A 72-year-old woman came to our hospital complaining of bilateral nasal obstruction. Nasal fiberscopy, MRI, and a biopsy of the left nasal tumor were performed, and the preoperative diagnosis was benign nasal tumor of vascular origin. Intranasal resection of the tumor was performed, and the histological diagnosis was sinonasal hemangiopericytoma-like tumor. Such tumors differ from hemangiopericytomas of other regions in terms of the clinical and pathological findings, but some of the immunohistochemical findings resemble those of glomus tumor.
To determine the effects of environmental air temperature and humidity on human nasal air passages, we measured nasal resistance by active anterior rhinomanometry with a nasal nozzle during quiet nasal breathing under totally regulated ambient temperature and humidity in an ambient air controlled room at a cosmetic company and compared the results in allergy patients and healthy subjects. Expiratory nasal resistances in five healthy subjects and four allergic rhinitis patients were measured under the following environmental temperature and humidity conditions: 1) a constant temperature of 20°C and 60% humidity for 20min, 2) a constant temperature of 20°C and 30% humidity for 20min, 3) a rapid change in environment from a temperature of 35°C and 60% humidity for 20min to 7°C and 60% humidity for 10min, 4) a rapid change in environment from a temperature of 35°C and 30% humidity for 20min to 7°C and 60% humidity for 10min. Under steady conditions at a milder temperature [20°C], there were no changes in nasal resistance in either group of subjects, whether the air was dry [30%] or moist [60%]. When ambient temperature was rapidly changed from warm [35°C] to cool [7°C], nasal resistance significantly increased in allergic rhinitis patients, but not in healthy subjects, whether the air was dry or moist. In conclusion, rapid changes in ambient air temperature from warm to cool significantly increased congestion of the nasal mucosa in patients with allergic rhinitis.
In a case of median nasal fistula with a cyst accompanied by recurrent infection around the nasal root, a 73-year old woman was reported. Imaging study showed a subcutaneus cyst and fistula tract penetrating the left nasal bone to the nasal mucosa. The fistula and cyst were removed. Pathological examination revealed a dermoid cyst. Cases of median nasal fistula should be studied by CT and MRI and operated on due to the possibility of the cyst extending to the skull base.
Two ultrasonic surgical systems, SonoSurg® (Olympus) and Harmonic Scalpel® (Johnson and Johnson), are frequently used for general chest and abdominal endoscopic surgery. However, their large tips have limited their use in otolaryngology, with only the Harmonic Scalpel® having been used in a few cases. SonoSurg® features 75-micron amplitude, 47-kHz vibration, which results in a high cutting ability with low tissue damage and bleeding, no vellication as caused by an electric knife, no high temperature as brought by the Shou heat knife, and no need of protective glasses for some laser knives. Since January, 2002, we have been collaborating with the Olympus Corporation of Japan in the development of a new fine spatula blade (3.8mm in diameter, 100mm long) to be used with SonoSurg® in nasal surgery. We have used SonoSurg® with the new blade for the treatment of inferior nasal turbinate with the nasal conchotomy in seven patients with allergic rhinitis and five with chronic hypertrophic rhinitis. The new system was found to be very effective, a short surgical time (procedure completed within 5 minutes), and with good working space even in pediatric surgery. The clinical outcomes were satisfactory, with a final improvement rate of 75%. This latest fine-grip prototype SonoSurg® provides better management in otolaryngology-Head and Neck Surgery than does the Harmonic Scalpel®.
Churg-Strauss syndrome (CSS) is characterized by bronchial asthma, hypereosinophilia, and systemic necrotizing vasculitis, frequently accompanied by recurrent severe sinusitis with nasal polyposis. We report two cases of CSS associated with sinusitis and nasal polyps. Case 1: A 29-year-old man with a history of bronchial asthma and allergic rhinitis from the age of 24 suffered myocardial infarction, intracranial hemorrhage, and hypereosinophilia. He has been followed up for pansinusitis with severe nasal polyposis since November 1997. He underwent endoscopic sinus surgery in October 1999, but nasal polyposis recurred less than 2 months postoperatively. Case 2: A 59-year-old woman experiencing bronchial asthma onset at age 29 had a history of chronic sinusitis and allergic rhinitis from about the age of 40. At the age of 57, she suffered polyneuropathy and hypereosinophilia. She has been followed up for mild sinusitis with a right nasal polyp since January 2001.
Small-dose, long-term therapy using macrolide antibiotics has been recently established as a medical treatment for chronic sinusitis in adults and children. This therapy has been reported to be highly effective, but problems related to the development of drug-resistant bacteria often long-term administration are now appearing. In the present study, we used small-dose macrolide therapy for the treatment of pediatric chronic sinusitis and examined the clinical efficacy, changes in detected bacteria with time, drug sensitivity and the presence of resistance genes from a bacteriological viewpoint. The subjects consisted of 13 children with pediatric chronic sinusitis who were treated at the Department of Otorhinolaryngology in Omori Hospital, Toho University, and at related hospitals between June 2001 and March 2002. Three kids of bacteria, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, were detected in the middle nasal meatus of these subjects. Patients with chronic pediatric sinusitis were treated with 5-7.5mg/kg of clarithromycin (brand name, Clarith) for one month or longer, and the clinical efficacy of the treatments was evaluated using intranasal findings and X-ray findings before and after the administration of clarithromycin. The presence of bacteria in the middle nasal meatus was examined once a week. When S. pneumoniae, H. influenzae or M. catarrhalis was detected at least twice in one patient, the bacteria was isolated; its drug sensitivity was then examined and an epidemiological study was performed using genetic methods. No correlations between the isolated bacteria and clarithromycin sensitivity were found, and small-dose macrolide therapy proved to be clinically effective. Clarithromycin had little effect on the sensitivity of the detected bacteria to various drugs over time.