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Effect of ESS in asthmatic patients with chronic sinusitis
Pl12
OtolaryngologyHead and Neck Surgery August T999
Scientific Sessions--Monday
12% of the patients did develop lateral synechia but many of those were asymptomatic. Conclusion: The middle turbinate medialization technique is simple and reliable. It provides excellent medialization with preservation of the middle turbinate essentially without any complications. 8:46 AM
Endoscopic Repair of CSF Leaks: Does Choice of Grafting Material Matter? JULIE L ZWEIG MD (presenter); RICARDO L CARRAU MD; SCO~ E CELIN MD; BARRY M SCHAITKIN MD; Pittsburgh PA
Objectives: CSF leaks may arise spontaneously or as a complication of endoscopic sinus surgery or trauma. They may result in life-threatening meningitis or brain abscess. This study retrospectively reviews techniques of repair, as well as the materials used for repair of CSF leaks to determine their role in surgical outcome. Methods: Retrospective review of 43 patients with CSF leaks that were repaired endoscopically at the Department of Otolaryngology of the University of Pittsburgh and Allegheny General Hospital between July 1992 and December 1998. Grafting materials included turbinate bone, temporalis fascia, abdominal fat, and mucoperichondrial and mucoperiosteal free and vascularized flaps. Perioperative management, which included lumbar drains, ventricular shunts, antibiotics, and packing will be discussed as well. Results: Surgeon experience, size of the leak, and site of the defect influenced the choice of method of repair; however, the choice of tissue and synthetic material used for repair did not significantly affect surgical outcome. Conclusion: In our experience, exposure of the defect is key to achieving adequate repair and therefore is the most important factor influencing surgical outcome. Surgeon experience, size of the leak, and site of the defect influenced the choice of method of repair. However, the choice of tissue and synthetic material used for repair, which often was based on availability and surgeon preference, did not significantly affect the surgical outcome. 9:00 AM
Outcome Analysis of Recurrent Acute and Chronic SinusitisManagement MARK CONVERSE MD (presenter); JAMES A DUNCAVAGE MD; JAMES BRACIKOWSKI MD; JOHN J MURRAY MD; S BOBO TANNER MD; Nashville TN
Objectives: To determine the level of response to medical management of recurrent acute and chronic sinusitis in a disease management center using treatment protocols at the Asthma, Sinus, and Allergy Program (ASAP). Methods: The short form 36 (SF-36) item health survey outcomes and health inventories were used to evaluate success of treatment by comparing the treatment results of recurrent
acute and chronic sinusitis patients to those of average normal subjects. Results: In all 8 domains of the SF-36, 121 patients studied with chronic sinusitis showed improvement. Forty-two patients with recurrent acute sinusitis showed improvement in all 8 domains. Neither group reached the average for the general population in all 8 domains. Conclusion: The use of a disease management center to treat recurrent acute and chronic sinusitis shows improvement in all domains of the SF-36, but this group of sinus patients did not reach average normal levels for all domains. 9:08 AM
Effect of ESS in Asthmatic Patients with Chronic Sinusitis YOO SEOK JUNG MD (presenter); HUN-JONG DHONG MD PHD; SEUNG-KYU CHUNG MD PHD; DONG-CHULL CHOI MD PHD; Seoul South Korea
Objectives: There has been clear evidence of the effects of endoscopic sinus surgery (ESS) in asthmatic patients with chronic paranasal sinusitis. Some authors have proposed that asthmatic conditions improved dramatically after ESS. However, controversies against the effects of ESS on asthma have also been suggested. There have been several subjective evaluations on this subject, but few objective results have been reported. The aim of this study is to examine the effect of ESS on the clinical course in asthmatic patients who have coexisting chronic sinusitis, with both subjective and objective evaluations. Methods: In 19 patients (6 males, 13 females) who had received ESS for chronic sinusitis with coexisting asthma, we distributed questionnaires on the changes of overall asthmatic symptoms during the day and at night, before and after ESS. Individual asthmatic symptoms like dyspnea, cough, wheezing, and sputum were evaluated. Sinusitis symptoms were questioned, too. We examined the changes of the asthma medications in the postoperative status with retrospective review of medical records. As well as these subjective measures, objective changes were evaluated with pulmonary function test (forced vital capacity, forced expiratory volume in 1 second) in preoperative and postoperative status. Results: Asthmatic symptoms improved significantly, both during the day and at night (P < 0.05). Dramatic improvements in the asthmatic medication scores were also certified (P < 0.05). Individual asthmatic symptoms like dyspnea, cough, wheezing, and sputum improved significantly (P < 0.05). Despite reduced asthmatic medication after ESS, objective parameters of pulmonary function test (FVC, FEV1) were not changed like scores of subjective asthmatic symptoms. Conclusion: After ESS, individual asthmatic symptoms improved significantly. Antiasthma medication use decreased after ESS. Pulmonary functions were stabilized even with reduced medication. Subjectively and much more objectively, it seems that ESS in asthmatic patients with chronic sinusitis
OtolaryngologyHead and Neck Surgery Volume t21 Number 2
has a significant role in the clinical improvement of bronchial asthma in this group of patients. 9:16 AM
Laser-Assisted Outpatient Septoplasty YVES-VICTOR KAMAMI MD (presenter); Paris France
Objectives: Septoplasty has been used for decades as the preferred surgical technique for managing nasal septal deviation with obstruction to nasal airflow. Using subjective and objective criteria, this study evaluates a new simple practice of this operation, using the CO 2 laser with the patient under local anesthesia. Methods: This technique is devised to minimize and simplify surgery, with the patient under local anesthesia, on an outpatient basis. Ablation of the septum includes lasing of nasal mucosa, perichondrium, septal cartilage, and fibroconnective tissue. With an adequate selection of patients and an adequate technique, using scanning anticharring devices, laser septoplasty (LAOS) results have shown good surgical success rates. Results: From August 1995 to January 1999, I have developed and practiced LAOS in 1005 patients. Based on subjective patient questionnaire criteria, on anterior rhinoscopy, on intranasal endoscopy, and on preoperative and postoperative rhinometric parameters, LAOS results demonstrated significant clinical airway improvement in 91% of patients. There were no incidences of septal perforation and only a few cases of benign bleeding and synechia formation, which were easily treated. Conclusion: LAOS, introduced in the United States by Dr Yosef R Krespi in 1997, is less invasive than traditional septoplasty, with reduced surgical time, decreased patient recovery time, less morbidity, lower medical costs, and rapid return to full activity. It appears to be a safe, simple, quick, and predictable in-office procedure on anterior septal spurs for treating airway obstruction.
8:00 to 9:30 AM MCC Rooms 255-257 9
O t o l o g y Session WILLIAM R LAMEAR MD; WILLIAM H SLAI-rERY Ill MD (moderators)
8:00 AM
Advances in Cochlear Implantation via the Middle Fossa VITTORIO COLLETrl MD (presenter); MARCO CARNER MD; FIORINO FRANCESCO MD', SACCHE~O LUCA MD; GIARBINI NADIA MD; FRANCESCO CILURZO MD; Verona Italy
Objectives: The results of cochlear implantation via the middle fossa in 30 parents are described. Subjects presented with a bilateral radical mastoidectomy cavity (n = 5), fibroadhesive otitis media (n = 4), otosclerosis (n = 3), autoimmune inner ear disease (n = 5), previous cranial trauma (n = 2),
Scientific Sessions--Monday
P113
genetic prelingual deafness (n = 9), and inner ear malformations (n = 2). Methods: A middle fossa approach with a small cochleostomy was performed on the most superficial part of the basal turn. A Lauraflex implant (Philips Hearing Implants) was used in 3 patients, a Nucleus 24 M cochlear implant system (Cochlear Corp) in 12, a COMBI 40+ (MED-EL) with double electrode array in 8, and a Clarion implant (Advanced Bionics) in 7. The single electrode array was inserted through the cochleostomy to the cochlear apex and occupied a portion of the basal, as well as the middle and apical, turns. When the double electrode arrays were inserted, one was directed toward the apex and one toward the round window. Results: Telemetry and intraoperative recording of electrically evoked auditory responses (EABR) were performed at the end of surgery. Speech perception tests performed over a period of time ranging from 1 to 17 months after cochlear implant activation yielded better results in these patients than in a homogeneous group of postlingually deaf patients operated on via the traditional transmastoid route. Conclusion: This approach is suitable for auditory rehabilitation of subjects with a bilateral radical mastoidectomy cavity, chronic middle ear disease, patients suffering from inner ear malformations, and patients with partial obliteration of the cochlea in the basal turn. It led to major improvements in speech perception in all patients compared with patients operated on with the transmastoid approach and thus, given the present state of the art, it is the only approach that allows stimulation of the entire cochlea, including the middle and apical turns, where a greater survival rate of spiral ganglion cells is known to occur. 8:08 AM
The Performance of Cochlear Implant Patients in Background Noise BRUCE L FETrERMAN MD (presenter); ELIZABETHH DOMICO MS CCC-A; Memphis TN
Objectives: Providing better speech understanding in noisy environments is a recognized goal in the research and development of cochlear implant systems. Speech processing strategies for the Nucleus device, such as Spectral Peak (SPEAK), Advanced Combination Encoder (ACE), and Continuous Interleaved Sampling (CIS), and for the Clarion implant, such as CIS and Simultaneous Analog Stimulation (SAS), may allow improved perception in noise due to the redundancy of the acoustic information in the signal. Methods: Eighty-nine cochlear implant patients--61 Nucleus and 28 Clarion users--were tested with the City University of New York (CUNY) Sentences presented in the auditory-only condition in a sound-attenuated booth. Recorded sentences were presented at 70 dB SPL in quiet and with competing 8-talker babble set at a signal-to-noise ratios (SNR) of +10 dB HL and +5 dB HL. Patients were asked to
OtolaryngologyHead and Neck Surgery August T999
Scientific Sessions--Monday
12% of the patients did develop lateral synechia but many of those were asymptomatic. Conclusion: The middle turbinate medialization technique is simple and reliable. It provides excellent medialization with preservation of the middle turbinate essentially without any complications. 8:46 AM
Endoscopic Repair of CSF Leaks: Does Choice of Grafting Material Matter? JULIE L ZWEIG MD (presenter); RICARDO L CARRAU MD; SCO~ E CELIN MD; BARRY M SCHAITKIN MD; Pittsburgh PA
Objectives: CSF leaks may arise spontaneously or as a complication of endoscopic sinus surgery or trauma. They may result in life-threatening meningitis or brain abscess. This study retrospectively reviews techniques of repair, as well as the materials used for repair of CSF leaks to determine their role in surgical outcome. Methods: Retrospective review of 43 patients with CSF leaks that were repaired endoscopically at the Department of Otolaryngology of the University of Pittsburgh and Allegheny General Hospital between July 1992 and December 1998. Grafting materials included turbinate bone, temporalis fascia, abdominal fat, and mucoperichondrial and mucoperiosteal free and vascularized flaps. Perioperative management, which included lumbar drains, ventricular shunts, antibiotics, and packing will be discussed as well. Results: Surgeon experience, size of the leak, and site of the defect influenced the choice of method of repair; however, the choice of tissue and synthetic material used for repair did not significantly affect surgical outcome. Conclusion: In our experience, exposure of the defect is key to achieving adequate repair and therefore is the most important factor influencing surgical outcome. Surgeon experience, size of the leak, and site of the defect influenced the choice of method of repair. However, the choice of tissue and synthetic material used for repair, which often was based on availability and surgeon preference, did not significantly affect the surgical outcome. 9:00 AM
Outcome Analysis of Recurrent Acute and Chronic SinusitisManagement MARK CONVERSE MD (presenter); JAMES A DUNCAVAGE MD; JAMES BRACIKOWSKI MD; JOHN J MURRAY MD; S BOBO TANNER MD; Nashville TN
Objectives: To determine the level of response to medical management of recurrent acute and chronic sinusitis in a disease management center using treatment protocols at the Asthma, Sinus, and Allergy Program (ASAP). Methods: The short form 36 (SF-36) item health survey outcomes and health inventories were used to evaluate success of treatment by comparing the treatment results of recurrent
acute and chronic sinusitis patients to those of average normal subjects. Results: In all 8 domains of the SF-36, 121 patients studied with chronic sinusitis showed improvement. Forty-two patients with recurrent acute sinusitis showed improvement in all 8 domains. Neither group reached the average for the general population in all 8 domains. Conclusion: The use of a disease management center to treat recurrent acute and chronic sinusitis shows improvement in all domains of the SF-36, but this group of sinus patients did not reach average normal levels for all domains. 9:08 AM
Effect of ESS in Asthmatic Patients with Chronic Sinusitis YOO SEOK JUNG MD (presenter); HUN-JONG DHONG MD PHD; SEUNG-KYU CHUNG MD PHD; DONG-CHULL CHOI MD PHD; Seoul South Korea
Objectives: There has been clear evidence of the effects of endoscopic sinus surgery (ESS) in asthmatic patients with chronic paranasal sinusitis. Some authors have proposed that asthmatic conditions improved dramatically after ESS. However, controversies against the effects of ESS on asthma have also been suggested. There have been several subjective evaluations on this subject, but few objective results have been reported. The aim of this study is to examine the effect of ESS on the clinical course in asthmatic patients who have coexisting chronic sinusitis, with both subjective and objective evaluations. Methods: In 19 patients (6 males, 13 females) who had received ESS for chronic sinusitis with coexisting asthma, we distributed questionnaires on the changes of overall asthmatic symptoms during the day and at night, before and after ESS. Individual asthmatic symptoms like dyspnea, cough, wheezing, and sputum were evaluated. Sinusitis symptoms were questioned, too. We examined the changes of the asthma medications in the postoperative status with retrospective review of medical records. As well as these subjective measures, objective changes were evaluated with pulmonary function test (forced vital capacity, forced expiratory volume in 1 second) in preoperative and postoperative status. Results: Asthmatic symptoms improved significantly, both during the day and at night (P < 0.05). Dramatic improvements in the asthmatic medication scores were also certified (P < 0.05). Individual asthmatic symptoms like dyspnea, cough, wheezing, and sputum improved significantly (P < 0.05). Despite reduced asthmatic medication after ESS, objective parameters of pulmonary function test (FVC, FEV1) were not changed like scores of subjective asthmatic symptoms. Conclusion: After ESS, individual asthmatic symptoms improved significantly. Antiasthma medication use decreased after ESS. Pulmonary functions were stabilized even with reduced medication. Subjectively and much more objectively, it seems that ESS in asthmatic patients with chronic sinusitis
OtolaryngologyHead and Neck Surgery Volume t21 Number 2
has a significant role in the clinical improvement of bronchial asthma in this group of patients. 9:16 AM
Laser-Assisted Outpatient Septoplasty YVES-VICTOR KAMAMI MD (presenter); Paris France
Objectives: Septoplasty has been used for decades as the preferred surgical technique for managing nasal septal deviation with obstruction to nasal airflow. Using subjective and objective criteria, this study evaluates a new simple practice of this operation, using the CO 2 laser with the patient under local anesthesia. Methods: This technique is devised to minimize and simplify surgery, with the patient under local anesthesia, on an outpatient basis. Ablation of the septum includes lasing of nasal mucosa, perichondrium, septal cartilage, and fibroconnective tissue. With an adequate selection of patients and an adequate technique, using scanning anticharring devices, laser septoplasty (LAOS) results have shown good surgical success rates. Results: From August 1995 to January 1999, I have developed and practiced LAOS in 1005 patients. Based on subjective patient questionnaire criteria, on anterior rhinoscopy, on intranasal endoscopy, and on preoperative and postoperative rhinometric parameters, LAOS results demonstrated significant clinical airway improvement in 91% of patients. There were no incidences of septal perforation and only a few cases of benign bleeding and synechia formation, which were easily treated. Conclusion: LAOS, introduced in the United States by Dr Yosef R Krespi in 1997, is less invasive than traditional septoplasty, with reduced surgical time, decreased patient recovery time, less morbidity, lower medical costs, and rapid return to full activity. It appears to be a safe, simple, quick, and predictable in-office procedure on anterior septal spurs for treating airway obstruction.
8:00 to 9:30 AM MCC Rooms 255-257 9
O t o l o g y Session WILLIAM R LAMEAR MD; WILLIAM H SLAI-rERY Ill MD (moderators)
8:00 AM
Advances in Cochlear Implantation via the Middle Fossa VITTORIO COLLETrl MD (presenter); MARCO CARNER MD; FIORINO FRANCESCO MD', SACCHE~O LUCA MD; GIARBINI NADIA MD; FRANCESCO CILURZO MD; Verona Italy
Objectives: The results of cochlear implantation via the middle fossa in 30 parents are described. Subjects presented with a bilateral radical mastoidectomy cavity (n = 5), fibroadhesive otitis media (n = 4), otosclerosis (n = 3), autoimmune inner ear disease (n = 5), previous cranial trauma (n = 2),
Scientific Sessions--Monday
P113
genetic prelingual deafness (n = 9), and inner ear malformations (n = 2). Methods: A middle fossa approach with a small cochleostomy was performed on the most superficial part of the basal turn. A Lauraflex implant (Philips Hearing Implants) was used in 3 patients, a Nucleus 24 M cochlear implant system (Cochlear Corp) in 12, a COMBI 40+ (MED-EL) with double electrode array in 8, and a Clarion implant (Advanced Bionics) in 7. The single electrode array was inserted through the cochleostomy to the cochlear apex and occupied a portion of the basal, as well as the middle and apical, turns. When the double electrode arrays were inserted, one was directed toward the apex and one toward the round window. Results: Telemetry and intraoperative recording of electrically evoked auditory responses (EABR) were performed at the end of surgery. Speech perception tests performed over a period of time ranging from 1 to 17 months after cochlear implant activation yielded better results in these patients than in a homogeneous group of postlingually deaf patients operated on via the traditional transmastoid route. Conclusion: This approach is suitable for auditory rehabilitation of subjects with a bilateral radical mastoidectomy cavity, chronic middle ear disease, patients suffering from inner ear malformations, and patients with partial obliteration of the cochlea in the basal turn. It led to major improvements in speech perception in all patients compared with patients operated on with the transmastoid approach and thus, given the present state of the art, it is the only approach that allows stimulation of the entire cochlea, including the middle and apical turns, where a greater survival rate of spiral ganglion cells is known to occur. 8:08 AM
The Performance of Cochlear Implant Patients in Background Noise BRUCE L FETrERMAN MD (presenter); ELIZABETHH DOMICO MS CCC-A; Memphis TN
Objectives: Providing better speech understanding in noisy environments is a recognized goal in the research and development of cochlear implant systems. Speech processing strategies for the Nucleus device, such as Spectral Peak (SPEAK), Advanced Combination Encoder (ACE), and Continuous Interleaved Sampling (CIS), and for the Clarion implant, such as CIS and Simultaneous Analog Stimulation (SAS), may allow improved perception in noise due to the redundancy of the acoustic information in the signal. Methods: Eighty-nine cochlear implant patients--61 Nucleus and 28 Clarion users--were tested with the City University of New York (CUNY) Sentences presented in the auditory-only condition in a sound-attenuated booth. Recorded sentences were presented at 70 dB SPL in quiet and with competing 8-talker babble set at a signal-to-noise ratios (SNR) of +10 dB HL and +5 dB HL. Patients were asked to