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  • ISSN: 2379-948X
    Volume 2, Issue 12
    Research Article
    Piergiorgio Giacomini, Roberta Di Mauro , Davide Topazio* and Stefano Di Girolamo
    Acute vestibular injury, such as vestibular neuritis (VN), can produce a profound alteration in balance manifested by perception disorder and impaired control of postural adjustment and execution of movements. Stabilometry assesses posture balance through the quantification of body oscillations from the orthostatic position in a force platform. It involves monitoring center of pressure (COP) displacement to the lateral direction (X) and anterior-posterior direction (Y). In our study we investigated the postural control of patients affected by VN. We analyzed 30 subjects: 15 patients constituted the case group affected by VN were compared with 15 healthy volunteers. A static posturography was made within 6-24 hours of symptoms onset. Our purpose was to assess the use of posturography Fourier Frequency analysis with head tilt for the detection of peripheral vertigo destabilization. Fourier spectral analysis of body sway reveals that, independently from visual control, patients exhibit a significantly higher level of low/middle frequency oscillations on the frontal plane. The macular stimulation by head tilt increases significantly the difference in all analyzed parameters: there are significant differences of body oscillation in the patients vs controls on X and Y planes, the latter evident only in head tilt tests. The head tilt seems to show an antero-posterior plane destabilization otherwise not evident.
    Thomas B. V Nguyen*, C. O'Meara, Ronald Y Chin, Peter Flynn and Micheal Walsh
    Introduction: Tracheal stents are deployed to attenuate intrinsic or extrinsic airway compression. They remain the gold standard for management of airway stenosis, especially when surgical resection is contraindicated. This study aimed to determine whether stent placement, by either fluoroscopic guidance or rigid bronchoscopy, resulted in improved procedural outcomes.
    Methods: We compared two techniques of tracheal stent insertion and their associated complications. Method one involved insertion of stent under fluoroscopic guidance, while Method two involved placement with rigid bronchoscopy under direct vision. Both techniques require pre-operative airway assessment with Computed Tomography imaging, but require different anesthetic intervention. Data from patients receiving stent insertion over a period of 4 years, at either Nepean Hospital or Beaumont Hospital, was assessed.
    Results: Both techniques enabled appropriate stent placement, resulting in patent airways and attenuation of dyspnea. Rigid bronchoscopy is advantageous in a setting lacking intraoperative image intensifier or flexible bronchoscopy; however insertion of stents under fluoroscopic guidance enables management of more distal stenosis, an area of challenge for rigid bronchoscopy.
    Conclusion: Tracheal stenting can be performed via different techniques with similar results in patient outcomes. We demonstrate that tracheal stenting via rigid bronchoscopy can be successfully performed to provide patients with patent airways in the emergency setting and may represent a more viable option in facilities lacking intraoperative image intensifier or flexible bronchoscopy.
    Carolina Rebelo van Schaik, Danielle Ho* and Ng Yuk Hui
    Background: Topical steroid therapy is first line in treatment of chronic rhino sinusitis. It is often combined with sinus surgery to improve distribution of medication to diseased mucosa. Despite having many delivery methods available, there is no conclusion on the most efficacious mode of penetration. This study aimed to evaluate whether a pulsed nebulised system significantly improves drug distribution to the Paranasal sinuses before and after sinus surgery compared to the conventional nebulizer.
    Methods: Intranasal distribution of Methylene blue staining solution delivered with the PARI sinus device with and without pulsation was assessed in the nasal cavities of 4 frozen cadaver heads (8 sides), before and after sinus surgery. 2 independent observers graded the surface area covered by the dye using a scoring system.
    Results: There was no significant difference in the surface area of dye distribution to all sites prior to surgical intervention between the pulsed and non-pulsed nebulizer (p = 0.29). This finding was consistent post-surgery within the nasal sinuses and recesses (p = 1) except for a statistically significant increase in dye distributed by the pulsed nebulizer in the posterior ethmoid and sphenoid sinus after surgery (p = 0.046 at both sites).
    Conclusion: The pulsation does not significantly alter the distribution of dye within the nasal sinuses pre-operatively. After endoscopic sinus surgery there was significant increase in dye distributed by the pulsed nebulizer within the posterior ethmoid and sphenoid sinus. However, further work is needed to evaluate the impact of different contrast agents in similar studies.
    Case Report
    Yi-Chan Lee, Chi-Che Huang, Shu-Hang Ng, Shih-Ming Jung, Ta-Jen Lee* and Chia-Hsiang Fu*
    Hepatocellular carcinoma (HCC) seldom presents only as acute visual loss without any other abdomen or systemic symptoms. Sinonasal area, besides, is an extremely rare metastatic site for HCC as well. We reported a rare case of a 69-year-old male, presenting initially with of left eye rapid vision loss, and the sinonasal mass lesion was found two months later when he had left epistaxis attacked. The initial magnetic resonance image was reviewed and indicated a mass lesion on lateral wall of left sphenoid sinus with cavernous sinus and left optic apex involved. Metastatic HCC was subsequently confirmed by biopsy with immunohistochemistry stain. The original HCC was subsequently discovered by abdomen echo and elevated α-fetoprotein. He was then referred for chemotherapy. The presenting symptom of sinonasal tract metastasis originated from hepatic malignancy as acute vision loss could be easily missed. Physicians should always take metastatic neoplasms into clinical differential diagnosis of a unilateral sinonasal lesion.
    Narin Nard Carmel, Leonor Trejo and Yael Oestreicher-Kedem*
    Giant cell tumor (GCT) is mostly a benign bone tumor. Only 2% of GCTs arise in the head and neck region, mostly in cranial bones. Laryngeal GCTs (LGCT)s are relatively rare and present as hoarseness and neck swelling, mostly in middle aged men. LGCTs are usually only locally destructive, and pulmonary metastases and malignant transformation are rarely observed. We present here a rare case of a man in his 50s with LGCT of the larynx originating in the thyroid cartilage lamina. The pathogenesis, physical, imaging and pathologic findings and treatment options of LGCT are discussed.
    Alain N Sabri, Nagi G El Sabbagh, Marie Therese Homsi and Randa Al Barazi3
    The prevalence of Mycobacterium tuberculosis infections is rising worldwide. Head and Neck lymphadenitis is the most common manifestation of extra-pulmonary tuberculosis. Such a condition can act as a precursor to more invasive deep neck space infections and abscess formation, namely in the parapharyngeal and retropharyngeal spaces. The diagnosis of parapharyngeal space tuberculosis abscesses poses a challenge to physicians in general and otolaryngologists in specific, especially in tuberculosis non-endemic areas of the world, where the level of clinical and epidemiological suspicion is low. This article reports a rare case of parapharyngeal space Mycobacterium tuberculosis abscess in an asymptomatic, previously healthy, 25 year old Middle Eastern patient. This report aims to highlight the challenges that lie in the differential and definitive diagnosis of this rare disease and to raise the awareness among general practitioners and otolaryngologists in the developed countries to the importance of maintaining a high index of suspicion whenever dealing with unusual cases, especially in patients originating from, or having recently visited tuberculosis endemic areas. Another aim of this report is to emphasize on the importance of screening such patients for states of immunodeficiency such as HIV status, malignancy, diabetes, long term corticosteroid therapy and inflammatory diseases.
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