Pneumocephalus following nasal polypectomy.
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Adult↗
Biomedical subjects
D Ophir
Publications and source records attributed to D Ophir.
Possible role of adenoid mast cells in the pathogenesis of secretory otitis media.
The distribution of mast cells in the adenoidectomy specimens of 76 children with enlarged adenoids was studied. Forty of the patients had secretory otitis media; the remaining 36 had normally aerated middle ears. The mast cells were identified on the basis of the metachromatic staining of their cytoplasmic granules with toluidine blue. Patients with secretory otitis media had a twofold increase of their mast cell population compared to those without middle ear disease. Statistical analysis confirmed that the difference between the two groups is significant (p = .0001). The results of the study are consistent with the previous finding of increased histamine concentration in adenoids of children with secretory otitis media and lend support to the adenoid mediator release hypothesis, whereby the adenoid mast cells degranulate and release histamine and other inflammatory mediators that induce eustachian tube insufficiency and otitis media with effusion.
Adenoidectomy↗
Angioleiomyoma of the nasal tip.
The clinical, histological and immunohistochemical findings of a rare case of a solitary subcutaneous angioleiomyoma (vascular leiomyoma) of the nasal tip in a 74-year-old woman are described. Histogenesis and histological characterization of this lesion are discussed.
Aged↗
Cystic hygroma of the parotid gland.
Cystic hygroma of the parotid gland is an uncommon benign congenital neoplasm that presents as an asymptomatic soft fluctuant mass. Cervical ultrasonography, computerized tomography (CT) and magnetic resonance imaging (MRI) are used to assess the size and extent of the lesion and to assist in planning the surgical approach. Ultrasonography may demonstrate a multilocular cystic mass containing septa of variable thicknesses. Extension of the mass into deeper structures is more accurately assessed by CT or MRI. A CT scan may show thin-walled cystic masses filled with material of density close to that of water. The use of contrast medium can demonstrate the relationship of the lesion to the surrounding structures. Magnetic resonance imaging is superior to CT in defining the nature and extent of the lesion.
Child↗
Nasopharyngeal profile and velopharyngeal valve mechanism.
Proper management of velopharyngeal insufficiency requires an understanding of normal velopharyngeal anatomy and function. The present cephalometric study correlates the nasopharyngeal profile at rest with velopharyngeal function as observed by nasendoscopy and fluorographic and videofluoroscopic studies. Fifty-two normal individuals and 23 patients with insufficient velopharyngeal valves were examined. A correlation was found between nasopharyngeal profiles at rest and the closure patterns of the velopharyngeal valve. It was found that when existent, Passavant's ridge is subsequently formed where thick soft tissue corresponding to the superior constrictor muscle is found beneath the mucosa of the posterior pharyngeal wall at rest. Our conclusion is that Passavant's ridge is formed by the superior constrictor. The present study represents additional confirmation that differences in velopharyngeal closure patterns are the result of differences in anatomy. A biomechanical model of velopharyngeal valving is presented based on individual spatial muscular orientation and the hierarchical recruitment of the velopharyngeal muscles. This recruitment is progressive and is dependent on the effort required to achieve tighter velopharyngeal sealing.
Adult↗
Endoscopic diagnosis and treatment of persistent halitosis after pharyngeal flap surgery.
A patient presenting with persistent dramatically offensive fetid malodor 1 year after pharyngeal flap surgery is described. Nasendoscopic examination revealed the presence of a foreign body within the nasopharynx lying on the flap. The foreign body was immediately removed by endoscopic telebiopter and revealed itself to be a gauze pad forgotten during the pharyngeal flap surgery. Modern endoscopic equipment allowed both quick diagnosis of this very rare complication and immediate and simple treatment under topical anesthesia.
Adult↗
Combined (external and internal) laryngopyocele.
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Aged↗
Peritonsillar abscess as a cause of transient velopharyngeal insufficiency.
"Hot potato voice" is a characteristic sign of peritonsillar abscess and peritonsillitis. Our findings show that the hot potato voice is the result of an underlying transient velopharyngeal insufficiency combined with muffled oral resonance. The hot potato voice should be distinguished from the muffled oral voice which can be occasionally encountered in cases of severe tonsillitis. The velopharyngeal insufficiency is the result of transient dysfunction of the palatal muscles on the affected side. Transient negative middle-ear pressure indicating eustachian tube dysfunction was found in few of the patients in whom concomitant sinusitis was also present. The clinical, nasendoscopic, and radiologic findings are analyzed and discussed. We believe that this phenomenon is valuable as a research tool for the investigation of the anatomy and physiology of the velopharyngeal valve.
Acoustic Impedance Tests↗
Obstructing adenoids in adolescents: changing trends?
The number of adolescents undergoing surgery for obstructing adenoids has increased significantly in our practice in recent years. Over an 11-year period during which 539 adenoidectomies were performed, the mean age of patients increased progressively from 4.6 years in 1980 to 7.88 years in 1990. The median age gradually increased over the same period from 4 to 7 years, and the standard deviation from 4.95 to 19.38. Enlarged adenoids should be considered in the differential diagnosis of adolescents suffering from nasal obstruction, snoring or obstructive sleep apnea.
Adenoidectomy↗
Evidence for genetic determination in human twins of olfactory thresholds for a standard odorant.
Olfactory thresholds for four odorants were determined in groups of monozygotic and dizygotic human twins. Odorants were presented in an ascending dilution series in odorless solvent, using a three-way forced choice method. For two of the tested odorants, 5 alpha-androst-16-en-3-one and isoamyl acetate, the thresholds showed a strong genetic component. This was demonstrated by respective values of 0.78 and 0.73 for the intraclass correlation difference, and of z = 3.69 and z = 2.71 in a within-pair difference analysis. The results for isoamyl acetate are novel, and suggest that genetic polymorphism in the affinity of odorant receptor proteins contributes to the (nearly normal) threshold distribution for this odorant.
Humans↗
[Septic cavernous sinus thrombosis].
Septic cavernous sinus thrombosis is a rare complication of facial infections, particularly of the dangerous triangle (nose and upper lip) and less often of the orbit, middle ear, pharynx or teeth. Staphylococcus aureus is the most frequent causative agent. Prompt diagnosis and early aggressive antibiotic therapy, with or without anticoagulants, is required. A 49-year-old woman developed this complication following multiple nasal abscesses. Despite intensive antibiotic and anticoagulant therapy she became permanently blind. We present this case to stress the fact that this disease is still fraught with high morbidity, and even mortality.
Abscess↗
Oral ciprofloxacin in the management of chronic suppurative otitis media without cholesteatoma in children: preliminary experience in 21 children.
The current medical management of children with chronic suppurative otitis media without cholesteatoma unresponsive to local treatment and oral antibiotics is intravenous antibiotic therapy in the hospital setting. We studied the efficacy and toxicity of oral ciprofloxacin in chronic suppurative otitis media. Twenty-one children received oral ciprofloxacin, 30 mg/kg/day. Ear discharge was positive for bacteria resistant to other oral medications and susceptible to the quinolones. The mean duration of treatment was 16.7 days. In 18 children suppuration ceased and 3 failed their first course. During a mean follow-up of 15.4 months, 6 children remained free of ear, nose and throat problems. Otorrhea recurred in 12 children. Ear cultures were positive for organisms susceptible to amoxicillin in 5 of them. In 7 cases Pseudomonas aeruginosa was again isolated from otorrhea. Repeated antibiotic therapy was advocated only in 3 (2 responded to ciprofloxacin; 1 failed ciprofloxacin and was cured by ceftazidime). Adverse clinical effects were not observed. Transient neutropenia was observed in 1 child. There was no change in the height percentile. The results of this study show that children with chronic suppurative otitis media without cholesteatoma can be effectively treated with oral ciprofloxacin. This novel approach may prevent hospitalization.
Administration, Oral↗
Long-term follow-up of the effectiveness and safety of inferior turbinectomy.
The long-term effectiveness and safety of inferior turbinectomy were assessed in 186 patients who were interviewed and examined 10 to 15 years after surgery (mean 12.3 years). Relief of nasal obstruction was reported by 82 percent of the patients; rhinoscopy showed wide, clean nasal airways in 88 percent. Rhinorrhea was still a problem for 34 percent of patients, and 19 percent were receiving medical treatment for this symptom. Smell acuity had improved in 52 percent of the patients. Before turbinectomy, 32 patients had suffered from bronchial asthma; postoperatively, there was an improvement in 16, and no change in 13; 3 patients reported exacerbation of asthmatic attacks. Atrophic changes of the nasal mucosa and chronic purulent infection were not observed in any of the patients.
Adolescent↗
Familial multicentric paragangliomas in a child.
A 12-year-old girl presented with bilateral carotid-body paragangliomas and a unilateral jugular paraganglioma. The tumours were surgically removed. This is a rare combination of tumours in any patient and previously unreported in a child of this age. Her father died of a cerebellar astrocytoma and her mother underwent surgical removal of a large mediastinal paraganglioma. The association of astrocytoma with familial paragangliomas has never been documented. The literature on the epidemiology and inheritance pattern of familial paragangliomas is reviewed. The need for thorough pre-operative evaluation of the patient and close follow-up of family members is stressed.
Carotid Body Tumor↗
Needle aspiration and pressure sutures for auricular pseudocyst.
Auricular pseudocyst is an asymptomatic cystic swelling of the upper portion of the auricle. Various therapeutic approaches have been employed with variable success. We report our results with nine patients treated by needle aspiration and bolstered pressure sutures applied over both aspects of the cyst for 1 week. Treatment resulted in complete resolution with no recurrence of the lesion in any of the patients. This procedure is simple, does not require an operating room setting, and is more comfortable and more acceptable aesthetically by the patient.
Cysts↗
[Pulmonary edema complicating upper airway obstruction].
A 40-year-old man who developed acute pulmonary edema following relief of upper airway obstruction is presented. The mechanism of pulmonary edema associated with upper airway obstruction is complex and not fully understood. It is therefore difficult to predict which patients will develop pulmonary edema during or after the relief of obstruction.
Acute Disease↗
Functional upper airway obstruction in adolescents.
Functional upper airway obstruction is an uncommon manifestation of a conversive reaction characterized by recurrent stridor attacks caused by adduction of the vocal cords during inspiration. The oxygen saturation never drops to pathologic levels. The stridor is not accompanied by an appropriate degree of anxiety and is not associated with other symptoms. Patients benefit from verbal reassurance and speech therapy, but stridor attacks tend to recur and psychiatric consultation seems necessary in most cases. We present the case histories of three adolescent patients with nonorganic upper airway obstruction and describe the features that may facilitate the diagnosis of this condition. Early diagnosis and intervention may prevent unnecessary and potentially harmful investigations and therapy.
Adolescent↗
Resection of obstructing inferior turbinates following rhinoplasty.
Total inferior turbinectomy was carried out in 38 patients who complained of nasal obstruction following rhinoplasty or rhinoseptoplasty and in whom hypertrophied inferior turbinates were found to be the cause of obstruction. Postoperatively, relief of nasal obstruction was reported by 84 percent of patients, while rhinoscopy showed wide, clean nasal airways in 92 percent. Nasal airflow measurements in 32 tested patients showed increased patency in all of them, including 3 who still complained of nasal obstruction postoperatively. The follow-up period ranged from 1 to 7 years (mean 2.8 years). Atrophic changes of the nasal mucosa or chronic purulent infection was not observed in any of the patients. Because the results of partial procedures on the inferior turbinates are often unsatisfactory, I suggest performing total inferior turbinectomy in patients with obstructing inferior turbinates following rhinoplasty.
Adolescent↗