Pediatric fungal sinusitis in immunocompromised patients: Case controlled study

Scientific Session—Monday

Results: The patient cohort had a mean age of 52 years, with a range of 16 –79. Mean follow-up time was 11.9 months. The indications for image-guided trephination were: superiorly or laterally based mucoceles (4); fibrous dysplasia (2); type 4 frontal cell pathology (2); frontal recess stenosis with complicated frontal sinusitis (2). Four patients had previous external surgical approaches with secondary scarring in the frontoethmoid region. In 8 patients, image-guided trephination was combined with endoscopic transethmoid frontal sinusotomy, whereas 2 patients were successfully treated solely through a trephination approach. No patients required revision, and all patients remain symptom-free to date. Conclusions: Image-guided frontal trephination enables targeted localization of frontal sinus pathology for endoscopic surgical treatment. The image-guided frontal trephination procedure offers a minimally invasive, mucosal sparing technique that is an attractive alternative to osteoplastic flap. 10:00 AM Lipid Based Ointment for Allergic Rhinitis Urban Geisthoff, MD (presenter); Marianne Rupp-Classen, MD; Andreas Blum, MD; Peter K Plinkert, MD PhD Homburg Germany; Homburg Germany; Mannheim Germany; Tubingen Germany

Objectives: About 15% of the population suffers from allergic rhinitis. Recently the therapeutic use of a lipid-based nasal ointment was discussed. The aim of this study was a first assessment of the efficacy as an adjuvant therapy on a statistical basis. Methods: A 2-center, prospective, open, randomized, controlled clinical study was carried out. The test agent consisted of a highly viscous, long chain fraction of lipids. Controls did not get placebos. Patients were asked to continue their normal antiallergic therapies. Results: The allergic symptoms (sneezing attacks, nasal itching, nasal secretion, nasal obstruction) of 17 patients using the test agent were compared to a control group of 16 patients. For the group using the test agent, before/after comparisons showed a significant circa. Forty percent improvement in the medium, relative total range of symptoms (Wilcoxon-Mann-Whitney U-test, P ⬍ 0.01). In the control group, the total range of symptoms remained unchanged. No side effects were recorded. Conclusions: By the local application of the test agent a significant improvement of the total allergic symptomatology was shown. The results of this study are consistent with an investigation by Bufe into pollen and a mineral-oil based agent. Bufe speculated in his study that the release of allergens from the pollen would be prevented in vivo by lipids, which would mean an elimination of allergens. However, the mechanism has not

been conclusively clarified. If confirmed, the observations made in this study might serve for new insights into allergic reactions and new therapeutic approaches. 10:08 AM Pediatric Fungal Sinusitis in Immunocompromised Patients: Case Controlled Study Albert H Park, MD (presenter); Arunkumar N Badi, MD PhD; Harlan R Muntz, MD; Marshall E Smith, MD Salt Lake City UT; Salt Lake City UT; Salt Lake City UT; Salt Lake City UT

Objectives: To determine parameters that predispose toward invasive fungal sinusitis (FS)in immunocompromised patients Methods: We conducted a retrospective chart review of 10 patients with lymphoproliferative disorders who developed invasive FS and compared them to 20 subjects with lymphoproliferative disorders who did not develop invasive FS. Signs and symptoms, endoscopic findings, radiographic findings, anatomic location of the lesions, absolute neurophil counts, medication preceding presentation, treatment, and outcome of the 2 groups were compared. Results: Fever and facial pain are the most common complaints in both patient groups. All patients had evidence of neutropenia and absent absolute neutrophil counts (ANC). Endoscopy in those patients with FS demonstrated mucosal edema, crusting, or white exudate. A general anesthetic was required for every endoscopy. Radiographic abnormalities were found in both groups and did not aid in FS diagnosis. Conclusions: Immunocompromised patients who present with fever or facial pain and neutropenia need to be evaluated promptly for possible FS. Endoscopic abnormalities were found to be the most reliable indicator of FS in this group of patients. In pediatric patients, a general anesthetic should be considered to enhance optimal endoscopic examination and facilitate nasal biopsies. 10:16 AM Angiogenic Squamous Dysplasia: Characteristics and Implications Bruce W Jafek, MD (presenter); Trudi Arlene Woodson, MD; Sherif Said, MD PhD Denver CO; Denver CO; Denver CO

Objectives: Keith et al described angiogenic squamous dysplasia (ASD) in the lung epithelium of patients at high risk for the development of lung carcinoma. We have recently observed similar changes in the nasal epithelium of occasional patients undergoing routine sinus surgery. This retrospective study evalautes the demographic characteristics of this small group of patients and compares them to a control series of patients undergoing similar surgery to evaluate whether this lesion is premalignant. Methods: Consecutive sinus and nasal surgical patholog-

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Otolaryngology– Head and Neck Surgery August 2004