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*

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

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

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: Frontal sinus fracture can have serious consequences due to proximity of the sinus to the intracranial cavity and the potential for serious combined injuries. Management of the Fractures depends on the type and severity of the fracture and the presence of associated injuries. In this article, we present an overview of fracture treatment options, and offer a simple algorithm for management based on the type and severity of the facture. PATIENTS AND METHODS: Twenty-three patients with frontal sinus fractures were analysed. All patients were male, with the mean age of 31. The average follow-up length was 13 months. Of 23 patients, 8 patients had anterior wall fractures and 15 patients had anterior and posterior wall fractures. Their types of fracture, combined injuries, surgical methods, surgical results, and complications were analysed. RESULTS: Six patients had conservative management and 17 patients had surgery. Of 17 patients who had surgery, 6 patients had only repair of the fracture, 3 patients had repair of the fracture with sinus obliteration, and 8 patients had repair of the fracture with cranialization of the frontal sinus. The most common associated injury was fractures of other facial bones (83%), especially the orbit. Traumatic optic neuropathy was the most common complication associated with the frontal sinus fracture or its accompanying injuries. CONCLUSION: Frontal sinus fractures were safely managed with repair of the fracture, sinus obliteration, or with sinus cranialization which was used irrespective of type and severity of fractures.
Facial Bones ; Follow-Up Studies ; Frontal Sinus* ; Humans ; Intraoperative Complications ; Male ; Optic Nerve Injuries ; Orbit

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. The pathogenesis of cholesterol granuloma is controversial. But three factors are thought to have an important role in its development: obstruction of ventilation, impaired drainage, and hemorrhage. It may arise from any portion of the pneumatized temporal bone. But huge cholesterol granuloma with intracranial and extradural extension has been rarely reported. Recently, we experienced a case of huge cholesterol granuloma with intracranial and extradural extension. The patient has never experienced chronic otitis media before. The cholesterol granuloma was successfully removed by transmastoid approach. So we report this case along with a literature review.
Cholesterol ; Drainage ; Foreign Bodies ; Granuloma ; Hemorrhage ; Humans ; Otitis Media ; Temporal Bone ; Ventilation

BACKGROUND: Deep neck infection is an inflammatory disease process within the deep cervical fascia of the head and neck. Although the frequency has declined dramatically with development of antibiotics, the morbidity is still high because the diagnosis is delayed in the course of the disease. OBJECTIVES: To determine the diagnostic value of neck computed tomography (CT) and treatment modality according to the disease severity. MATERIALS AND METHODS: Forty-three patients with deep neck infection admitted and treated from January 1992 to December 1996 were analysed retrospectively. CT was checked at the initial state and checked again at the seven to ten days later for evaluation of treatment. RESULTS: CT was valuable for early diagnosis when this disease was suspected and follow-up evaluation of treatment results. Hospital days were longer in patients with underlying disease. The size of abscess and the involved regions of cellulitis were used guides for the decision of treatment modality. In cases of cellulitis and small abscess less than 3cm, intravenous antibiotic therapy and CT-guided aspiration was efficient. Combined therapy with intervention and antibiotics was needed in patients with abscesses larger than 3cm and progressive disease. CONCLUSION: CT was an excellent diagnostic method and valuable for the evaluation of treatment. Treatment modality was decided according to the size of abscess and the presence of underlying disease.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Diagnosis* ; Early Diagnosis ; Fascia ; Follow-Up Studies ; Head ; Humans ; Neck* ; 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