Sequential Imaging in Patient With Suspected Menière's Disease Identifies Endolymphatic Sac Tumor.

Objective: The standard evaluation of patients with suspected Menière's disease (MD) includes initial imaging to rule out tumors of the temporal bone. Few guidelines, however, advocate sequential imaging. We propose that sequential imaging may reveal other etiologies of auditory and vestibular symptoms as demonstrated in a patient with an endolymphatic sac tumor that was originally diagnosed Menière's after initial imaging.

Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings.

Background: Performance of septoplasty is dependent on objective evidence of nasal septal deviation. Although physical examination including anterior rhinoscopy and endoscopic examination is the gold standard for evaluation of septal deviation, third-party payors' reviews of septoplasty claims are often made on computed tomography (CT) findings. However, the correlation between radiographic evaluation of septal deviation with physical examination findings is unknown.

Preapproval of sinus computed tomography for otolaryngologic evaluation of chronic rhinosinusitis does not save health care costs.

Objectives/hypothesis: To evaluate the cost-effectiveness of preapproval requirements for computed tomography (CT) of the sinuses in the evaluation and management of chronic rhinosinusitis (CRS).

Study Design: Retrospective analysis of prospectively collected data.

Methods: Over a 6-month period, all sinus CT scans ordered by an otolaryngology practice and requiring preapproval by a third-party payor were tabulated.

Radiographic patterns of orbital involvement in IgG4-related disease.

Purpose: Immunoglobin G4 (IgG4)-related disease is a systemic condition characterized by lymphoplasmacytic infiltrates that can involve the orbit. The purpose of this study was to identify the various patterns of orbital IgG4-related disease on imaging.

Methods: Retrospective review of radiologic examinations including CT, MRI, and positron emission tomography was performed in patients with proven cases of IgG4-related disease.

Clinical assessment is an accurate predictor of which patients will need septoplasty.

Objectives/hypothesis: Septoplasty is a frequently performed surgical procedure with the most common indication being nasal airway obstruction. Almost universally, health insurance companies mandate a trial of medical therapy consisting of intranasal corticosteroids prior to performance of septoplasty regardless of clinical assessment. Evidence for this requirement is lacking.

Bolsterless management for recurrent auricular hematomata.

Objectives/hypothesis: The objectives were to describe our experience with a bolsterless technique for the management of auricular hematomata and discuss the management options for auricular hematomata and the comparative benefits of the bolsterless technique.

Study Design: Retrospective case series.

Methods: Patients presented with recurrent auricular hematomata following traditional treatment with incision and drainage and bolster placement.

Decontamination of nasal atomizer tips: alcohol versus guards.

Objective: To determine the efficacy of wiping the nasal atomizer tip with 70% isopropanol versus using single-use plastic atomizer tip guards in preventing cross-contamination.

Study Design: Single-center, prospective, partially blinded, alternating double-arm trial.

Setting: Specialty-specific otolaryngology emergency room.

Lateral dermoid cyst of the floor of mouth: unusual radiologic and pathologic findings.

A lateral dermoid cyst is a rare lesion of the floor of mouth, with only 12 cases reported in the literature. We describe the case of a 60-year-old man with a slowly enlarging mass in the submandibular region. Magnetic resonance imaging demonstrated a lesion containing multiple uniformly rounded foci, creating a "sack-of-marbles" appearance.

Reformation of concha bullosa following treatment by crushing surgical technique: implication for balloon sinuplasty.

Objectives/hypothesis: There are various surgical techniques designed to treat conchae bullosae (CB). These include partial or total resection and crushing. Frontal sinus balloon sinuplasty is thought to work by the crushing/remodeling of the agger nasi and frontal recess air cells.

Ameloblastoma associated with the nevoid basal cell carcinoma (Gorlin) syndrome.

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder characterized by a wide range of clinical signs and symptoms. The major criteria for the diagnosis are multiple cutaneous basal cell carcinomas, multiple odontogenic keratocysts of the jaw, palmar and plantar pits, and skeletal abnormalities. Here, we report an unusual case of NBCCS in a 68-year-old woman with late onset of clinical signs and symptoms and with an associated ameloblastoma.

Efficacy of montelukast in the treatment of nasal polyposis.

Objectives: Twenty-four consecutive patients with symptomatic nasal polyposis and nonallergic or perennial rhinitis who were undergoing chronic nasal steroid therapy were prospectively evaluated for response to adjunctive oral montelukast sodium therapy.

Methods: The patients were undergoing daily intranasal steroid sprays for a minimum of 6 months before being started on montelukast sodium 10 mg by mouth per day for 3 months while intranasal steroids were continued. The patients were given a validated symptom score survey at the start and end of therapy, with a lower score indicating fewer symptoms.

Correlation between preoperative clinical diagnosis and histopathological findings in patients with rhinosinusitis.

Background: The diagnosis of chronic rhinosinusitis (CRS) or chronic rhinosinusitis with polyposis (CRSP) is typically clinical and based on the combination of medical history, physical examination, and imaging. The recommendation to perform surgery and the type of surgery is tailored to the diagnosis. The objective of this study is to determine the accuracy of preoperative clinical CRS or CRSP diagnosis in patients who underwent endoscopic sinus surgery.

Isolated chronic maxillary sinusitis of non-dental origin does not correlate per se with ipsilateral intranasal structural abnormalities.

A case series of 35 patients with isolated chronic maxillary sinusitis of inflammatory non-dental origin was retrospectively reviewed to determine the correlation of ipsilateral intranasal structural abnormalities. The records were examined for computed tomographic, nasal endoscopic, and intraoperative findings. The incidence of ipsilateral and contralateral intranasal structural abnormalities at the ostiomeatal complex region, including conchae bullosae, Haller cells, paradoxical middle turbinates, and septal deviations, was determined.

Same-day discharge for selected patients undergoing combined nasal and palatal surgery for obstructive sleep apnea.

To determine the safety of same-day discharge for patients who undergo combined nasal and palatal surgery for obstructive sleep apnea syndrome, we undertook a retrospective review and analysis of 2 groups of patients (total, 86 patients) who underwent such surgery. The patients with obstructive sleep apnea syndrome who underwent combined nasal and palatal surgery were considered for same-day discharge if they fulfilled the following postoperative criteria: sustained O2 saturation of 94% or greater on room air while asleep, no history of cardiopulmonary disease or diabetes mellitus, adequate oral analgesia and oral intake, hemostasis, and normal vital signs. Twenty-three patients met these criteria and were assigned to group 1.

Treatment of isolated sphenoid sinus inflammatory disease by endoscopic sphenoidotomy without ethmoidectomy.

Objectives/hypothesis: Isolated chronic sphenoid sinusitis is a rare entity. The study was conducted to determine the efficacy of endoscopic sinus surgery with partial middle turbinectomy and without ethmoidectomy in treating isolated sphenoid opacification from inflammatory and infectious disease.

Study Design: Case series of 20 patients generated by retrospective review of 307 consecutive patients who underwent surgical treatment for chronic rhinosinusitis.

Endoscopic sinus surgery for inflammatory maxillary sinus disease.

Objective/hypothesis: The role of endoscopic sinus surgery for treating chronic maxillary sinusitis is well established. The purpose of the study is to determine the efficacy of endoscopic sinus surgery in the treatment of maxillary sinus inflammatory disease that includes mucoceles, retention cysts, and antrochoanal polyps.

Study Design: This is a retrospective review of 32 consecutive patients who underwent endoscopic sinus surgery for mucoceles (n = 21), retention cysts (n = 5), or antrochoanal polyps (n = 6).