedings within 14 days after the primary treatments were found in 181 patients (14%). Hospitalized surgical treatments were required in 3% (6/181 patients). Conclusion: Outpatient therapy is usually enough to arrest hemorrhage in major cases. However, we have encountered patients with repeating arterial pulsing bleedings who require emergent hospitalized surgical therapy. Risk of re-bleeding within a day should be considered if patients had uncertain bleeding point and circulatory diseases.