An orbital abscess is a serious complication of sinusitis that can lead to blindness and sometimes death. Immediate surgical drainage via an endonasal endoscopic approach or through a traditional Lynch-type incision is required for successful treatment. We describe a case of an orbital abscess with a medial subperiosteal abscess complicating acute sinusitis in a five-month-old infant. The patient was successfully treated with endonasal endoscopic surgery. Following an anterior ethmoidectomy and an antrostomy, the medial subperiosteal abscess was drained by removing the involved lamina papyracea and the orbital abscess was drained by incising the periorbita.
Abscess* ; Blindness ; Drainage ; Humans ; Infant ; Orbit* ; Sinusitis

Sudden sensorineural hearing loss (SSNHL) is characterized by abrupt unilateral loss of hearing, sometimes accompanied by tinnitus or vertigo. From the majority of patients with SSNHL, no specific cause can be identified, but numerous conditions including viral infection, vascular compromise and intracochlear membrane break are considered as possible causes of disease. According to these etiologic hypotheses, a combination therapy has been frequently used combining several options among steroids, antiviral agents, vasodilators, volume expanders, stellate ganglion block and carbogen or hyperbaric oxygen. The contents of the combination could vary according to the experience of each clinic, but steroids have been accepted as the mainstay of the treatment for SSNHL since Wilson's landmark study although two recent meta-analysis of steroid treatment suggested there was no benefit. The amount and the length of oral steroid therapy have not been well established. Commonly used regimen of oral steroid therapy is prednisone. A reported success rate with systemic steroid therapy is between 49% and 89%, whereas only 30% to 65% of patients without treatment achieved hearing improvement. Recently there is an obvious trend for an increasing number of positive results of intratympanic steroids injection. It is difficult to evaluate the efficacy of a certain drug or regimen prescribed for SSNHL because of various drugs used as combination therapy, many prognostic factors and different inclusion criteria.
Antiviral Agents ; Carbon Dioxide ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Membranes ; Oxygen ; Prednisone ; Stellate Ganglion ; Steroids ; Tinnitus ; Vasodilator Agents ; Vertigo

Nostril stenosis is a rare disease causing cosmetic problem and nasal airway obstruction. Various etiologies including iatrogenic cause the stenosis. Usually the shortage of internal lining of vestibule initiates secondary intention healing where granulation and contracture results in the stenosis. Many surgical techniques have been used to correct the stenosis. The objective of this article is to present a case of iatrogenic unilateral nostril stenosis which was successfully repaired with the use of auricular composite graft.
Constriction, Pathologic* ; Contracture ; Intention ; Nasal Obstruction ; Rare Diseases ; Transplants*

Noise-induced hearing loss could be caused by mechanical destruction of the delicate membranes of the inner ear, hair cells and supporting structures of the organ of Corti, and by intense metabolic activity, which increases free radical formation in the cochlea. When exposure is continuous, injury is a consequence of the total amount of energy to which cochlear tissues are exposed and a hearing conservation program is essential including hearing protection devices. Several therapeutic trials including antioxidant agents have been shown at least partially effective in prevention of hearing loss and hair cell death.
Cell Death ; Cochlea ; Ear, Inner ; Hair ; Hearing ; Hearing Loss* ; Hearing Loss, Noise-Induced ; Membranes ; Noise* ; Organ of Corti

Fibrous dysplasia of temporal bone is a rare disease that may lead to progressive stenosis of external auditory canal. This stenosis leads to trapping of skin and development of cholesteatoma. Most cases with fibrous dysplasia of temporal bone are monostotic, and the polyostotic type is far more rare. We have experienced a recurred polyostotic fibrous dysplasia with cholesteatoma on the external auditory canal and the mastoid. Our purpose of this paper is to discuss properties and management of this rare disease. A twenty-one-year-old woman who had undergone canaloplasty for polyostotic fibrous dysplasia of right temporal bone and occipital bone 5 years ago returned complaining of intermittent right-sided otorrhea for one year. She underwent canal down mastoidectomy with tympanoplasty type 3 for recurred canal obstruction and developing cholesteatoma. The patient has been followed up regularly for one year. There is no evidence of the recurrence of the disease or associated symptoms. We emphasize the need for a long term follow-up of patients with this disease as cholesteatoma or restenosis may develop insidiously.
Cholesteatoma* ; Constriction, Pathologic ; Ear Canal* ; Female ; Fibrous Dysplasia, Polyostotic* ; Follow-Up Studies ; Humans ; Mastoid* ; Occipital Bone ; Rare Diseases ; Recurrence ; Skin ; Temporal Bone ; Tympanoplasty

Otolaryngologists are sometimes confronted with various complications. They may be minor or sometimes they can be major, and rarely fatal. Some complications can be prevented, but some are unavoidable. Five cases of major complications, which occurred during or after routine rhinologic surgery, are presented. Two patients died of toxic shock syndrome: one patient after endoscopic sinus surgery (ESS) and the other patient after closed nasal bone reduction. One patient died of acute myocardial infarction during the recovery of anesthesia after uneventful ESS. One patient had a lidocaine shock, which required treatment in the intensive care unit. One patient had a transient unilateral blindness after intranasal steroid injection. Though the 3rd and 4th cases of complications were unavoidable, the others could have been prevented if precautions had taken place. The presumed pathophysiology, possible prevention measures, and their implications in routine otolaryngologic surgery are discussed.
Anesthesia ; Blindness ; Humans ; Intensive Care Units ; Lidocaine ; Myocardial Infarction ; Nasal Bone ; Shock ; Shock, Septic

BACKGROUND AND OBJECTIVES: The success rate of endoscopic endonasal dacryocystorhinostomy (DCR) is not satisfactory enough compared to that of external approach because the newly made ostium is easily obstructed due to granulation tissue formed around the small ostium. The objective of this study is to describe a new technique of an endoscopic DCR which minimizes the stenosis of neo-ostium and to report its success rate. MATERIALS AND METHOD: Twenty patients who had undergone endoscopic DCR with the diagnosis of proximal nasolacrimal duct obstruction were investigated retrospectively. All procedures were done by the same surgeon. The surgical technique includes elevation of mucosal flap, full sac exposure using diamond drill, and design of mucosal flap to cover the denuded bone and approximate with opened sac mucosa. Postoperative symptom improvement and endoscopic finding of the neo-ostium were evaluated. The mean duration of follow-up was 8 months. RESULTS: Ninety percent success rate was noted without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in two patients. CONCLUSION: Endoscopic DCR using mucosal flap after full sac exposure gives satisfactory success rate without any serious complications.
Constriction, Pathologic ; Dacryocystorhinostomy* ; Diagnosis ; Diamond ; Endoscopy ; Follow-Up Studies ; Granulation Tissue ; Humans ; Mucous Membrane ; Nasal Mucosa ; Nasolacrimal Duct ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Among the various alloplastic materials which are used in reconstruction of the traumatic orbital defects, porous polyethylene sheets (PPSs) are increasingly used due to their improved biocompatibility, easy malleability, and minimal complication. We report our experience with PPSs in reconstruction of the traumatic orbital defects. MATERIALS AND METHODS: PPSs (0.85 mm or 1.5 mm) were used in 23 patients with significant traumatic orbital defects. Twenty patients were treated for orbital floor defects, 2 for medial wall defects, and 1 for both floor and medial wall defects. Their surgical results and postoperative complications were studied. Their mean follow-up period was 18 months. RESULTS: Postoperatively, diplopia or limitation of eye movements were resolved in 11 of 17 patients and enophthalmos in 6 of 9 patients. No patients had induced diplopia or exacerbation of preoperative symptoms. There were no complications like graft extrusion, infection, clinically detectable graft distortion, or resorption. CONCLUSION: PPS appears to be an excellent material for reconstruction of the traumatic orbital defects.
Diplopia ; Enophthalmos ; Eye Movements ; Follow-Up Studies ; Humans ; Orbit* ; Polyethylene* ; Postoperative Complications ; Transplants

BACKGROUND AND OBJECTIVES: Reconstruction of the nasal defect caused by resection of nose neoplasm or trauma represents a particular challenge to reconstructive surgeons. Each tissue defect has to be evaluated individually in terms of the best possible substitution or alteration from both aesthetic and functional points of view. The method of reconstruction varies according to the location, size, and depth of the defect. Of various methods, local Rap is frequently used because the nasal contours are variable with convex and concave surfaces in close proximity, and there is little lax skin from which to borrow tissue for closure, and the skin of the nose has a texture and color not easily matched by skin elsewhere. Of various local flaps, transposition flap and forehead flap are most frequently used for reconstruction of the nasal defect. The authors carried out retrospectively a clinical study on seven cases of nasal reconstruction that used local flaps after resection of malignant tumors of the nose with a brief review of the literature. MATERIALS AND METHODS: A single surgeon's results in seven consecutive patients were clinically analyzed retrospectively. RESULTS: There were no significant complications. Good aesthetic and functional outcomes were observed with nasal defects reconstructed with the local flaps. CONCLUSION: Local flaps were the most useful choice for reconstructive rhinoplasty. Transposition flaps and forehead flaps, in particular, were particularly useful for each cosmetic unit of the nose.
Forehead ; Humans ; Nose ; Nose Neoplasms ; Retrospective Studies ; Rhinoplasty ; Skin

Cryptococcus neoformans is a yeast-like organism causing opportunistic infection in the immunocompromized host. Men-ingitis is the most frequent manifestation and causes serious morbidity and mortality. Other sites are less commonly involved. There have been a few cases presenting hearing loss and vertigo as a result of the extension of meningitis through the internal auditory canal. Authors report a case of cryptococcal infection combined with cholesteatoma that developed in a 54-year-old woman who did not have either evidence of immunocompromised state or pathological signs of cryptococcal infection. Cryptococcus neoformans was incidentally found in the keratinized layer of cholesteatoma.
Cholesteatoma* ; Cryptococcus ; Cryptococcus neoformans ; Female ; Hearing Loss ; Humans ; Meningitis ; Middle Aged ; Mortality ; Opportunistic Infections ; Vertigo