Search PubMed⌕ Search

Biomedical subjects

P Eloy

Publications and source records attributed to P Eloy.

At least 19 recordsLinked to original sources

The silent sinus syndrome.

Silent sinus syndrome is a rare clinical entity typically characterized by spontaneous and progressive enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary collapse in the setting of the chronic maxillary sinus hypoventilation. The authors report an unusual case revealed by mild dental pain, present the imaging (before, during and after the development of the disease), discuss the different theories related to pathogenesis and comment the treatment.

Animals↗

[Actinomycotic lachrymal canaliculitis: a case report].

The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.

Actinomycosis↗

Thornwaldt's cyst and surgery with powered instrumentation.

Thornwaldt's cyst is a relatively rare lesion located in the posterior wall of the nasopharynx. Most are small and asymptomatic whereas some cause nasal obstruction, postnasal drip, occipital headache or Eustachian tube dysfunction. Nasal endoscopy is the easiest way to visualize this during a routine ENT examination. If in any doubt, MRI is the most sensitive method for detecting and evaluating its size, its anatomic relationships and its content. When the lesion is large, symptomatic or close to the Eustachian tube torus, surgery by marsupialization is the treatment option. For small lesions, the endonasal approach is recommended but for large lesions, a transoral retrovelar approach using a 70 degree telescope is the method of choice. The powered instrumentation with a specific blade for adenoid resection permits large marsupialization with minimal trauma and bleeding and excellent postoperative results. The authors present their experience and review the relevant literature.

Adult↗

Guidelines to the management of epistaxis.

This article is a review of the literature on epistaxis and its treatment. Data were collected from MedLine until mid September 2005, and from others readings and books. Its first goal was to present to the Belgian ENT practitioners an overview, as complete as possible, of the modern concepts in etiologies, medical, conservative, surgical (including embolization), and adjunctive therapies of epistaxis. All these topics are discussed and commented, from a medico-surgical point of view, and also from a cost effectiveness one.

Cost-Benefit Analysis↗

Management of chronic rhinosinusitis without polyps in adults.

Chronic Rhinosinusitis (CRS) is a group of multifactorial diseases characterised by inflammation of the mucosa of the nose and paranasal sinuses with a history of at least 12 weeks of persistent symptoms and signs despite maximal medical therapy. IgE-mediated hypersensitivity and asthma are the two most important associated factors. Diagnosis of CRS is based upon the medical history and either an endoscopy or CT scan. Initial medical treatment usually consists of the avoidance of all the contributory factors and then nasal douching and nasal steroids. If medical treatment fails, endoscopic sinus surgery is considered. The authors review the most important factors associated with CRS, the diagnostic work-up and different treatment options. They also present a rationale for treatment.

Adult↗

Smell disorders in ENT clinic.

Olfactory disorders may have several causes. Nasal polyposis or chronic sinusitis can result in nasal obstructions that block the access of odorants to the olfactory epithelium, and this can explain the development of olfactory disorders. On the other hand, when nasal endoscopy has revealed that the nasal cleft is free of inflammatory or tumoural disease, olfactory disorders may be explained by neuroepithelial or central nervous system disturbances. This paper will provide information about current approaches to smell disorders in otorhinolaryngology. Major causes will be reviewed as outcomes after medical or surgical treatment. An algorithm will also be given to standardise clinical investigations, including psychophysical olfactory testing, imaging and electrophysiological examinations.

Central Nervous System Diseases↗

Transnasal repair of unilateral choanal atresia.

OBJECTIVES: To evaluate the outcomes of the surgical correction of unilateral choanal atresia using a transnasal approach. PATIENTS AND METHOD: Over a 36-months period (from 1999 to 2001), seven children underwent endoscopic endonasal repair of an unilateral choanal atresia using the microdebrider (powered instrumentation). At the end of the procedure, topical application of Mitomycin-C was performed. No postoperative nasal stenting was inserted. Clinical characteristics of these patients, CT scan examination, complications of the procedure and outcomes were analysed and compared to historical cases treated in the same institution from 1990 to 1998. RESULTS: Seven patients (2 M/5F) (age 6 to 46 months) presented with primary unilateral choanal atresia and were operated during the period from 1999 to 2001. All the patients were symptomatic before surgical correction. No patients showed other facial anomaly. Of the 7 patients procedures, 6 (85.7%) remained patent (follow-up range 12 to 36 months). Mean surgical repair per patient before obtaining patent choana was 1.14. One patient required surgical transnasal revision nine months after the initial procedure with a patent choanal after this second procedure (follow-up 9 months). Minor turbinoseptal synechiae diagnosed 6 months after the surgical correction occurred in one patient and was the only postoperative complication. When compared to historical cases of unilateral choanal atresia (19 patients from 1990 to 1998) repaired without endoscopic control and without Mitomycin-C, it was shown that this current method provided better results; mean surgical repair per patient; 1.14 vs 1.89 and 85.7% of patent choanae at twelve months vs 47.3%. CONCLUSION: An endoscopic endonasal approach without postoperative stenting, using the microdebrider seems to us the treatment of choice for unilateral choanal atresia. The exact role of the topical application of Mitomycin-C needs to be further investigated.

Child, Preschool↗

[Choanal atresia: a retrospective study of 39 cases].

The purpose of this study was to investigate the clinical characteristics and the surgical management in patients with choanal atresia. We performed a retrospective study at the Saint-Luc University hospital, Brussels, between January 1988 and June 2000. Surgical corrections were performed using different approach (transnasal endoscopic, transpalatal) and different instrumentations (urethral sounds, laser nd-YAG, laser CO2, microdebrider). Portex endotracheal tubes were inserted as nasal stents in the vast majority of the patients with bilateral choanal atresia. Thirty-nine children with choanal atresia (22 unilateral and 17 bilateral) (9: M, 30: F) were studied. 38 of them were surgically managed. Based on clinical inspection and On CT-Scan, choanal atresia was defined as membranous for 4 patients, osseous for 6 and mixte for 29. Associated congenital anomalies were found in 22.7% of unilateral and in 70.5% of bilateral choanal atresia (Total: 43.5%). Of those children with bilateral choanal atresia, 75% were asymptomatic after four surgical procedures. In children with unilateral choanal atresia, 45% were asymptomatic after one surgical correction and 100% after three surgical corrections. Four patients were managed using an endoscopic endonasal approach with the microdebrider and showed no evidence of recurrence. Outcome analyses of factors that may influence the results of surgery are difficult to establish since many different surgical options were taken during this period. However, it seems that bilateral choanal atresia is associated with more surgical corrections before achieving a normal nasal breathing than unilateral choanal atresia. After this review, our current strategy regarding the choanal atresia will be to begin with the endoscopic endonasal approach using the microdebrider (stents if bilateral) and to propose the transpalatal approach in case of recurrence.

Age Factors↗

[Sinus-nasal polyposis: one-year outcome after endoscopic sinus surgery followed by topical corticosteroid therapy in 72 patients].

Nasal polyposis (NP) is considered as an inflammatory disease for which first line therapy is topical and/or oral corticosteroid. In this paper we attempted to determine the efficacy of endoscopic endonasal surgery followed by topical corticoid in 72 adults suffering from bilateral NP refractory to corticosteroid therapy and to delineate the clinical characteristics of this cohort of patients. NP was confirmed endoscopically and with computed tomography. Visual analog scale for the subjective evaluation and endoscopic examination of the paranasal cavities for the objective evaluation were obtained 3 and 12 months postoperatively. Endoscopic endonasal surgery was based on a radical removal of the NP with wide opening of all the sinuses in the vast majority of the cases. Topical corticoid therapy was started 2 months after surgery. Clinical characteristics of the 72 patients revealed: 29.2% of coexisting allergy; 34.7% of coexisting asthma; 19.4% with food and/or aspirin intolerance. Anterior and posterior ethmoid sinus and maxillary sinus were the most affected sinuses. 53.5% of our patients presented a stage II. One year after surgery we observed that 59.1% of our patients revealed a marked decrease of their symptoms with no polyp on nasal endoscopic evaluation, that 28.8% revealed a marked decrease of their symptoms with recurrence of the NP on nasal endoscopic evaluation and that 12.1% presented moderate to severe symptoms with recurrence of NP on nasal endoscopic evaluation. Based on this experience, we think that endoscopic endonasal surgery will continue to play an important role in the management of NP when the patient becomes refractory to corticoid.

Administration, Topical↗

Is septal deviation a risk factor for chronic sinusitis? Review of literature.

INTRODUCTION: The purpose of this work is to examine the role of septal deviation in adults in the pathogenesis of chronic sinusitis. This evaluation would allow a better understanding of the contributing factors to this pathology and would improve results in their management. MATERIAL AND METHODS: This review was based on a Medline research over English and French literature published between 1980 and May 2001. Twenty-five papers were scrutinized. RESULTS: Few investigators examined the role of the deviated septum on sinus disease. Methodologies and results are often contradictory. Furthermore, these studies are mainly based on radiological imaging. In most studies, prevalence of septal deviation looks the same when having compared among patients with radiological rhinosinusitis and among general population. An increased incidence and severity of sinus disease correlated to an increasing angle of septal deviation in the ostiomeatal complex area is reported by Calhoun (7), Youssem (4), Matschke (18) et Elahi (20). One study (1) demonstrates a significant association between the shape of the nasal septum and the location of the sinus disease: septal crest is associated with homolateral sinusitis, "watch-glass shaped diformity" with controlateral sinusitis. Stammberger (21, 25) suggests a pathophysiological role of the septum through a mechanical obstruction on the ostiomeatal complex; Danese (1) and Blaugrund (19) by an alteration of the ciliary activity secondary to a modified air flow. Bachert (24) demonstrates a connection between septal deviation and antral ventilation. CONCLUSION: This literature review cannot establish a definite role to the nasal septum neither as the pathogenesis of chronic sinusitis nor as a contributing factor. No relationship between septal surgery combined with sinus surgery, and the postoperative prognosis nor on the subjective comfort of patients can be demonstrated. Subsequently, it appears that performing septoplasty only aims at relieving nasal obstruction complaint or at improving surgical access to the ethmoïd sinus.

Adult↗

Sinonasal lymphomas. Case report.

In the field of Otorhinolaryngology sinonasal lymphomas are relatively uncommon and represent less than 1% of all head and neck malignancies. Nowadays, they are regarded as consisting of two distinct subgroups, characterised by phenotype, location, prognosis and treatment. Lymphomas of the B-Cell phenotype are the most frequent type found in the paranasal sinuses. They are less aggressive and carry a relatively better prognosis. T/NK-Cell lymphomas are mostly found in the nasal cavity. They are more aggressive and carry a relatively worse prognosis. We present a case of a 65-year-old patient, who complained with unilateral right-sided nasal obstruction associated with a sensation of right aural fullness. CT scan demonstrated opacity of the posterior ethmoid and sphenoid sinuses on the right side, with evidence of erosion of the anterior wall of the sphenoid. Nasal endoscopy revealed a smooth purple mass, arising from the right superior meatus, which bled on contact, and which was subsequently shown to be, on histological assessment, a malignant high grade lymphoma, non-Hodgkin's B-cell phenotype. Following a discussion of the case we will present a review of these tumours, which have a poor overall prognosis, focusing on epidemiology, sites of origin, symptoms, investigation and management.

Aged↗

Congenital nasal pyriform aperture stenosis in newborn: report on three cases.

Congenital nasal pyriform aperture stenosis (CNPAS) is recognized as a cause of nasal airway obstruction in the newborn. The nasal pyriform aperture is narrowed by a bony overgrowth of the nasal process of the maxilla. The CNPAS may occur as an isolated congenital defect or in combination with other abnormalities. Three cases of CNPAS are reported with special attention to the clinical presentation and to the management recommendation prior to surgery. Surgical repair was performed for all these three highly symptomatic patients using a sublabial approach for drilling the nasal process in order to obtain a wider nasal vestibular patency. All of them were equipped with bilateral nasal stenting.

Female↗

Endoscopic endonasal surgery for paranasal sinus mucoceles.

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.

Adolescent↗

Surgery of inverted papillomas under endoscopic control.

Six centers cooperated in a retrospective study on endoscopic surgical resection of Papillomas of the nose and paranasal sinuses in order to assess both the efficiency and the safety of this kind of surgical approach. From 1991 till march 2000, 87 cases of Papillomas resections under--at least partially--endoscopic control were gathered, among which 85 were Inverted Papillomas (IP), 2 were Exophytic Papilloma (EP) and one was IP coexisting with Collumnar Cell Papilloma (CCP). Malignant transformation was found out in 3 cases of IP. Regarding the 85 patients with IP demographics are as follows: 61 males, 24 females, with a mean age of 58.4 years (STDV: 13.96) in a range from 27 to 92 years. The mean follow-up was of 41.9 months with range of 1-120 months. Fifteen recurrences occurred that were treated by revision surgery either under endoscopic control or by limited external approach. The mean time for recurrences to occur was 8.07 months with range of 1-24 months. The three patients with malignant transformation underwent postoperative radiation therapy. All of the patients are free of recurrence, however for some of them the follow-up is too short to definitely assess their free of disease status. The role of modern diagnostic tools in medical imaging--CAT and MRI--in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The stress is put on the need for radical excision under endoscopic control which can be combined with the Caldwell-Luc transantral approach or with frontal trepanation for the cure of tumors impossible to be reached under endoscopic control only. Irrespective of the tumor extent and of the approaches that was used for excision a close endoscopic follow-up still remain mandatory, by trained surgeons, in the long term management of IP. Biopsies, CAT and/or MRI must be performed in any case with recurrence suspicion.

Adult↗

Transcanalicular diode laser assisted dacryocystorhinostomy.

AIM OF THE STUDY: To assess the validity of transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) in the treatment of distal obstruction of the lachrymal pathways. MATERIAL AND METHOD: Between June 1999 and February 2000, 29 TLADCR were performed in the ENT department on 26 patients. Surgical indications included chronic dacryocystitis in 19 cases and dacryostenosis in 10 cases. In all cases but one, the surgery was carried out under a standard general anesthetic. The diode laser was used with a power setting of 10 watts. RESULTS: Seventeen out of 29 TLADCR were regarded as having successful outcomes. 2 out of 29 TLADCR had a little persisting tearing regarded as non debilitating and much less than which was present preoperatively. In 10 out of 29 TLADCR, the procedure was deemed a failure. These failures included 4 out of the 10 primary dacryostenosis and 6 out of the 19 chronic dacryocystitis. Two patients refused further treatment. In the other 8, surgical revision was undertaken via the traditional endonasal approach. In 7 of these cases, the lachrymal system was full of purulent secretions. COMPLICATIONS: Two patients developed a partial stenosis of one canaliculus that was diagnosed during the surgical revision. Another patient had a small fistula between the canalicular system and the skin of the corner of the eye that disappeared after the revision surgery. In one other case, the superior canaliculus was cauterised by the denudated portion of a resculpted laser fibre. Two bicanalicular nasal stent required reinsertion. Three patients developed a granuloma around the stent. Four patients developed an episode of infection whilst the stent was still in situ. CONCLUSION: Transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) performed with a 600-micron contact fibre is a relatively simple, elegant and effective procedure when used in conjunction with nasal endoscopy, to treat distal obstruction of the lachrymal pathways. But, the cost, the high prevalence of minor complications and the currently higher reported failure rate would favour external or endonasal approaches over this approach.

Adolescent↗

Transnasal endoscopic orbital decompression and Graves' ophtalmopathy.

AIM OF THE STUDY: To assess the validity and the limits of endoscopic endonasal orbital decompression for Graves' ophtalmopathy resistant to the medical theapy. MATERIAL AND PATIENTS: Between September 1994 and May 1998, 16 patients with Graves' ophtalmopathy resistant to the medical treatment underwent an orbital decompression transnasally. 27 orbits were decompressed. The surgery was bilateral in 11 patients. In the 5 remaining cases, the surgery was unilateral. It was carried out on the left side in 2 cases and on the right side in 3 cases. RESULTS: Preoperatively, the average visual acuity was 8/10. Postoperatively, the visual acuity was 9.5/10. The average preoperative exophtalmometry measurement was 25.04 mm and the average postoperative measurement was 21.83 mm. The average retrodisplacement was 3.17 mm (range: 2-8). Preoperatively, 3 patients had mild diplopia whereas 5 others had moderate to severe extraocular muscle dysfunction. Postoperatively, 6 patients had mild diplopia whereas 10 patients required squint surgery for moderate to severe extraocular muscle dysfunction. CONCLUSION: Endoscopic orbital decompression improve all the symptoms of Graves' ophtalmopathy but one: the extraocular muscle dysfunction. Its cardinal indication is the treatment of compressive optic neuropathy whereas this surgical approach provides an excellent control of the medial wall of the orbit and the orbital apex. But the average reduction of proptosis of 3.17 mm is not high enough to propose this approach alone for the treatment of disfiguring proptosis. In such cases, a 2 or 3 wall orbital decompression should be performed to get marked cosmetic and functional improvement. In all cases, the patient should be informed about the risk of postoperative diplopia.

Adult↗

Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a rare tumour of the head and neck with very specific characteristics: adolescent males, choana-nasopharynx, pterygomaxillary fossa widening, specific and intense vascularisation. Staging is very important in the decision of the surgical approach. Endoscopic management of juvenile nasopharyngeal angiofibroma is technically possible after preoperative embolisation. Up to now 13 angiofibroma have been treated using the endonasal endoscopic sinus surgery approach in Belgium (Leuven 8; Mont-Godinne 2; Ghent 1; Liege 1; Woluwe 1). In smaller tumors endoscopic resection has been successful in four cases without any recurrence. Five larger tumors, extending in the pterygomaxillary fossa, were also successfully resected. Extension into the infratemporal fossa or the cavernous sinus can be endoscopically removed, but recurrences may occur as they do after classical, external approaches. In conclusion, the endoscopic approach is an acceptable alternative in small to middle sized juvenile nasopharyngeal angiofibroma.

Adolescent↗

Secondary ciliary dyskinesia in upper respiratory tract.

The system of mucociliary clearance has the important task to remove from the airways inhaled substances and locally formed secretions. Inborn disorders of the mucociliary transport are due to ciliary dysfunction (Primary Ciliary Dyskinesia) (PCD) or of increased viscosity of the bronchial secretions (Cystic Fibrosis). To differentiate PCD from the ultrastructural abnormalities found during or after injuries such as respiratory infections, the name of Secondary--or acquired--Ciliary Dyskinesia (SCD) was created. In controls, less than 4% of the cilia may show ultrastructural abnormalities. The most frequent of these are the compound cilia and the peripheral microtubular abnormalities. Compound cilia often appear after infection and therefore are thought to arise secondarily. Secondary ultrastructural abnormalities of cilia include also blebs of the axoneme membrane, ciliary disorientation, and absence of axoneme membrane. No increase in ultrastructural ciliary abnormalities has been found in a variety of respiratory disorders: smoking, asthma and allergic rhinitis, chronic rhinitis and sinusitis, chronic bronchitis, cystic fibrosis, and lung carcinoma. But severe modifications of the respiratory epithelium can be seen. Important for the secondary ciliary disorders is their local and reversible character. To distinct from ultrastructural images between primary and secondary ciliary dyskinesia is often uneasy because some of the findings in secondary ciliary dyskinesia obviously mimic those dedicated to primary ciliary dyskinesia.

Bacterial Infections↗