Recently, biomaterials for spacers following sinus surgery have been extensively researched. Such materials may reduce the incidence of early postoperative bleeding and formation of synechiae, and possibly promote mucosal healing. The aims of this study are to review recent advances in absorbent packing materials for the nasal cavity and to differentiate their effects on hemostasis, wound healing and prevention of adhesion.
Biocompatible Materials ; Hemorrhage ; Hemostasis ; Incidence ; Nasal Cavity* ; Nasal Surgical Procedures ; Wound Healing

Otologic surgery and surgical drilling of the skull are well known precipitating factors of secondary benign paroxysmal positional vertigo (BPPV). Especially if BPPV is developed after ear surgery, operated ear has been thought as the side of BPPV with little doubt. Recently we experienced a patient of BPPV developed 3 days after mastoidectomy. Positional test showed nystagmus with pure horizontal component and it was geotropic direction changing nature depending on the head position. Initial location of the particles was assumed in the lateral semicircular canal of operated ear, but following repositioning maneuver, positional nystagmus was compatible with anterior semicircular canal of contralateral ear. With this case report, authors suggest plausible mechanisms of the contralateral side BPPV after mastoid surgery as follows. Surgical position during mastoid surgery (contralateral ear down) and postoperative bulky mastoid compressive dressing usually kept the patient's head to the contralateral side can be precipitating factors for migration of detached particles into the semicircular canal of dependent position. Anyway, appropriate differential diagnosis and management plans should be prompted using bed side vestibular evaluation, since serious irreversible inner ear complications are more frequent cause of postoperative vertigo than BPPV.
Bandages ; Diagnosis, Differential ; Ear ; Ear, Inner ; Head ; Humans ; Mastoid ; Nystagmus, Physiologic ; Otitis Media ; Precipitating Factors ; Semicircular Canals ; Skull ; Vertigo*

Although most of the maxillary sinus retention cysts are asymptomatic, a few of them increase in size and cause symptoms. However, they rarely erode bony walls nor protrude into the inferior meatus. I present 2 cases with maxillary sinus retention cysts protruding into the inferior meatus by making a large defect on the medial wall of the maxillary sinus.
Cytochrome P-450 CYP1A1 ; Maxillary Sinus*

Mucormycosis is a rare invasive fungal infection of the nose and paranasal sinus, which often has an acute fulminant course and distinctive clinical findings. It usually occurs in diabetics or immunocompromised patients and shows rapid progression with a high mortality rate. Slow, silent progression is a highly unusual presentation of this disease. Herein, we report a case of mucormycosis with a chronic course of invasion into the hard palate and the maxillary sinus.
Diabetes Mellitus ; Immunocompromised Host ; Maxillary Sinus ; Mortality ; Mucormycosis* ; Nose ; Palate, Hard ; Rare Diseases* ; Sinusitis

Chronic invasive fungal sinusitis is a relatively rare disease that can span from months to years in its clinical course and is described to be more common in immunocompetent patients. Most cases of chronic invasive fungal sinusitis are due to the Aspergillus species and have been treated with a combination of surgery and antifungal agents. However, the incidence is increasing with frequent use of antibiotics, cytotoxic drugs, and systemic corticosteroids. We report a case of chronic invasive fungal sinusitis with orbital complication in the patient who underwent endoscopic sinus surgery for chronic rhinosinusitis. Although chronic invasive fungal sinusitis is relatively rare, it is important for otolaryngologists to be aware of its diagnosis and treatment.
Adrenal Cortex Hormones ; Antibiotics, Antineoplastic ; Antifungal Agents ; Aspergillosis ; Aspergillus ; Diagnosis ; Endoscopy ; Fungi ; Humans ; Incidence ; Orbit ; Postoperative Complications ; Rare Diseases ; Sinusitis*

OBJECTIVES: The purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Retrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables. RESULTS: Of 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001). CONCLUSION: These results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS.
Airway Obstruction ; Dependency (Psychology) ; Fluoroscopy ; Humans ; Palate, Soft ; Polysomnography ; Retrospective Studies ; Sleep Apnea, Obstructive ; Supine Position ; Tongue

BACKGROUND AND OBJECTIVES: Parapharyngeal space tumors are extremely rare head and neck tumors. Therefore, there are just a few reports about them. The purpose of this study was to report our experiences of parapharyngeal space (PPS )tumors regarding clinicopathological features and management. SUBJECTS AND METHOD: This study included 51 patients with PPS tumors which were diagnosed from January 1990 through June 2004. Medical records were reviewed retrospectively. RESULTS: The male-to-female ratio was close to 1:1. The mean age was 47 years (6 mo -83 Y ). The most frequent presenting manifestation was asymptomatic neck mass. All patients were subjected to CT scan, while 31 patients underwent MRI in addition. Diagnostic accuracy of fine needle aspiration cytology of 28 cases matched with pathologic reports by 50%. Salivary gland neoplasms occupied the biggest parts (43.1%, 53.8%)of both benign and malignant PPS tumors. Thirteen patients (25.5%)had malignant lesions. Surgical excision was performed in 39 cases (76.5%). The transcervical (30.8%)and the transcervical-transparotid approaches (38.5%)were commonly performed surgical procedures. Overall postoperative morbidity rate was 23.1%. There were 3 recur-rences (42.8%)in malignant tumors and no recurrence in benign ones after surgical excision during the mean follow-up period of 35 months (13 -89 mo ). Close observation, sclerotherapy and radiotherapy were only applicable for a few selected benign lesions. CONCLUSION: Most benign PPS tumors could be removed surgically with low complication and recurrence rates. Optimal surgical approach based on transcervical approach allows safe removal of various types of PPS tumors.
Biopsy, Fine-Needle ; Follow-Up Studies ; Head ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Neck ; Neurilemmoma ; Paraganglioma ; Parotid Neoplasms ; Radiotherapy ; Recurrence ; Retrospective Studies ; Salivary Gland Neoplasms ; Sclerotherapy ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Headache secondary to sinonasal disease can improve after surgery, but few prospective studies have investigated this outcome. We aimed to evaluate the characteristics of headaches, such as clinical features, underlying disease, and postoperative improvement in patients who underwent nasal surgery, and to identify the characteristics that reliably predict rhinogenic headache. MATERIALS AND METHOD: Of 356 patients who underwent nasal surgery between March and December 2009, 41 patients with headaches were enrolled in this prospective study. Clinical features of headache, such as onset, time of day, duration, frequency, nature, side and location, existence of aura, aggravating and relieving factors and accompanying nasal symptoms, underlying diseases, endoscopic findings, and computed tomography scans of the paranasal sinuses were evaluated. Headache intensity was graded based on a 10-point visual analog scale (VAS) pre- and post-operatively. RESULTS: The most common characteristics of rhinogenic headache included a stabbing or squeezing nature, frontal area location, accompanying nasal obstruction or rhinorrhea, and underlying sinusitis or septal deviation. The subjective intensity of the headache, measured using the VAS score, improved in 80% (33/41) of the patients after surgery. CONCLUSION: Nasal surgery should be considered when rhinogenic headache is suspected and there are definite nasal pathologies.
Epilepsy ; Headache* ; Humans ; Nasal Obstruction ; Nasal Surgical Procedures ; Nose Diseases ; Pain, Postoperative ; Paranasal Sinuses ; Pathology ; Prospective Studies* ; Sinusitis ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.
Facial Pain ; Follow-Up Studies ; Gingiva ; Headache ; Humans ; Hypesthesia ; Maxillary Sinus ; Nasal Polyps ; Prospective Studies ; Recurrence ; Sinusitis

BACKGROUND AND OBJECTIVES: Facial nerve stimulation (FNS) as a complication of cochlear implantation can produce significant discomfort, limit effective use of cochlear implant, and require extensive reprogramming in some patients. The purpose of this study is to review the clinical features of children with FNS after cochlear implantation and to discuss its possible solutions. SUBJECTS AND METHOD: Thirteen children who had FNS after cochlear implantation were included. Their medical records were reviewed retrospectively regarding the presence of inner ear anomaly (IEA), the programming techniques for cochlear implant, timing and progression of FNS, and the management of it. RESULTS: Ten out of 13 children (76.9%) with FNS had IEA. In those 10 patients with IEA, FNS appeared within 6 months from the operation and showed a tendency of being relevant to all electrodes. Authors used four methods to eliminate FNS. They included (a) turning off the specific electrodes when FNS seems related to some specific electrodes, (b) changing the coding strategy or the programming mode, which proved not to be effective, (c) reducing the C-level, which resulted in severe narrowing of dynamic range as well as a relative control of FNS, and (d) surgical exploration in specific cases. CONCLUSION: FNS after CI is at greater risk for IEA. FNS in those cases can interfere with the progression of speech development. This should be sufficiently informed of the parents of CI candidates with IEA preoperatively. Surgical exploration can be reserved for elimination of FNS in specific cases.
Child* ; Clinical Coding ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner ; Electrodes ; Facial Nerve* ; Humans ; Medical Records ; Parents ; Retrospective Studies