The procedure for endoscopic frontal sinusotomy via the route anterior to the ethmoid bulla (intact bulla frontal sinusotomy [IBFS]) is safe and of educational importance. IBFS is not possible in all cases; therefore, we examined the factors affecting the success rate of IBFS. We examined 65 sides to investigate whether the following items might affect the success rate of IBFS: (1) variation in the number of anterior ethmoid cells, (2) presence of frontal sinus lesion, (3) variations of the superior attachment of the uncinate process, (4) anteroposterior diameter of the agger nasi cell (ANC), (5) distance between the agger nasi and the frontal sinus drainage pathway (FSDP), (6) anteroposterior diameter (AP diameter) of the frontal recess, and (7) other factors (sex, age, pathophysiology of sinusitis, presence of nasal polyps in middle meatus). The success rate of IBFS was 52% (11/21) in cases with a supra bulla frontal cell (SBFC) and 93% (41/44) in those without a SBFC (p=0.0003). The success rate of IBFS was 73% (36/49) in the presence of lesions in the FSDP and 100% (16/16) in the absence of lesions in the FSDP (p=0.027). Other investigated factors had no effect on the IBFS success rate. Thus, the most important factors that affected the success of IBFS were the presence of the SBFC and lesions in the FSDP.
Cognitive Behavioral Therapy (CBT) is receiving attention as an approach to the control of stuttering, although few studies have examined its effect. In this report, we report cases of adult stuttering that improved with low-intensity CBT.
The participants were 11 adults with stuttering (AWS, 22 to 47 years old, 2 women), who sought consultation at our clinic. In CBT, the patients were made to understand that stuttering was related to anxiety and that it can be dealt with by coping with anxiety, such as with exposure therapy. We explained to the AWS that while rehearsing their speech in the mind, they should distract their attention from “whether stuttering will occur or not.” The scores on the Liebowitz Social Anxiety Scale (LSAS-J) and Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A) showed statistically significant improvement after 5 sessions, although there was no significant change of the score on the Modified Erickson Scale of Communication Attitudes (S-24) or in the stuttering frequency. Although the stuttering frequency did not improve, our findings showed that CBT was still effective against stuttering by improving social anxiety disorder and difficulty suffering.
Velopharyngeal insufficiency is one of the common complications of adenoidectomy, but conservative treatments are sufficient for obtaining improvement in most cases. We encountered a patient who presented with severe hypernasality developing after adenoidectomy and required surgical treatment for improvement.
A five-year-old girl with bilateral otitis media with effusion and adenoid vegetation underwent adenoidectomy. After the surgery, she developed hypernasality with decreased speech clarity. Speech training was started 4 months after the operation and applied for 10 months, but the symptoms showed no improvement. Radiologic investigations revealed a very deep nasopharynx. Congenital velopharyngeal incompetence was considered as the cause of the velopharyngeal insufficiency, which had been asymptomatic prior to the adenoidectomy, probably as a result of the valve effect of the adenoids. The patient underwent surgery wherein the costal cartilage was transplanted into the posterior pharyngeal wall, which led to resolution of the hypernasality. Here, we discuss the possibility of preoperative detection and treatment methods for velopharyngeal insufficiency after adenoidectomy.