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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred patients, aged 13-79 years, have undergone 195 endoscopic 'ethmoidectomies'. The operative method was entirely based upon the Messerklinger technique. In this study there were two main groups. (1) Patients with moderate to massive nasal/endonasal polyposis. (2) Patients with recurrent sinusitis. In the second group, the preoperative endoscopic findings were dominated by disease in the middle meatus and in the area of the anterior ethmoid, verified either by conventional hypocycloidal or computed tomography. Close to 90% of the patients were treated on an out-patient basis, under local anaesthesia. No serious peroperative complications (major bleeding, CSF leak, or visual problems) have been encountered. Thorough and meticulous post-operative care to avoid adhesions and renewed ostiomeatal obstruction, is felt to be important. The mean follow-up was 14 months. The post-operative results are encouraging, and correspond to larger European and American reports. The Messerklinger technique has proved to be suitable for smaller ENT departments, such as ours, especially as the patients can be treated on an out-patient basis using local/topical anaesthesia.
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PMID:Functional endoscopic sinus surgery on a day case out-patient basis. 149 18

While rhino-liquorrhea is a severe condition, its incidence is not exceptionally rare, and it raises problems, namely etiopathogenic, diagnostic and therapeutical ones, which call for the close collaboration of ENT doctors, neuroradiologists and neurosurgeons. 4 relatively recent cases are reported here, whereby the diversity of the problems encountered is made apparent. ENT specialists must be aware of those when faced with refractory aqueous rhinorrhea, often triggered by forward head motion, Valsalva's maneuver... Screening for rhinorrhea is readily achieved by biochemical tests, or simply using a Labstix-type diagnostic strip. Rhinoscopic examination should be accurate and carried out optically to check for any congenital malformation (meningocele). Most of the times, but not always, a thorough radio-neurological workup (isotopic analysis, CT-scan with contrast medium, MR imaging) will provide precise data regarding the infraction site and its possible cause, invariably warranting surgical management. Surgery should be case-adapted (CSF derivation, filling of the gap via the extra- or intracranial approach).
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PMID:[Apparently primary cerebrospinal rhinorrhea. Apropos of 4 cases]. 201 76

Recurrent meningitis in children is not only a potentially life threatening condition, but often involves the child in the trauma of repeated hospital admissions and multiple and invasive investigations to try and find an underlying cause. Symptoms and signs of CSF rhinorrhoea or otorrhoea are infrequent in these patients. Unilateral deafness may be difficult to diagnose in the young child. Full ENT examination may be normal. We report seven cases of children with recurrent meningitis in whom inner ear abnormalities were only indicated as the site of entry of infection by hypocycloidal tomography or high resolution CT scanning of the temporal bone. Subsequent tympanotomy confirmed the site of the CSF leak as the oval window in the majority of cases; packing the vestibule with muscle halted further attacks in these patients.
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PMID:Recurrent meningitis in children due to inner ear abnormalities. 275 16

Twenty-four patients have undergone resection of tumours involving the cranial base by a multidisciplinary team consisting of a neurosurgeon, ENT surgeon and plastic surgeon. The resultant defects of the cranial base have been reconstructed using local fascial flaps, transposition of local muscle flaps and microsurgical transfer of free muscle flaps. Indications for reconstruction have included obliteration of paranasal sinuses, coverage of tenuous dural repairs or dural grafts and separation of the nasopharynx from the dura of the frontal and temporal lobes and posterior fossa to prevent CSF leakage and meningitis.
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PMID:Reconstruction of the cranial base following tumour resection. 303 19

CSF fistulas are a major complication of head injury but also occur spontaneously or symptomatically in connection with tumours of the skull base, empty sella syndrome, ethmoidal encephalomyelocele, intracranial hypertension or postoperatively in connection with operations on skull base tumours or ENT operations. Their main risk is the possibility of meningitis. The main clinical symptom is CSF leakage from the nose, but meningitis may be the first manifestation. Isotope cisternography and metrizamide CT cisternography are the most important methods for precise localization, sometimes also for verification of a suspected fistula. Most traumatic CSF fistulas of the frontal and ethmoidal region have to be treated operatively. The method of choice is the transfrontal approach and the closure of the fistula opening using a pedicled pericranial flap or fascia lata graft. Most sphenoidal fistulas have to be treated by packing the sphenoidal sinus with muscle. The treatment methods of the rare spontaneous and symptomatic CSF fistulas are also described. The results of operative treatment are satisfactory. About 6% recurrences, which as a rule can be cured by reoperation, and a mortality rate of about 1-3% seem to be an acceptable price for prevention of an otherwise unavoidable and oftenly deadly meningitis. Future efforts are necessary to improve the operative technique in order to reduce the incidence of anosmia. Our descriptions and advice are based not only on literature reports but also on our own experiences with a combined material of 237 cases operated on for rhinorrhea.
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PMID:Traumatic, spontaneous and postoperative CSF rhinorrhea. 653 67

After craniofacial resection for ethmoid and nasal cancer the resulting defect in the anterior base of skull often is a problem because of liquorrhoea, followed by meningitis and brain herniation. Two approaches were used for surgery of ethmoid and nasal cancer involving the anterior base of skull-the transfrontal and the transethmoidal. The neurosurgeon performs the transfrontal approach, an additional lateral rhinotomy and ethmoidectomy is made by the ENT-surgeon. Seven patients underwent radical operation with immediate repair of the skull base defect performed in four and delayed repair in three cases with a microvascular latissimus dorsi muscle flap. The flap was tailored as a pure muscle transplant if only the base of skull had to be repaired and the surgical cavity had to be obliterated. In three cases a skin paddle was left on the muscle to perform closure of the orbit and of the hard palate. The aim of reconstruction is a good functional and cosmetic result and reduction of postoperative problems-such as brain herniation, CSF-leakage and meningitis-by obliteration of surgical cavities. Furthermore crusting of large cavities and disorders of phonation are reduced. The disadvantage of limited direct postoperative tumour control by nasal endoscopy however is justified by an increase of quality of life.
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PMID:Repair of anterior base of skull with free latissimus dorsi flap. 874 66

A safe closure of a dura lesion is necessary on account of the risk of potentially fatal (late) meningitis. 161 duraplasties of the frontal skull base carried out from 1979 to 1994 at the ENT-department Fulda were evaluated in a retrospective study in regard to etiology, operative techniques and results. Duraplasty of the rhinobasis was indicated in 70 cases of rhinobasal trauma, 47 cases after paranasal sinus surgery, 36 cases of tumors and 8 malformations. After an average follow-up time of 6 years the patients were interviewed for postoperative liquorrhea, sinusitis treated with antibiotics and meningitis. As an objective measure to verify the tight closure of the treated CSF-leaks a fluorescein test was performed in 50.9% 6 to 8 weeks after the operation. Duraplasty was successful in more than 96%. The approach and technique to perform a duraplasty have to be chosen individually considering size, location and etiology of the dural defect. In the majority of dural defects in the area of the frontal skull base reconstruction can be carried out now a days via an endonasal approach. By use of allogenic tissue, a mucosal flap from the surrounding area to cover the graft and fibrin clue good results were obtained.
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PMID:[Long-term follow-up of fronto-basal dura-plasty]. 941 33

The authors discuss problems of the nasal dermoids treatment. They point at difficulties with settlement of right term of operation, and they stress that X-ray diagnosis before operation should be taken into consideration to exclude the contact of the dermal cyst or sinuses with cranial cavity. They confirm necessities of radical removal of the cyst or/and the sinus to gain the recovery. They analyse the material of 6 patients with dermal cysts or sinuses who were operated since 1988 to 1997 in the ENT Department of Municipal Hospital, Gdynia. They were 4 boys and 2 girls. In each case a cyst with fistulas was observed. All children were treated surgically, and their ages were 2-14 years (mean 6 1/2). In 2 cases there was self-existent destruction of the nasal bones, other 2 patients had median rhinotomy made, in 2 cases only simple excision of the cyst and sinuses was performed. In any case it was no recurrence of the disease (time of follow-up is 1-10 years). The analysis is illustrated with two case reports. The first case was a 2-year-old boy who had a dermal cyst with sinus penetrating into the cranial cavity. CT imaging did not reveal obvious evidences of that. During operation, a momentary CSF leak was observed but it was stopped using oxycel and tissucol. The second case, a 7-year-old boy, was treated by curettage of the dermoid, with recurrence after 6 months. This patient was cured after total resection of the cyst and sinuses. In conclusion, the authors present in detail signs that can attest that contact of the cyst with the cranial cavity exists. They stress the necessity of right surgical treatment in cases of dermal cysts of the nose to avoid recurrence or complications.
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PMID:[Nasal dermoid cysts and sinuses]. 1058 51

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk factors such as underlying disease, cancer, diabetes alcoholism, surgery, VLBW, ENT infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared in both groups. Significant differences in etiology and risk factors between both groups were reported. Those after neurosurgery had more frequently Coagulase negative staphylococci (p<0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p<0.001), Neisseria meningitis (p<0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p<0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p<0.001) as well as otitis/sinusitis (p<0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p<0.001) but cure after modification was more common in PM (p=0.002). Therefore outcome in both groups was similar (14.6% vs. 12.4%, p=NS).
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PMID:Comparison of postsurgical and community acquired bacterial meningitis--analysis of 372 cases within a nationwide survey. 1803 Feb 63

Only few epidemiological studies evaluate the role of ENT infections in meningitis. A retrospective review of data shows that the frequency of ENT infections is estimated at 25% in adults and children. Meningitis may occur during otological and nasosinusal infections. Acute otitis media and mastoiditis are the most common ear infections responsible for meningitis. Chronic otitis (cholesteatoma) are rarely involved. In case of acute rhinosinusitis, frequently responsible frontal and ethmoidal locations are investigated by nasal endoscopy and CT scan. A CSF leak originating mostly from anterior skull base or middle ear, either posttraumatic or spontaneous, may also be associated with meningitis. The management of ENT infections begins with antibiotics. Drainage may be discussed when identification of the bacteria is needed or if the medical treatment seems inefficient. In case of a CSF leak, closure of the defect is performed according to its location and size after evaluation by imaging (CT scan, MRI).
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PMID:[Diagnosis and management of ENT conditions responsible for acute community acquired bacterial meningitis]. 1941 28


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