Extending the use of the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire in a cross-sectional study:Patients with chronic rhinosinusitis versus healthy controls

Objectives There are several instruments to assess health-related quality of life (HRQoL) in chronic rhinosinusitis (CRS). Unfortunately, none of them evaluates all three health domains (physical, social and psychological) important to assess the overall well-being of the patient. The Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) does assess all these elements. Initially, the EES-Q is validated to evaluate the impact of endoscopic endonasal surgery (EES) on HRQoL. The aim of this study is to assess whether EES-Q outcomes differ in patients with CRS compared with healthy individuals. Therefore, extending the use of the EES-Q for all CRS patients. Design Cross-sectional study. Setting Tertiary referral hospital. Participants One hundred patients with uncontrolled CRS (50% with nasal polyps) scheduled to receive EES. The questionnaire was completed preoperatively. Healthy control subjects (n = 100) without any history of sinusitis or a known current medical treatment at a hospital were included. Main outcome measures Mann-Whitney U test was performed to identify differences in EES-Q scores (domain scores and EES-Q score). Results The median EES-Q score in CRS patients (33.8) was significantly higher (p < 0.001) than in the control group (10.4). As well as the physical (52.5 vs. 16.4, p < 0.001), psychological (13.8 vs. 5.0, p < 0.001) and social (37.5 vs. 2.5, p < 0.001) domain scores. Conclusions With this study, we are extending the use of the EES-Q. It indicates that the EES-Q can be a valuable clinical tool to assess multidimensional HRQoL in all patients with CRS

The effect of three-dimensional visualisation on performance in endoscopic sinus surgery:A clinical training study using surgical navigation for movement analysis in a randomised crossover design

Objectives: Endoscopic imaging techniques and endoscopic endonasal surgery (EES) expertise have evolved rapidly. Only few studies have assessed the effect of three-dimensional (3D) endoscopy on endoscopic sinus surgery (ESS). The present study aimed to objectively and subjectively assess the additional value of 3D high-definition (HD) endoscopy in ESS. Design: A randomized crossover study of endoscopic surgery performance, using five ESS tasks of varying complexity, performed on Thiel embalmed human specimens. Setting: Simulated surgical environment. Participants: Thirty participants, inexperienced in ESS. Main outcome measures: Performance was assessed using video imaging, surgical navigation and questionnaires. Main outcome measures were as follows: efficiency (defined by time to task completion), distance covered inside the nose, average velocity towards target, accuracy (measured by error rate), and subjective assessment of endoscope characteristics. Results: During ESS tasks, both efficiency and accuracy did not differ significantly between 2D HD and 3D HD endoscopy. Subjectively, imaging characteristics of the 3D HD endoscope were rated significantly better. Conclusions: ESS performance of inexperienced participants was not significantly improved by the use of 3D HD endoscopy during ESS tasks, although imaging characteristics of the 3D HD endoscope were rated significantly better. Surgical field characteristics and surgical techniques are likely to influence any additional value of 3D HD endoscopy

Unilateral Hyperlucent Lung in a Child Caused by a Foreign Body Identified With V/Q Scintigraphy

A 5-year-old girl presented with episodes of coughing, inspiratory stridor, and occasionally squeaking breath sounds. There was no history of a foreign body aspiration. Initially, she was diagnosed with allergic asthma. However, signs and symptoms continued despite a trial of inhaled corticosteroids. A chest radiograph showed a hyperlucent right lung, mainly in the upper lobe, with decreased vascular markings compatible with Swyer-James-MacLeod syndrome, or foreign body aspiration. V/Q imaging showed markedly diminished right lung ventilation and perfusion, especially in the upper lobe, with a hot spot in the area of the right bronchus. At bronchoscopy, a pistachio nutshell was removed from the right main bronchus

Communicative abilities in toddlers and in early school age children with cleft palate

Objectives: Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate. Methods: Longitudinal retrospective case history Study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL +/- A; n = 10, 5%), unilateral cleft lip and palate (UCLP; n = 23,37%), bilateral cleft lip and palate (BCLP: n = 9,14%) and isolated cleft palate (CP; n = 21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed. Results: Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p = 0.00), language production problems from 21% to 6% (p = 0.01), articulation problems from 57% to 25% (p = 0.00) and hypernasality from 38% to 10% (p = 0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31 % (p = 0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a Success rate of 86%. Conclusions: At early school age, in children with clefts, speech and language problems were significantly improved following a Multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat. (c) 2009 Elsevier Ireland Ltd. All rights reserved

Epistaxis caused by a dural AV-fistula at the cribriform plate

Objectives/HypothesisA dural arteriovenous fistula (DAVF) with cortical venous reflux (CVR) is a dangerous neurovascular entity. A DAVF at the cribriform plate is typically silent until its inevitable presentation with intracranial hemorrhage. Case SummaryA 67-year-old male presented with severe epistaxis. Following unsuccessful conventional measures and a surgical exploration, a catheter angiography showed a DAVF at the cribriform plate, with its nidus extending into the nasal cavity. The DAVF was treated via a small craniotomy. ConclusionIn case of atypical or unexplained nosebleeds, the possibility of a DAVF or other neurovascular pathology should be excluded by MRI/MRA or catheter angiography. Laryngoscope, 124:2476-2477, 201

Epistaxis following skull trauma

AchtergrondEpistaxis is een veelvoorkomende aandoening die meestal onschuldig van aard is. Soms is epistaxis echter een symptoom van een ernstige onderliggende aandoening.CasusEen 20-jarige man werd conservatief behandeld na schedel-hersenletsel dat bestond uit aangezichtsfracturen en schedelbasisfracturen. Enkele weken na de behandeling maakte hij recidiverende episoden van epistaxis door. Bij aanvullend onderzoek werd een extraduraal aneurysma dissecans van de linker A. carotis interna gezien, dat uitpuilde in de sinus sphenoidalis. Daarop werd patiënt endovasculair behandeld met plaatsing van een ‘coil’ in het aneurysma en een stent in de arterie. Aan de hand van deze casus beschrijven wij de diagnostiek en behandeling bij patiënten met posttraumatische posterieure epistaxis.ConclusieBij epistaxis die enige tijd na een schedel-hersenletsel is ontstaan, moet men bedacht zijn op letsel van de A. carotis interna. Dit is een potentieel levensbedreigende situatie, die snelle behandeling behoeft.BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition.CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis.CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment.</p

Epistaxis na een schedeltrauma

BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition. CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis. CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment

Evaluation of the psychometric properties of the endoscopic endonasal sinus and skull base surgery questionnaire (EES-Q) in a prospective cohort study

OBJECTIVES: The patients' perspective on health has become increasingly important when assessing treatment outcomes. Recently, the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) was developed to determine the impact of endoscopic endonasal surgery on health-related quality of life (HRQoL). The aim of this study was to evaluate the test-retest reliability, construct validity, and responsiveness of the EES-Q. DESIGN: Prospective cohort study. SETTING: University Medical Center Groningen, tertiary referral hospital, the Netherlands. PARTICIPANTS: One hundred patients who underwent endoscopic endonasal surgery because of sinus or anterior skull base pathology. MAIN OUTCOME MEASURES: Test-retest reliability, construct validity and responsiveness. RESULTS: The EES-Q domains exhibited good test-retest reliability (ICC > 0.90). Construct validity was corroborated by significant positive and negative correlations between the EES-Q and the SNOT-22 and postoperative health status (p < 0.01) respectively. The correlation between the social EES-Q domain and the ability to move and perform usual activities (EQ-5D-3L) was significant positive (p < 0.01). In patients with paranasal sinus pathology, the EES-Q was responsive to clinical change (Cohen's d = 0.6). CONCLUSION: The EES-Q is a reliable and acceptable responsive disease-specific HRQoL instrument. The expected construct validity of the EES-Q is supported by the results in this study. Inconveniences in social functioning had the greatest negative impact on postoperative health status rating. This reflects the importance of a multidimensional HRQoL assessment after EES. The results indicate that the EES-Q is a promising disease-specific tool for the HRQoL assessment after endoscopic endonasal sinus or anterior skull base surgery. This article is protected by copyright. All rights reserved