Biomedical subjects
Publications and source records attributed to J Claes.
Chondrosarcomas of the nasal septum are extremely rare tumours. The clinical presentation, imaging features, histopathological characteristics, and therapeutical options for this uncommon lesion are discussed. In this report, two cases are presented, and the literature regarding this rare pathology is reviewed.
We report a four generation family with features of the facio-audio-symphalangism syndrome. This condition is characterized by proximal symphalangism, conductive hearing loss due to stapes fixation and a distinctive facies. A novel nonsense mutation in the NOG gene on chromosome 17q22 was identified in the patients. The variable expression and progressive nature of the syndrome is well illustrated by this family. The role of Noggin as the causative factor of symphalangism is discussed.
Stridor is the sound caused by abnormal air passage into the lungs and can exist in different degrees and be caused by obstruction located anywhere in the extra-thoracic (nose, pharynx, larynx, trachea) or intra-thoracic airway (tracheobronchial tree). Stridor may be congenital or acquired, acute, intermittent or chronic. Laryngotracheal inflammation (croup) is the most common cause of acute stridor. Laryngotracheomalacia is the most common cause of congenital, chronic stridor. Stridor is a clinical sign and not a diagnosis. The golden standard in the workup of stridor is an upper and lower airway endoscopy under general anaesthesia. Endoscopic examination under general anaesthesia requires a multidisciplinary approach and close cooperation between anaesthesiologist, paediatrician, ENT surgeon and nursing staff. Following this procedure, a place in the intensive care unit should be available for those cases presenting with stridor in which a definite diagnosis could not yet be established. Although important, pre-endoscopy assessment including history, physical examination and radiological examination, is only a guide to the type and degree of pathology found during endoscopy. About 1 out of 10 infants are found to have lesions in more than one anatomical site of the upper aerodigestive tract.
Initial management of a neck mass in adults is a frequently encountered problem in ENT practice. The differential diagnosis with regards to clinical presentation, localization, imaging studies and cytology and/or histology is reviewed. An algorithm is provided to help the practioner.
We present a case report of a patient who suffered from an acute cochleovestibular deficit after topical application of potassium iodide solution into the left ear. Although the vestibular symptoms progressively disappeared, severe sensorineural hearing loss persisted after treatment with hyperbaric oxygen therapy and intravenous administration of corticosteroids and vasodilating agents. The mechanisms of ototoxicity after topical application of solutions are discussed with emphasis on the particular features of the present case: a patulous Eustachian tube syndrome and the presence of a tympanostomy tube in the left ear.
Lethal complications after tonsillectomy. Two cases of serious complications after paediatric tonsillectomy, that were referred to our department, resulted in death, one due to massive haemorrhage and one due to hyponatremia. Thanks to early recognition and adequate treatment, two other cases could be successfully treated. The literature on serious complications after tonsillectomy was critically reviewed. Guidelines on peri- and postoperative fluid management are given. Vascular anatomy of the tonsillar region is reviewed. Location and treatment policy on severe haemorrhages are discussed.
OBJECTIVE: To measure the effect of 4 different matching strategies on the accuracy of computer navigation on the face and within the nose and rhinopharynx. DESIGN: Survey. SETTING: Laboratory study. SUBJECTS: Six human cadavers studied within 24 hours of death. INTERVENTIONS: A commercially available navigation system with infrared optical tracking was used for computer navigation on the face and within the nose of the subjects after matching with external fiducials or with 3 different configurations of anatomical landmarks. Navigation errors were measured and correlated to matching strategies and compared through statistical analysis. RESULTS: Matching with external fiducials on the face results in smaller navigation error than matching with anatomical landmarks. The configuration of matching strategies with anatomical landmarks also significantly determines the accuracy of computer navigation, especially when different locations of accuracy measurement are considered. CONCLUSION: Statistically significant findings have shown that the choice of a matching strategy is a major factor in the accuracy of computer navigation for ear, nose, throat surgery. Arch Otolaryngol Head Neck Surg. 2000;126:1462-1466
A review of the literature on drug therapy for Ménière's disease was made using Medline to search for all publications between January 1978 and September 1998. A total of 152 publications were identified that specifically dealt with medical treatment for Ménière's disease. Only betahistine and diuretics appear to have proven efficacy in double-blind studies on the long-term control of vertigo. No treatment has a proven beneficial effect on hearing levels or on the long-term evolution of the disease. Recent publications have proposed a role for the intratympanic use of medication, mainly aminoglycosides, for control of vertigo. We conclude this review by proposing a strategy for the medical treatment of Ménière's disease.
Paranasal sinus mucoceles are benign, space-occupying, cystic lesions that require a surgical treatment. An endoscopic endonasal marsupialisation is nowadays the surgical approach of choice in most of the cases. The aim of the present study is to validate this option and to determine the clinical characteristics of paranasal sinus mucoceles. A retrospective study based on the clinical experience of several ENT surgeons was performed using a standardised questionnaire. The respondents participate to a report on endoscopic endonasal surgery for non-inflammatory disease in Belgium. One hundred and fourty patients presenting 178 mucoceles were included in this study. Primitive mucoceles were reported in 35% of the patients, posttraumatic mucoceles in 2.1% and postoperative mucoceles in 62.9%. The time interval between first rhinologic procedure and the mucocele diagnosis was respectively 24.4 months after FESS and 108.3 months after an external procedure. Paranasal sinus mucoceles predominantly occur in the fronto-ethmoidal region (64%), followed by the maxillary sinus (18.6%), the sphenoid sinus (8.4%) and the posterior ethmoid sinus (6.7%). Uncommon locations were also reported in 2.3% (Inferior turbinate, middle turbinate, pterygomaxillary space). Endoscopic endonasal marsupialisation (combined with an external procedure for 8 patients) was successful in 97.9% of the patients. Only 3 patients showed recurrence. Endoscopic endonasal marsupialisation of paranasal sinus mucoceles is a reliable therapeutic option with favorable results and is supported by the questioned ENT surgeons in Belgium.
The technique and indications of an endonasal endoscopic technique for treatment of posterior epistaxis are presented. Three cases were successfully treated in our department in 1999. The posterior vascularisation of the nose is reviewed with emphasis on surgical anatomy. Endoscopic endonasal ligation of posterior nasal arterial vascularisation is compared with other treatment choices in posterior epistaxis. The technique is save and efficient. Since it is also a minimally invasive technique, it has become our first choice surgical procedure for posterior epistaxis.
Twenty-seven cases of choanal atresia operated between 1979 and 2000 have been reported from 4 different institutions (19 females, 8 males, age of first surgical procedure ranging from 2 days to 35 years). Of these 27 cases, 22 were previously untreated. The outcomes for 19 of these new cases were available for the present report. Bilateral atresias were somewhat more frequent (15 versus 12) and associated anomalies were present in 10 out of 27 patients. Details about the types of atresia, associated anomalies, surgical techniques, duration of stenting and outcomes are given together with a theoretical review on choanal atresia.
Tonsillectomy and adenoidectomy procedures are among the oldest surgical procedures still performed today. Tonsils and adenoids are part of Waldeyer's ring, the basic function of which is antibody formation. Because of their location at the portal of entry of many airborne and alimentary antigens, the tonsils and adenoids often have been considered as the first line of defense against respiratory infections. Indications for adenoidectomy or tonsillectomy are to date still controversial. The two main indications for tonsillectomy are upper airway obstruction due to tonsillar hypertrophy and recurrent acute or chronic tonsillitis. Adenoid hypertrophy with upper airway or eustachian tube obstruction and recurrent acute or chronic adenoiditis or otitis media are main indications to perform an adenoidectomy. The possible immunological effects of tonsillectomy and adenoidectomy are still controversial. Some authors have found changes in immunoglobulin levels after tonsillectomy, while others failed to find significant changes. In a review of long-term follow-up studies, the authors showed that while tonsillectomy may lead to certain changes in the cellular and humoral immune system, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.
Mesna (Mistabron) is a mucolytic substance that is also used for chemically assisted dissection during cholesteatoma surgery. The present animal study aims to evaluate its possible ototoxic side effects. To this end, the right tympanic cavity of 9 guinea pigs was filled with either 20% mesna or 10% neomycin (serving as a positive control), while the left tympanic cavity was filled with saline (serving as a negative control). One week after administration, the inner ears were dissected out and further processed for morphological evaluation by means of either interference contrast microscopy or scanning electron microscopy. No macroscopic signs of middle ear inflammation were observed in any of the ears treated. Whereas damage was obvious in all neomycin-treated specimens, the morphology of both saline- and mesna-treated inner ears was unaffected. These findings led us to conclude that, at least on a morphological basis, no indications are at hand to assume ototoxic effects of this mucolytic substance due to a single application during cholesteatoma surgery.
The Medivision Image Guided Surgery System was used in the E.N.T. Department of the Antwerp University Hospital in 10 different E.N.T. surgical procedures between October 1997 and February 1998. The authors report and discuss the procedure for computer assisted surgery in E.N.T. interventions, based on this preliminary experience, and conclude that computer assisted surgery has many useful applications in our speciality.
Cochlear implants (CI) bypass the external and middle ear and parts of the inner ear, by delivering electrical stimuli to the remaining neural fibres of the acoustic nerve in a meaningful way. Many features of current CI are similar. They are all multi-channel devices with intracochlear placement of the active electrodes and with transcutaneous information and energy transfer. Factors affecting the auditory performance of CI recipients are patient-linked factors and device factors. An overview is given of key design parameters, processing characteristics and specifications of following CI platforms: Clarion S-Series, Combi 40 and Combi 40+, Digisonic DX 10, Laura-Flex and nucleus CI22 and CI24M. These data, combined with outcome parameters can enhance the information of CI-teams, patients or parents of children in their decision making process when faced with a hearing impairment to such an extent that hearing aids are of little or no benefit.
This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Meniere's disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.
A review of the literature on drug therapy for Menière's disease was made using the Medline on-line biomedical database to screen publications between January 1978 and April 1995. In total there were only 118 publications in this 17-year period which specifically dealt with medical therapy for Menière's disease. It appears that only betahistine and diuretics have a proven effect in double-blind studies on long-term control of vertigo in Menière's disease. No medical therapy, however, has a proven effect on hearing or long-term evolution of the disease. There are multiple reports, especially in the recent literature, regarding the intratympanal use of aminoglycosides for vertigo control. Based on this literature review and on empirical findings, a strategy for medical treatment of Menière's disease is proposed.
We report a case of hearing preservation after removal of the semicircular canals and discuss the possible explanations for the mechanisms of preservation of hearing after removal of the labyrinth. We hope to promote the perspectives and possibilities of functional surgery of the inner ear and for tumors of the cerebellopontine angle.