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Common inferior meatus pathologies causing epiphora
P110
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
subgroups without polyps. No histopathologic findings correlated with baseline disease-specific or general QOL. CONCLUSIONS: Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although numerous other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with baseline disease-specific or general QOL scores. Common inferior meatus pathologies causing epiphora Aaron Rogers, MD (presenter); John M DelGaudio, MD OBJECTIVES: Nasolacrimal duct obstruction (NLDO) is a common presenting complaint to the otolaryngologist and frequently requires surgical intervention by dacryocystorhinostomy (DCR). Evaluation of the inferior meatus (IM) for obstructive pathology has not been described until recently. We are the only institution to have published on the use of routine office endoscopy of the IM to identify distal NLD pathology, along with directed endoscopic treatment of the IM with excellent results. We will discuss common obstructing lesions encountered at the NLD orifice, and the value of IM endoscopy in identifying this pathology and allowing less invasive directed treatment for the obstruction. METHODS: Adult patients presenting with constant epiphora to a tertiary referral rhinology service over a two-year period were evaluated for pathology at the IM with office nasal endoscopy. Clinical findings and photographs are presented. RESULTS: Several pathologies at the IM are commonly associated with epiphora from NLDO. These include mucosal hypertrophy at Hasner’s valve, NLD orifice cysts, obstructing polypoid degeneration of inferior turbinates, and dacryoliths. Endoscopic treatment of the specific obstructive pathologies in the IM are less invasive and at least equally as effective (⬎90%) as DCR. CONCLUSIONS: We have found that distal NLDO is found in most patients with epiphora and can be attributed to a number of pathologies in the IM. These pathologies are very amenable to minimally invasive endoscopic treatment. We recommend that endoscopic evaluation of the inferior meatus and the NLD orifice in cases of idiopathic epiphora should be part of the standard workup. Comparison of two groups undergoing endo-nasal dacrocystorhinostomy Velauthapillai Nandapalan, FRCS (presenter); Swati Kumar OBJECTIVES: To evaluate the long term results of endonasal dacryocystorhinostomy with and without stents. METHODS: 63 eyes (44 patients) with blockage were oper-
ated between September 2002 and September 2005. From October 2005 the use of silicone tube was discontinued. 65 eyes (45 patients) were operated from October 2005 until December 2006. Patients with pre saccal block, previous surgery, and concurrent sinus disease excluded. Patients were assessed at two weeks, six weeks, six months and yearly for three years. Complete resolution or significant improvement of epiphora, as subjectively assessed by patient scoring was considered as a successful outcome. Objective assessment was made by endoscopic nasal examination. RESULTS: 70% reported a successful outcome in the stent group at six months, reducing to 66% in the first year, 63% in the second year and 58% in the third year. In the non stent group, 98% reported a successful outcome at six months, 96% and 93% in the first and second year. Third year evaluation is ongoing. Six eyes in the first group and two eyes in the second group continue to have symptoms without any evidence of blockage in the dacrocystogram. CONCLUSIONS: Patients without stents showed significant longterm improvement. Failure to improve the symptoms may be due to pump failure of the lacrimal sac. Complement deficiency ameliorates smoke-induced nasal damage Kara Davis (presenter); Rodney Schlosser, MD; Carl Atkinson OBJECTIVES: Illustrate the role of complement in mediating the inflammatory response following acute exposure to cigarette smoke. METHODS: Exposure to cigarette smoke is a risk factor for chronic rhinosinusitis. We utilized wild type mice and mice deficient in complement components: C3, the central component, and fB, an alternative pathway protein. Mice were exposed to the smoke of four cigarettes/mice/exposure with mice receiving two exposures/day for three days. Mice were sacrificed 12 hours after the last exposure, and mouse heads were serially sectioned for histological evaluation. RESULTS: Hematoxylin and eosin staining demonstrated changes in the epithelium on smoke exposed animals with the epithelium appearing shortened and flattened as compared to non-smoke controls. Furthermore, smoke exposure resulted in edematous changes in the sub-mucosa, but no significant inflammation was apparent. Changes in epithelial cell structure and sub-mucosa swelling were less evident in complement deficient mice. CONCLUSIONS: Complement deficiency was associated with reduced epithelial damage as evidenced by increased epithelial ratio as compared to wildtype animals, suggesting that complement activation plays a role in the epithelial/sub-mucosa damage seen in this acute model of smoke exposure.
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
subgroups without polyps. No histopathologic findings correlated with baseline disease-specific or general QOL. CONCLUSIONS: Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although numerous other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with baseline disease-specific or general QOL scores. Common inferior meatus pathologies causing epiphora Aaron Rogers, MD (presenter); John M DelGaudio, MD OBJECTIVES: Nasolacrimal duct obstruction (NLDO) is a common presenting complaint to the otolaryngologist and frequently requires surgical intervention by dacryocystorhinostomy (DCR). Evaluation of the inferior meatus (IM) for obstructive pathology has not been described until recently. We are the only institution to have published on the use of routine office endoscopy of the IM to identify distal NLD pathology, along with directed endoscopic treatment of the IM with excellent results. We will discuss common obstructing lesions encountered at the NLD orifice, and the value of IM endoscopy in identifying this pathology and allowing less invasive directed treatment for the obstruction. METHODS: Adult patients presenting with constant epiphora to a tertiary referral rhinology service over a two-year period were evaluated for pathology at the IM with office nasal endoscopy. Clinical findings and photographs are presented. RESULTS: Several pathologies at the IM are commonly associated with epiphora from NLDO. These include mucosal hypertrophy at Hasner’s valve, NLD orifice cysts, obstructing polypoid degeneration of inferior turbinates, and dacryoliths. Endoscopic treatment of the specific obstructive pathologies in the IM are less invasive and at least equally as effective (⬎90%) as DCR. CONCLUSIONS: We have found that distal NLDO is found in most patients with epiphora and can be attributed to a number of pathologies in the IM. These pathologies are very amenable to minimally invasive endoscopic treatment. We recommend that endoscopic evaluation of the inferior meatus and the NLD orifice in cases of idiopathic epiphora should be part of the standard workup. Comparison of two groups undergoing endo-nasal dacrocystorhinostomy Velauthapillai Nandapalan, FRCS (presenter); Swati Kumar OBJECTIVES: To evaluate the long term results of endonasal dacryocystorhinostomy with and without stents. METHODS: 63 eyes (44 patients) with blockage were oper-
ated between September 2002 and September 2005. From October 2005 the use of silicone tube was discontinued. 65 eyes (45 patients) were operated from October 2005 until December 2006. Patients with pre saccal block, previous surgery, and concurrent sinus disease excluded. Patients were assessed at two weeks, six weeks, six months and yearly for three years. Complete resolution or significant improvement of epiphora, as subjectively assessed by patient scoring was considered as a successful outcome. Objective assessment was made by endoscopic nasal examination. RESULTS: 70% reported a successful outcome in the stent group at six months, reducing to 66% in the first year, 63% in the second year and 58% in the third year. In the non stent group, 98% reported a successful outcome at six months, 96% and 93% in the first and second year. Third year evaluation is ongoing. Six eyes in the first group and two eyes in the second group continue to have symptoms without any evidence of blockage in the dacrocystogram. CONCLUSIONS: Patients without stents showed significant longterm improvement. Failure to improve the symptoms may be due to pump failure of the lacrimal sac. Complement deficiency ameliorates smoke-induced nasal damage Kara Davis (presenter); Rodney Schlosser, MD; Carl Atkinson OBJECTIVES: Illustrate the role of complement in mediating the inflammatory response following acute exposure to cigarette smoke. METHODS: Exposure to cigarette smoke is a risk factor for chronic rhinosinusitis. We utilized wild type mice and mice deficient in complement components: C3, the central component, and fB, an alternative pathway protein. Mice were exposed to the smoke of four cigarettes/mice/exposure with mice receiving two exposures/day for three days. Mice were sacrificed 12 hours after the last exposure, and mouse heads were serially sectioned for histological evaluation. RESULTS: Hematoxylin and eosin staining demonstrated changes in the epithelium on smoke exposed animals with the epithelium appearing shortened and flattened as compared to non-smoke controls. Furthermore, smoke exposure resulted in edematous changes in the sub-mucosa, but no significant inflammation was apparent. Changes in epithelial cell structure and sub-mucosa swelling were less evident in complement deficient mice. CONCLUSIONS: Complement deficiency was associated with reduced epithelial damage as evidenced by increased epithelial ratio as compared to wildtype animals, suggesting that complement activation plays a role in the epithelial/sub-mucosa damage seen in this acute model of smoke exposure.