Post-traumatic BPPV is considered one of the most common known etiologies. An accurate understanding of trauma mechanism, gender prevalence, and therapeutic success rates of each event, could be useful in adequately treating and planning follow-up examinations.
ObjectivesIn onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients.MethodsA retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction.ResultsLocal anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group.ConclusionBalloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure.
In this study we tried to demonstrate how balloon sinuplasty could be an option in the treatment of the Rhinogenic Headache due to a probably disventilation of frontal sinus recess. 107 patients were included in the study with diagnosis of Rhinogenic Headache. The surgical group underwent bilateral balloon sinuplasty of the frontal sinus. The medical group underwent pharmacological treatment. Headaches characteristics were evaluated by a clinical personal diary. The severity was recorded by Visual Analog Scale 4 and 8 months after treatment. 98 out of 107 patients completed the protocol. In surgical group and in medical one the mean headache score improved at four and eight months follow up. The headache frequency attacks per month decrease from a preoperative frequency of 18 (±4 SD) in surgical group and 17 (±3 SD) in medical group to 3 (±1 SD) and 6 (±3 SD) respectively at 4 months control but increased slightly to 5 (±2 SD) and 12 (±4 SD) after 8 months. We concluded that the balloon sinuplasty should be considered as an effective alternative option after an accurate selection of surgical candidates. However, it is important a 6-8 month follow-up to evaluate the efficacy and stability of the treatment used.
The objective of this study is to evaluate electromyographic waveforms related to vagus monitoring. We collected data from patients undergoing thyroidectomy with CIONM, regardless of vocal cord response amplitude initially measured. We divided data of 193 nerves into three groups, according to initial amplitude value: ≥500 µV (Group 1,110 pt.), between 100 and 500 µV (Group 2, 79 pt.), and <100 µV (Group 3, 4 pt.). ROC curve showed a high diagnostic accuracy of final amplitude absolute value in vocal cord paralysis detection in both groups (89 and 86%). An increase of vocal cord paralysis risk was associated with progressive amplitude reduction (Group 1: OR=1.05, CI=1.02–1.09, p=0.001; Group 2: OR=1.05, CI=1.02–1.08, p=0.002). Cut-off values for amplitude reduction with optimal sensitivity and specificity were −77% in Group 1 and −15% in Group 2. In Group 3 signals showed an amplitude <100 µV for all monitoring, with no loss of a recognizable signal and normal postoperative cordal functionality. The use of a strict amplitude signal cut-off value ≥500 µV could be too restrictive. Also, signal with baseline amplitude <500 µV may be considered equally adequate. Setting the alarm for a reduction of 77% in patients with initial amplitude ≥500 µV and of 15% for those <500 µV could make monitoring safe and an effective aid for surgeons. In conclusion, there are cases in which initial amplitude is lower than that considered as adequate by current literature but with well recognizable and stable EMG waveforms. How those cases should be approached and what should the surgeon’s attitude be are a matter of discussion.
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