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

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

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

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*

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: 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: Fibrous dysplasia of the paranasal sinus is rare. It is usually secondary to the extension of disease from adjacent bones and rarely limited to the sinuses. The purpose of this study is to get an improved appreciation of the clinical features and courses of fibrous dysplasia involving paranasal sinuses. SUBJECTS AND METHOD: Medical records of 15 patients diagnosed as fibrous dysplasia involving paranasal sinuses from 1990 to 2004 were reviewed retrospectively. Clinical informations including age of diagnosis, presenting symptoms, radiographic findings, treatment and clinical outcome for each patient were analyzed. The male to female ratio was 7 : 8. Their ages ranged from 7 to 68 with the median of 32. Seven patients were younger than 30 years old at presentation. RESULTS: The most common complaint was headache followed by facial swelling. The mean duration of illness was 11 months. In the findings of CT, eight patients belonged to the sclerotic type, six to the pagetoid type, and one the tocystic type. Eight patients were polyostotic while the others were monostotic. The most commonly involved sinus was the sphenoid sinus followed by ethmoid sinus. Seven patients who had facial swelling, exophthalmos or nasal obstruction underwent surgery, and in four of them, the lesion was in progression or recurred. Lesions in eight patients who were older than 30 years old and had no symptoms except headache did not progress thereafter. CONCLUSION: The progression of fibrous dysplasia stops when the bony growth is completed. Thus, if the patients are diagnosed with fibrous dysplasia over the age of 30 and do not have specific symptoms, there may be no need for surgical treatment.
Adult ; Diagnosis ; Ethmoid Sinus ; Exophthalmos ; Female ; Headache ; Humans ; Male ; Medical Records ; Nasal Obstruction ; Paranasal Sinuses* ; Retrospective Studies ; Sphenoid Sinus

BACKGROUND AND OBJECTIVES: Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon tumor with poorer prognosis compared with its cutaneous counterpart. The purpose of this study is to investigate the clinical features and treatment outcomes of mucosal malignant melanoma of the nasal cavity and paranasal sinuses. SUBJECTS AND METHOD: Eighteen patients who were diagnosed and treated as mucosal malignant melanoma of nasal cavity and paranasal sinuses from 1995 to 2004 were included. Male to female ratio was 10 to 8. Their ages ranged from 43 to 87 years with median of 62 years. The medical records were reviewed retrospectively with respect to presenting symptoms, stage, treatment modalities and outcome. RESULT: The most common symptoms were epistaxis and nasal obstruction. The mean duration of symptom was 4.2 months. Commonly involved sites were middle turbinate, inferior turbinate, maxillary sinus and ethmoid sinus. Eight cases belonged to stage I, nine cases to stage II and only one case to stage III. Among them, seventeen patients underwent surgery with or without radiotherapy and immunotherapy. Of the seventeen patients who underwent surgery, twelve had recurrence and the mean period for recurrence was 8.2 months. During the follow-up periods, five had distant metastases. Five-year survival rate was 27.2% and the survival rates according to age, sex, tumor size and stage were not statistically significant. CONCLUSION: Mucosal malignant melanomas of the nasal cavity and paranasal sinuses developed commonly in the 6th to 8th decades. Epistaxis and nasal obstruction were the most common presenting symptoms. Almost all cases belonged to the stage I or II and the mainstay of the treatment was surgery. However, it was associated with frequent recurrences and a poor prognosis.
Epistaxis ; Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Immunotherapy ; Male ; Maxillary Sinus ; Medical Records ; Melanoma* ; Nasal Cavity* ; Nasal Obstruction ; Neoplasm Metastasis ; Paranasal Sinuses* ; Prognosis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Turbinates

BACKGROUND AND OBJECTIVES: Vibration-induced nystagmus(VIN) may be a useful bedside sign for detecting vestibular imbalance. However, the clinical significance of VIN remains unclear. The aim of this study is to analyze the lateralizing value of VIN in patients with unilateral vestibular deficit after acute vestibular functional loss. SUBJECTS AND METHOD: Forty patients with peripheral vestibular loss of acute etiology were included. Patients assuming fluctuating or slowly aggravating vestibular dysfunction were excluded. VIN was induced by applying 100 Hz vibratory stimuli to both mastoids side by side. Direction and intensity of horizontal nystagmus were analyzed by using video-oculography. Post-head shaking nystagmus(HSN), caloric test and vestibular evoked myogenic potential(VEMP) were also performed. Age matched 25 healthy volunteers were included for control. RESULTS: Of the 40 patients, 37(92.5%) showed contralesional VIN whereas only one exhibited ipsilesional nystagmus. Two patients(2.5%) did not develop VIN. Immediate HSN was present in 31(77.5%) patients. VIN and HSN were present in the same direction in 24 patients and in the opposite direction in 5. The intensity of VIN showed significant correlations with the intensity of HSN and the degree of canal paresis on bithermal caloric test, whereas it did not depend on the presence of VEMP. CONCLUSION: VIN is mostly contralesional in peripheral vestibulopathies. VIN may be a simple and useful clinical sign for indicating lateralization in fixed vestibular loss.
Caloric Tests ; Evoked Potentials ; Healthy Volunteers ; Humans ; Mastoid ; Nystagmus, Pathologic ; Paresis ; Vestibular Diseases ; Vibration