- Email: [email protected]
S274 – Smoker's Nose
P166
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
a visual analog scale. A rhinomanometric evaluation was conducted prior to and after the procedure. All patients were asked to evaluate the improvement of their symptoms. All patients’ data and potential complications were put in a database and were statistically assessed. RESULTS: Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes. CONCLUSIONS: Septal cartilage reshaping is an easy, painless, and bloodless method using an Erbium doped glass fiber Laser. Laser device LSC-701 (Arcuo Medical Inc.) is an effective, safe, and inexpensive medical equipment. S272 – Diagnostic and Staging Accuracy of MRI vs. CT in CRS Harrison W Lin, MD (presenter); Neil Bhattacharyya, MD OBJECTIVES: Determine the correlation between computed tomography (CT)- and magnetic resonance imaging (MRI)based staging and classification of chronic rhinosinusitis (CRS). METHODS: Paired CT and MRI scans of 89 adult patients who were imaged by both modalities within a 3-month time period for evaluation of pituitary disease were scored for sinus disease using the Lund-Mackay system in a randomized and blinded fashion. The Lund scores were compared for similarity, correlation, and diagnostic classification between modalities. RESULTS: The mean Lund scores were 2.3 ⫾ 0.6 (95% CI) for CT-based staging and 2.1 ⫾ 0.5 for MRI-based staging with a median time interval between scans of 3 days. The difference in means was not statistically significant (p⫽0.444, paired t-test). Correlation analysis revealed a significant association between CT- and MRI-based scores (Pearson’s r⫽0.837, p⬍0.001). Disease classification agreement analysis using published Lund score cutoffs (3 versus 4) for the likelihood of true sinus disease revealed that CT- and MRI-based scoring agreed on 76 cases (85.4%). Disagreement in disease classification occurred in 13 cases (7 MRI positive but CT negative and 6 CT positive but MRI negative) for a kappa value of 0.557 (p⬍0.001). CONCLUSIONS: Lund-Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly over-stage or over-classify patients with sinus disease. S273 – Does Nasal Obstruction Mean that the Nose Is Obstructed? Thomas Kjaergaard (presenter); Milada Småstuen Cvancarova, MSc; Sverre Steinsvåg, MD, PhD
OBJECTIVES: To what extent a sense of nasal obstruction correlates with objective measures for nasal space and air flow is still a matter of controversy. Knowledge about this is important in the evaluation of nasal complaints and the planning of treatment. The primary objectives of our study were to evaluate the relationship between subjective nasal blockage and 1) acoustic rhinometry (AR), and 2) Peak Nasal Inspiratory Flow (PNIF). METHODS: 2341 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring, or nose-related complaints were included in this cross-sectional study. Subjects underwent AR and nasal flow measurements (PNIF). Subjective grading of nasal obstruction was obtained by a Visual Analogue Scale (VAS). Associations between VAS recordings and measurements of PNIF and AR were evaluated with multivariate analysis using linear regression, adjusting for age, sex, body mass index, asthma, allergy and smoking history. The study was conducted in the period 20052007. RESULTS: The sense of nasal obstruction was correlated to volumes in both anterior and middle segments of the nasal cavities (p⬍0,001), to minimal cross-sectional areas in middle segments, and for the nasal airway as a whole (p⬍0,001) and to PNIF (p⬍0,001). CONCLUSIONS: The present study indicates that there are significant correlations between the subjective sensation of nasal obstruction and the corresponding measures for space and air flow. We conclude that AR and PNIF are valuable objective investigational tools correlating well with the sensation of nasal obstruction. S274 – Smoker’s Nose Thomas Kjaergaard (presenter); Milada Småstuen Cvancarova, MSc; Sverre Steinsvåg, MD, PhD OBJECTIVES: Do smokers have more upper airway symptoms than non-smokers? Despite extensive knowledge about the health-damaging effects of smoking, little is known about whether and to what extent smoking causes complaints from the upper airway. The main objectives of our study: 1) evaluate the role of cigarette smoking in relation to upper airway symptoms, and 2) study the dose response relationship between daily cigarette consumption and upper airway symptoms. METHODS: 2294 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring or nose-related complaints were included in this cross-sectional study. Subjects completed a detailed questionnaire including Visual Analogue Scales (VAS), grading 13 upper airway symptoms. In addition, smoking habits were registered. Associations between VAS recordings and smoking status were evaluated by multivariate analysis based on regression analysis and Anova, adjusting for age, sex, body mass index, asthma, and allergy. Differences of 10% or more were considered
clinically relevant. The study was conducted in the period 2005-2007. RESULTS: Smokers had between 12 and 27% higher VAS scores in 8 out of 13 symptoms compared with non-smokers (p⬍0,001). Further, VAS scores were related to the daily cigarette consumption in a dose-dependent manner within the majority of the symptom categories. CONCLUSIONS: Our study indicates that cigarette smoking is an important etiologic factor for upper airway symptoms. The results give support to campaigns against smoking even in an upper airway perspective. Cessation of smoking should be considered, accepted, and used as a therapeutic measure when dealing with smokers presenting with upper airway complaints. S275 – Nasal Morphology and Nasal Patency in Leprosy Patients Maria Teresa Torres Larrosa, MD, PhD (presenter); Luis Jorge Pere´z Pere´z; Juan-Jose Artazkoz-del Toro, MD OBJECTIVES: 1) To assess the impact of multi-drug leprosy therapy on the development of nasal deformities and nasal airway patency. 2) Evaluate the nasal morphology and nasal patency in leprosy patients treated with the multidrug therapy in comparison with patients treated with 1 drug therapy and a group of healthy volunteers. METHODS: In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug, and 22 were treated with multi-drug therapy, while 24 subjects formed a control group. We used anterior rhinoscopy to analised the morphology of the nose. We meassured the nasal inspiratory and expiratory resistance of the right and left nostrils and total nasal inspiratory and expiratory resistance at a transnasal pressure of 150 Pa. by using active anterior rhinomanometry. The statistical analysis was carried out using the Varianza analisys. RESULTS: The nasal structures in the 1-drug therapy group underwent bone and cartilaginous resorption with an increase in nasal resistances. We found significant statistical differences between the resistance values obtained in this group and the control group (p⬍0,05). In the multidrug therapy group, the morphology of the nose remains as in healthy patients. No significant statistical differences were found between the resistance values obtained in the multidrug therapy patients and the control group (P⬎0,05). CONCLUSIONS: The multidrug therapy prevents developing nasal deformities and maintains a normal nasal airflow. S276 – Nasal Sinus Diseases Demonstrating Ophthalmologic Symptoms Kenzo Tsuzuki, MD, PhD (presenter); Hironori Takebayashi, MD; Masashi Nishimura, MD; Keijiro Fukazawa, MD; Masafumi Sakagami, MD, PhD
P167 OBJECTIVES: This study reviewed the clinical features of paranasal sinus diseases demonstrating ophthalmologic manifestations. METHODS: Between April 1995 and December 2007, we performed endoscopic sinus surgery (ESS) in 106 patients with paranasal sinus diseases presenting with ophthalmologic symptoms. There were 57 men and 49 women, aged 56.4 years (10 - 86 years). Diagnosis was based on the pre- and intraoperative findings. Patients with symptoms due to tumors were excluded from this study. RESULTS: Of 106 patients, loss of visual acuity was most frequently observed in 40 patients (37.7%). Other symptoms were eyelid swelling (28.3%), diplopia (18.9%), constriction of the visual field (13.2%), exophthalmos (13.2%), ocular pain (12.3%), external ophthalmoplegia (3.8%), and epiphora (1.9%). The symptoms involved in paranasal sinus cysts were found in 67 patients (63.2%), those in bacterial sinusitis in 36 patients (34.0%), those in fungal sinusitis in 2 patients, and those in Wegener’s granulomatosis in 1 patient. The 38 patients (35.8%) were diagnosed as rhinogenic optic neuropathy, and most of them (32/38 patients, 78.9%) initially referred to ophthalmologists. Major lesions were observed in anterior and posterior ethmoid sinus (40 patients, 37.7%). For the treatment, external approaches were required in 11 patients (10.4%). During the postoperative course, reoperation (ESS) was required in 3 patients (2.8%) because of recurrence in the sphenoid sinus, whereas the other 103 patients had an uneventful course. CONCLUSIONS: Pre- and postoperative observation by not only otolaryngologists, but also ophthalmologists, is recommended in order to perform minimally invasive surgery and to avoid recurrence. S277 – The Role of Helicobacter Pylori in Nasal Poliposis Engin C¸ekin, MD (presenter); Bulent Evren Erkul, MD; Hakan Cincik, MD; Salim Dogru, MD; Atila Gungor, MD; I. Ethem Poyrazoglu, MD OBJECTIVES: 1) To investigate the role of Helicobacter pylori in etiopathogenesis of nasal polyposis. 2) To compare the severity of nasal polyposis disease with presence of Helicobacter pylori. METHODS: This study was performed on 35 patients (29 male, 6 female; aged between 17 and 77) who applied to GATA Haydarpasa Training Hospital Otolaryngology Clinic in 2006 and 2007. They all complained of nasal obstruction and were diagnosed as nasal polyposis after examination. Samples taken from all patients during endoscopic sinus surgery were subjected to cetyl metil amonium bromur (STAB) method to purify DNA of Helicobacter pylori(H. pylori). All patients were evaluated for reflux disease. Severity of nasal polyposis disease was compared with presence of H. pylori by performing endoscopic nasal examination and computerized tomography.
SCI. POSTERS
Scientific Posters
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
a visual analog scale. A rhinomanometric evaluation was conducted prior to and after the procedure. All patients were asked to evaluate the improvement of their symptoms. All patients’ data and potential complications were put in a database and were statistically assessed. RESULTS: Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes. CONCLUSIONS: Septal cartilage reshaping is an easy, painless, and bloodless method using an Erbium doped glass fiber Laser. Laser device LSC-701 (Arcuo Medical Inc.) is an effective, safe, and inexpensive medical equipment. S272 – Diagnostic and Staging Accuracy of MRI vs. CT in CRS Harrison W Lin, MD (presenter); Neil Bhattacharyya, MD OBJECTIVES: Determine the correlation between computed tomography (CT)- and magnetic resonance imaging (MRI)based staging and classification of chronic rhinosinusitis (CRS). METHODS: Paired CT and MRI scans of 89 adult patients who were imaged by both modalities within a 3-month time period for evaluation of pituitary disease were scored for sinus disease using the Lund-Mackay system in a randomized and blinded fashion. The Lund scores were compared for similarity, correlation, and diagnostic classification between modalities. RESULTS: The mean Lund scores were 2.3 ⫾ 0.6 (95% CI) for CT-based staging and 2.1 ⫾ 0.5 for MRI-based staging with a median time interval between scans of 3 days. The difference in means was not statistically significant (p⫽0.444, paired t-test). Correlation analysis revealed a significant association between CT- and MRI-based scores (Pearson’s r⫽0.837, p⬍0.001). Disease classification agreement analysis using published Lund score cutoffs (3 versus 4) for the likelihood of true sinus disease revealed that CT- and MRI-based scoring agreed on 76 cases (85.4%). Disagreement in disease classification occurred in 13 cases (7 MRI positive but CT negative and 6 CT positive but MRI negative) for a kappa value of 0.557 (p⬍0.001). CONCLUSIONS: Lund-Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly over-stage or over-classify patients with sinus disease. S273 – Does Nasal Obstruction Mean that the Nose Is Obstructed? Thomas Kjaergaard (presenter); Milada Småstuen Cvancarova, MSc; Sverre Steinsvåg, MD, PhD
OBJECTIVES: To what extent a sense of nasal obstruction correlates with objective measures for nasal space and air flow is still a matter of controversy. Knowledge about this is important in the evaluation of nasal complaints and the planning of treatment. The primary objectives of our study were to evaluate the relationship between subjective nasal blockage and 1) acoustic rhinometry (AR), and 2) Peak Nasal Inspiratory Flow (PNIF). METHODS: 2341 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring, or nose-related complaints were included in this cross-sectional study. Subjects underwent AR and nasal flow measurements (PNIF). Subjective grading of nasal obstruction was obtained by a Visual Analogue Scale (VAS). Associations between VAS recordings and measurements of PNIF and AR were evaluated with multivariate analysis using linear regression, adjusting for age, sex, body mass index, asthma, allergy and smoking history. The study was conducted in the period 20052007. RESULTS: The sense of nasal obstruction was correlated to volumes in both anterior and middle segments of the nasal cavities (p⬍0,001), to minimal cross-sectional areas in middle segments, and for the nasal airway as a whole (p⬍0,001) and to PNIF (p⬍0,001). CONCLUSIONS: The present study indicates that there are significant correlations between the subjective sensation of nasal obstruction and the corresponding measures for space and air flow. We conclude that AR and PNIF are valuable objective investigational tools correlating well with the sensation of nasal obstruction. S274 – Smoker’s Nose Thomas Kjaergaard (presenter); Milada Småstuen Cvancarova, MSc; Sverre Steinsvåg, MD, PhD OBJECTIVES: Do smokers have more upper airway symptoms than non-smokers? Despite extensive knowledge about the health-damaging effects of smoking, little is known about whether and to what extent smoking causes complaints from the upper airway. The main objectives of our study: 1) evaluate the role of cigarette smoking in relation to upper airway symptoms, and 2) study the dose response relationship between daily cigarette consumption and upper airway symptoms. METHODS: 2294 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring or nose-related complaints were included in this cross-sectional study. Subjects completed a detailed questionnaire including Visual Analogue Scales (VAS), grading 13 upper airway symptoms. In addition, smoking habits were registered. Associations between VAS recordings and smoking status were evaluated by multivariate analysis based on regression analysis and Anova, adjusting for age, sex, body mass index, asthma, and allergy. Differences of 10% or more were considered
clinically relevant. The study was conducted in the period 2005-2007. RESULTS: Smokers had between 12 and 27% higher VAS scores in 8 out of 13 symptoms compared with non-smokers (p⬍0,001). Further, VAS scores were related to the daily cigarette consumption in a dose-dependent manner within the majority of the symptom categories. CONCLUSIONS: Our study indicates that cigarette smoking is an important etiologic factor for upper airway symptoms. The results give support to campaigns against smoking even in an upper airway perspective. Cessation of smoking should be considered, accepted, and used as a therapeutic measure when dealing with smokers presenting with upper airway complaints. S275 – Nasal Morphology and Nasal Patency in Leprosy Patients Maria Teresa Torres Larrosa, MD, PhD (presenter); Luis Jorge Pere´z Pere´z; Juan-Jose Artazkoz-del Toro, MD OBJECTIVES: 1) To assess the impact of multi-drug leprosy therapy on the development of nasal deformities and nasal airway patency. 2) Evaluate the nasal morphology and nasal patency in leprosy patients treated with the multidrug therapy in comparison with patients treated with 1 drug therapy and a group of healthy volunteers. METHODS: In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug, and 22 were treated with multi-drug therapy, while 24 subjects formed a control group. We used anterior rhinoscopy to analised the morphology of the nose. We meassured the nasal inspiratory and expiratory resistance of the right and left nostrils and total nasal inspiratory and expiratory resistance at a transnasal pressure of 150 Pa. by using active anterior rhinomanometry. The statistical analysis was carried out using the Varianza analisys. RESULTS: The nasal structures in the 1-drug therapy group underwent bone and cartilaginous resorption with an increase in nasal resistances. We found significant statistical differences between the resistance values obtained in this group and the control group (p⬍0,05). In the multidrug therapy group, the morphology of the nose remains as in healthy patients. No significant statistical differences were found between the resistance values obtained in the multidrug therapy patients and the control group (P⬎0,05). CONCLUSIONS: The multidrug therapy prevents developing nasal deformities and maintains a normal nasal airflow. S276 – Nasal Sinus Diseases Demonstrating Ophthalmologic Symptoms Kenzo Tsuzuki, MD, PhD (presenter); Hironori Takebayashi, MD; Masashi Nishimura, MD; Keijiro Fukazawa, MD; Masafumi Sakagami, MD, PhD
P167 OBJECTIVES: This study reviewed the clinical features of paranasal sinus diseases demonstrating ophthalmologic manifestations. METHODS: Between April 1995 and December 2007, we performed endoscopic sinus surgery (ESS) in 106 patients with paranasal sinus diseases presenting with ophthalmologic symptoms. There were 57 men and 49 women, aged 56.4 years (10 - 86 years). Diagnosis was based on the pre- and intraoperative findings. Patients with symptoms due to tumors were excluded from this study. RESULTS: Of 106 patients, loss of visual acuity was most frequently observed in 40 patients (37.7%). Other symptoms were eyelid swelling (28.3%), diplopia (18.9%), constriction of the visual field (13.2%), exophthalmos (13.2%), ocular pain (12.3%), external ophthalmoplegia (3.8%), and epiphora (1.9%). The symptoms involved in paranasal sinus cysts were found in 67 patients (63.2%), those in bacterial sinusitis in 36 patients (34.0%), those in fungal sinusitis in 2 patients, and those in Wegener’s granulomatosis in 1 patient. The 38 patients (35.8%) were diagnosed as rhinogenic optic neuropathy, and most of them (32/38 patients, 78.9%) initially referred to ophthalmologists. Major lesions were observed in anterior and posterior ethmoid sinus (40 patients, 37.7%). For the treatment, external approaches were required in 11 patients (10.4%). During the postoperative course, reoperation (ESS) was required in 3 patients (2.8%) because of recurrence in the sphenoid sinus, whereas the other 103 patients had an uneventful course. CONCLUSIONS: Pre- and postoperative observation by not only otolaryngologists, but also ophthalmologists, is recommended in order to perform minimally invasive surgery and to avoid recurrence. S277 – The Role of Helicobacter Pylori in Nasal Poliposis Engin C¸ekin, MD (presenter); Bulent Evren Erkul, MD; Hakan Cincik, MD; Salim Dogru, MD; Atila Gungor, MD; I. Ethem Poyrazoglu, MD OBJECTIVES: 1) To investigate the role of Helicobacter pylori in etiopathogenesis of nasal polyposis. 2) To compare the severity of nasal polyposis disease with presence of Helicobacter pylori. METHODS: This study was performed on 35 patients (29 male, 6 female; aged between 17 and 77) who applied to GATA Haydarpasa Training Hospital Otolaryngology Clinic in 2006 and 2007. They all complained of nasal obstruction and were diagnosed as nasal polyposis after examination. Samples taken from all patients during endoscopic sinus surgery were subjected to cetyl metil amonium bromur (STAB) method to purify DNA of Helicobacter pylori(H. pylori). All patients were evaluated for reflux disease. Severity of nasal polyposis disease was compared with presence of H. pylori by performing endoscopic nasal examination and computerized tomography.
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