We recently encoutered a case of cerebrospinal fl uid rhinorrhea (CSF) caused by an injury occurring during operation for chronic sinusitis and nasal polyps. Treatment of this case was difficult. The case was a 34-year-old male who had undergone total radical sinusedomy for right chronic sinusitis. After removal of the pack, CSF leakage was observed. The CSF was improved by insertion of gelfoam and compression with a tampon, but it became worse again after subsequent operation for correction of the deviated nasal septum and radical operation for left sinusitis. Four months after the operation on the left sinusitis, the patient was referred to our Department. Closure of the wound leaking CSF was attempted three times using a fascia, gelfoam and fibrin glue; success was finally achieved after a 3rd operation. Four openings were the source of the CSF, with the major one located in almost the center of the roof of the ethmoid sinus and the others located in the roof of the olfactory issure region (anterior and posterior) and anterolateral region of the roof of the ethmoid sinus.
Endonasal sinusectomy developed and performed in our department for a long time is a useful method for treating chronic sinusitis. The key points of this surgical technique under local anesthesia are removal of pathologic mucosa of the anterior and posterior ethmoid sinuses by an endonasal approach, opening of the cellulae and, in addition, establishment of sufficient communication between the ethmoid sinus and the maxillary, frontal sinus. Even if pathologic mucosa is present in the maxillary sinus, we leave it intact and attempt to heal it indirectly by achieving good drainage and ventilation. This surgical technique often, includes correction of septal deviation and conchotomy. Recently, by using rigid endoscope and a VIDEO system (CCD-camera, TV monitor, etc), surgical complications have been prevented, because of achieving a wide and clear visual field, decreasing the dead angles and give a close view of the site of manipulation of the paranasal sinuses which have a delicate and complicated structure. Post-operative treatment includes irrigation of maxillary sinus and this is necessary to make a good evaluation. I discuss these surgical techniques, approaches, post-operative findings and evaluations, etc.
Sensorineural deafnens with low tone disturbance on rapid onset is called sudden deafness. In the present study, we studied 20 such patients. Our study revealed following characteristic points: 1. Low tone sudden deafness (LTSD) has rapid onset with a main complaint of feeling of obstructed ears and tinnitus of unknows origin. 2. Only low tone range in disturbed in slight to moderate degrees. 3. LTSD occurs more frequently in women. 4. LTSD is well responsive to treatments and mostly cured in a short time. In addition, this disease has been reported to relapse and after a long period of time may proceed to Meniere's disease. It is important to observe its prgress in way case.
Isolated bone fragments in the maxillary sinus can occasionally be found during a radical operation for chronic sinusitis. The ethiopathogenesis of isolated bone fragments has been a matter of dispute. The histology of chronic nonspesific sinusitis in 114 cases with 141 maxillary sinus mucosa was investigated to elucidate the origin of the formation of isolated bone fragments. The study revealed that tiny bone fragments, at different stages of metaplastic bone formation, were embedded in the maxillary sinus mucosa. The intramucosal ossification, which was found in 49 out of the 141 sinuses (34.8%) with chronic sinusitis, was more frequent in the fibrotic type of sinusitis and in the deep layer of the lamina propria. These findings suggest that isolated bone fragments originate inside the chronically inflamed maxillary sinus mucosa.
We examined headache in 80 outpatients who had nasal complaints by applying the ENT-Ori-ented Checklist for Headache (E. O. C. H.) and the Self-Rating Questionnaire for Depression (SRQ-D) Checklist. Among eighty patients, forty-two (52.5%) were defined as having headache under E. O. C. H. and SRQ-D checklist. The distribution of varied nasal disease entities in forty-two headache patients were: nasal allergy, 23 patients (48.9%) chronic sinusitis, 13 patients (31.9%), deviation of nasal septum, 3 patients (6.4%), cyst of ethmoid sinuses, 2 patients (4.3%) and frontal sinusitis, 2 patients (4.3%). The headache mostly manifested over the frontal or temporal areas. The majority of patients with chronic sinusitis complained of pain over the frontal area. In contrast, nasal allergy patients complained of pain over the frontal, temporal, or occipital areas. As to the quality of pain, 44% were heavy and dull while, 40.7% were throbbing in character. The concomitant complaints were: shoulder discomfort, 26.4%. Depression, 22%, nausea, 14.5% and, insomnia, 7.7%. 13.7% of the forty-two patients with headache recognized by SRQ-D checklist probably have depression. The onset of headache was more prominent in the mornings in chronic sinusitis but, was no clear timeband of onset in nasal allergy.
The basic setup for endoscopic ethmoidectomy includes three different angled endoscopes, small CCD camera, which can be coupled directly to the endoscope, a monitor television, a good light source and a U-matic cassette tape recorder. Good control of bleeding is the prerequisite for a successful surgery. Small surgical instruments, which can be used in the ethmoid sinus together with an endoscope are available. A special instruments are necessary for clearance of diseases at the nasofrontal duct and fontanelle areas, that can be visualized under a 70 degree angled vision endoscope.
We evaluated the safety and influence of nebulizer therapy in cases with chronic sinusitis and in guinea pigs. The patients were treated with Tobracin ®using a nebulizer for 3 months, but no changes were observed in GOT, GPT, or BUN. The guinea pigs were treated with Panimycin ® 8 times daily for 4 weeks at a dose 40 times higher than that in the patients, but hematological examination showed no abnormalities. The blood concentrations of the drugs administered by a nebulizer were 1/40 of those of the same drugs injected intramuscularly. In the treatment using a nebulizer, since minute particles increase in the treatment room, adequate air exchange is needed. The distribution of the drug sprayed using a nebulizer in the body was 30% in the nasal cavity, 10% in the pharyngolaryngeal area, 10% in the chest and 1% in the abdomen, and 40-50% was scattered into the air including expired gas. Three to six minutes seem to be the adeqwate duration of time for drug spraying in nebulizer treatment.