Abstract: OBJECTIVES Although polyps seem to be a manifestation of the chronic inflammation of nasal/paranasal sinuses mucosa in both allergic and non-allergic subjects, the pathogenesis of nasal polyposis remains unknown. The aim of this prospective study was to compare the clinical characteristics of nasal polyposis in non-allergic and allergic patients, to compare the cytokine levels in nasal secretions in atopic and non-atopic nasal polyp patients and to correlate these levels with eosinophil counts in nasal polyp tissue specimens. METHODS This study included thirty patients with nasal polyposis (13 atopic and 17 non-atopic) requiring surgical treatment. Nasal secretion samples were collected from the nasal cavities of all 30 subjects a few days before the surgical treatment. The levels of tumour necrosis factor-alpha (TNF-alpha), tumour necrosis factor-beta (TNF-beta), interleukin (IL)-1beta, IL-2, IL-12, interferon-gamma (IFN-gamma), IL-4, IL-5, IL-6, IL-10, and IL-8 were measured using the flow cytometric method. Each of the 30 patients was staged clinically according to nasal symptom score, endoscopic score and Lund-Mackay computed tomography (CT) score. All these patients had undergone sinus surgery. Eosinophils were counted in hematoxylin- and eosin-stained sections of all nasal polyp samples. RESULTS Our results showed that allergy does not modify the symptoms, or the endoscopic and CT findings, of nasal polyposis. We found significantly higher concentrations of IL-4 (p < 0.01), IL-5 (p < 0.05), IL-6 (p < 0.05) and TNF-beta (p < 0.05) in nasal secretions of allergic nasal polyp patients than in non-allergic ones. Eosinophil counts were significantly higher in tissues of atopic patients' polyps than in non-atopic subjects (p < 0.01). No correlation was observed between cytokine levels and eosinophil counts. CONCLUSION Non-atopic and atopic patients' polyps have different immunological patterns. Our results showed that the presence of Th2 cytokines was a more significant feature in allergic patients with nasal polyposis than in non-allergic patients.

Abstract: 3 de "cirkel": Cocheair Implant Reflexie-, Kennis En Leernetwerk, Deurne, Antwerp Key-words. Cochlear; implant; fixation; migration; device; evidence; based; medicine Abstract. Fixation of cochlear implants: An evidence-based review of literature. Hypothesis : There are numerous cochlear implant fixation techniques to prevent soft tissue complications related to device migration. The literature does not provide sufficient evidence to determine the most suitable fixation method. Background : Cochlear implants (CI) are becoming a routine treatment for patients with severe to profound deafness. Steadily growing numbers of implant centres and surgeons worldwide are inevitably leading to higher rates of compli - cations, including device migration. It is currently unknown whether this can be prevented by proper implant fixation during surgery. The low prevalence of this complication makes it challenging to interpret publications regarding CI fixation techniques. Methods : An exhaustive literature review reveals a variety of different fixation techniques. Most authors advocate the creation of a bony well for the CI receiver/stimulator (R/S); however, an increasing number of surgeons no longer secure implants at all. Here we give an overview of all published fixation methods, with special attention to the evidence-based quality and descriptions of the advantages and drawbacks of each. Conclusions : Literature review reveals an absence of level I evidence-based publications addressing device migration. Existing publications report on too few cases to draw a conclusion on whether surgical fixation prevents implant migration. To have statistical power, studies of alternative or new fixation methods should include high numbers of implantations in each study arm and the studies should be longitudinal and prospective. In default of other evidence, it seems fair to define good practice as the creation of at least a bony well and/or (bony) sutures.

Abstract: Aim To investigate the role of smoking, alcohol, coffee consumption, demographic factors, toxic agents, and occupation in laryngeal carcinogenesis. Materials/methods A case-control study included 70 patients with histologically confirmed laryngeal cancer and 70 controls with non-neoplastic conditions unrelated to diet/smoking/alcohol. Relative risk, odds ratio (OR), and 95% confidence intervals were estimated using multiple logistic regression. Results Current smokers had 19.46 OR of laryngeal cancer compared to non-smokers (p = 0.006). The respective OR for alcohol consumption was 3.94 (p = 0.006). While the risk increased in heavy drinkers, there was no difference in duration of alcohol consumption. There was a strong and consistent relation between laryngeal cancer and the consumption of Greek/Turkish coffee cups/day (p = 0.002, OR = 1.77). Diesel exhaust fumes also seemed to increase the risk of laryngeal cancer, although the association was found to be no longer significant after analysis with logistic regression. Conclusion The present study confirmed the relation of smoking and alcohol with laryngeal cancer. However, other factors such as coffee and diesel exhaust fumes may play an important role in laryngeal carcinogenesis.

Abstract: Objective Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may be associated with systemic disease. In this study we aimed to characterize children who underwent nasal surgery at our medical center due to nasal polyps and review the current literature related to pediatric nasal polyps. Study design We retrospectively reviewed all medical records of patients younger than 18 years who had sinus surgery from 2000 to 2010. We collected demographic and clinical data including age, sex, laterality, revision operations, and comorbidities including asthma, allergy, and cystic fibrosis (CF). Results Thirty-one patients age 8.8 to 18 years (mean 13.7) were treated surgically in our hospital. Thirteen had antrochoanal polyp, 16 had chronic sinusitis with nasal polyps, and 2 had mucocele. Among patients treated for nasal polyps, there were 6 boys and 10 girls, mean age was 14.2 years, and 14 (87.5%) had bilateral disease. Mean Lund McKay score was 15.8. Five (31.2%) had asthma, 15 (93.7%) had sleep breathing disorder, and none had known allergy. Three patients (18.7%) had more than one surgery, including one patient with CF. Nine healthy children were tested for CF; one was positive. Conclusions Nasal polyps in children are more common in teenagers, are usually bilateral, and are commonly associated with bronchial asthma. There was no association with allergy. Meticulous anamnesis and a high index of suspicion are recommended to manage other comorbidities.

Abstract: OBJECTIVE: This study on patients undergoing surgery for vestibular schwannoma investigated tumour (i) the effect of pre-operative factors on tinnitus, (ii) the effect of translabyrinthine or hearing preservation surgical approaches on tinnitus, and (iii) the effect of postoperative tinnitus status on the patient's quality of life (QOL) METHODOLOGY: Seventy-nine patients who underwent vestibular schwannoma (VS) excision between 2001 and 2005 were selected Postoperative tinnitus status was evaluated using a standard questionnaire for tinnitus, and QOL was measured using the Glasgow Benefit Inventory (GBI) RESULTS: Overall, 58% of patients noted tinnitus before tumour removal Pre-operative tinnitus was not associated with age, gender, tumour size, or hearing thresholds The total percentage of patients suffering postoperative tinnitus was 64% Hearing preservation approaches showed no difference in terms of changes in tinnitus compared to the translabyrinthine approach Twenty-one patients (30%) reported better QOL, 40 patients (56%) reported worse QOL, and 10 patients (14%) reported the same QOL A significant association was found between tinnitus worsening as measured by GBI score and QOL CONCLUSIONS: Most patients do not report significant changes in their tinnitus status after surgery Tinnitus evolution is unpredictable and not related to the type of surgical approach Thus, tinnitus should not be used as a criterion for selecting the surgical approach Tinnitus worsening appears to influence QOL following surgery for VS

Abstract: OBJECTIVE Recent studies show that benign paroxysmal positional vertigo (BPPV) may also affect the macula of the saccule. We investigated vestibular evoked myogenic potential (VEMP) results in patients with BPPV. MATERIALS AND METHODS The study group included 31 patients (31 ears) diagnosed with posterior canal BPPV and the control group included 23 healthy volunteers (46 ears) with no neurotologic symptoms. After VEMP recordings were performed, mean latency values for p13 of the study and control groups were compared. RESULTS VEMP responses were elicited in all controls (46 ears). In the study group, responses were normal in 19, delayed in 5, and absent in 7 ears. There was a significant difference between abnormal VEMP rates for patients versus controls (p < 0.001). Although VEMP responses were elicited in all non-affected ears of patients, there was a delayed response in 6 (19%) non-affected ears. This was statistically significant when compared with controls (p = 0.002). There was no correlation between abnormal VEMPs and the number of canalith reposition maneuvers required (p = 0.392). CONCLUSION Our findings suggest the prolongation of mean latency values for p13 of VEMP in patients with BPPV might signify neuronal degeneration in the macula of the saccule, and the absence of VEMP waves might represent the extent of damage. Also, high latency values for p13 in non-affected ears of patients might indicate bilateral neural degeneration in BPPV.

Abstract: OBJECTIVE To investigate whether mean platelet volume (MPV) levels rise in patients with nasal polyposis (NP) and whether higher MPV levels are correlated to the extension of polyps in these patients. MATERIALS AND METHODS This study included 50 patients with NP and 40 age- and sex-matched healthy subjects as controls. The Lund-Mackay staging system was used to assess paranasal sinus computed tomography (CT) scans in patients with NP, and paranasal sinus CT scores were recorded. MPV was measured in a blood sample collected in EDTA tubes and was also used for whole blood counts in all patients. The Mann-Whitney U-test and Student's t-test were used to compare the results of the two groups. RESULTS NP patients had higher MPV levels than the control group (9.60 +/- 1.06 fl and 8.77 +/- 0.88 fl, p < 0.001 respectively). However, there was no significant correlation between MPV and paranasal sinus CT scores. CONCLUSION To our knowledge, this is the first study to investigate MPV levels in patients with NP. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with NP. Increased platelet activation may be related to an increase in cardiovascular risk in patients with NP.

Abstract: Objective To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). Material and methods Data were collected prospectively in an observational study through evaluations at two tertiary academic institutions, i.e. St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada, and King Fahd Medical City, Riyadh, Saudi Arabia, from December 2006 to December 2009. A 2-page evaluation form was developed in conjunction with the Objective Assessment of Technical Skills Surgery (OSATS) evaluation form developed by Reznick et al in Toronto to assess residents' surgical skills. A Likert scale (1-5 where 5 = excellent) was used for evaluations. The Global Rating of Endoscopic Surgical Skills (GRESS) evaluation instrument was designed with input from academic otolaryngologists, fellowship-trained rhinologists, and experts in medical education. The experts' comments were incorporated, establishing face and content validity. Residents from various levels of training were assessed objectively using this instrument. Internal consistency was evaluated using Cronbach's alpha. Test-retest and inter-rater reliability was measured using intra-class correlation. Results A total of 31 assessments were completed by 15 residents. GRESS showed high reliability in the context of internal consistency (alpha = 0.99), test-retest (0.95, CI = 0.83-0.98), and inter-rater reliability (0.86, CI = 0.31-0.98). Conclusions This pilot study demonstrated that GRESS is a valid and reliable assessment tool for operating room performance.

Abstract: Objectives: Acute otitis media (AOM) commonly affects young children and occasionally results in serious complications/sequelae This pilot cost-of-illness study aimed to assess the economic burden of long-term AOM complications/sequelae in Belgium, and to establish a thorough methodology for a larger study Methodology: We retrospectively reviewed charts of patients aged 10-20 years with long-term complications/sequelae considered to be AOM-related, and >= 8 years of follow-up From a list of 215 eligible patients, we selected 25 patients representing each of seven categories of complications/sequelae Results: Included patients had a mean age of 129 years; nine had chronic suppurative otitis media with cholesteatoma; six sensorineural hearing loss; six chronic perforation of the tympanic membrane; and one each with conductive hearing loss, facial paralysis, neurological impairment after intracranial complications, and complications of surgery During 8-15 years of follow-up, the most common complications were hearing loss, chronic otitis media (OM), and cholesteatoma These generally occurred >5 years after the first AOM event, although chronic OM occurred after a mean time of 33 years Yearly public health care payer (PHCP) costs ranged from (sic) 119 to (sic) 7957 per patient, and were highest for patients with sensorineural hearing loss Yearly costs to the patients ranged from (sic) 7 to (sic) 289 per patient, and were also highest for patients with sensorineural hearing loss Conclusions: Although complications/sequelae of AOM are rare, they can result in substantial costs The applied methodology should be feasible for a larger study, with some minor adjustments

Abstract: Problem: We present the case of a term neonate referred shortly after birth because of breathing and feeding difficulties. Methodology: Fiber-endoscopic examination of the nasal cavity showed a pendulating mass in the nasopharynx. Results: A complete surgical resection was performed and the baby recovered completely. Microscopic examination of the mass showed an overlying non-keratinized squamous cell lining with an atypical cell population in some fragments. Histological features were compatible with a high-grade epithelial tumour like a midline carcinoma, but a final diagnosis of a salivary gland anlage tumour was established. Conclusion: Flexible fiber endoscopy is the method of choice for examining the nasal passages and oropharynx in neonates with respiratory distress. Congenital salivary gland anlage tumour is a rare cause of neonatal nasal obstruction; it is benign and complete excision results in a cure. Histologically, it may mimic a malignant tumour owing to the high mitotic index.

Abstract: In children, all ENT cavities are particularly prone to the development of chronic inflammation. This is due to many predisposing factors, of which the most common are unfavourable anatomy, absence of nasal blowing, day care attendance, allergy, immature immunity, gastro-oesophageal reflux and tobacco smoke exposure. The aim of this paper is to outline the most specific paediatric clinical aspects of chronic pharyngo-tonsillitis, rhinosinusitis, otitis media, adenoiditis and laryngotracheitis and the important influence that some of these pathologies exert on the others.

Abstract: Background We reviewed our experience with MTC (medullary thyroid cancer), focusing on recurrence and survival, recommendations for the extent of lymph node (LN) dissection and surgery for recurrent disease. Methods Of 51 MTC patients treated between 1988 and 2008 at the University Hospitals Leuven, 38 previously untreated patients were analysed. Results Overall and disease-specific (DSS) five-year survival rates were 75% and 82%. Variables univariately associated with DSS were age, pN, stage, vascular invasion, pre-operative recurrent laryngeal nerve function and last calcitonin level. Recurrence occurred in 10 patients (26%). For recurrence, age was no longer a prognostic factor and post-operative calcitonin, number of positive LN and of positive compartments proved to be prognostic factors. Of 21 clinical NO patients, 2 out of 6 (33%) undergoing a prophylactic central neck dissection (ND) based on per-operative palpatory suspicion proved pN+, and 2 out of 9 patients (22%) undergoing a prophylactic lateral ND were pN+. Five patients surgically treated for recurrence did not achieve long-term normalisation of calcitonin, but remained alive with locoregional control. Conclusion Overall survival and DSS rates are within the range reported in the literature. The results confirm that (1) total thyroidectomy and central compartment dissection is the treatment of choice in the cN0 patients, (2) additional ipsilateral lateral ND is needed for cN+ disease in the ipsilateral lateral compartment, and (3) in the clinically uninvolved contralateral lateral neck, per-operative inspection should serve as a basis for a decision about further ND. Locoregional control and prolonged survival is achieved in surgically treated locoregionally recurrent MTC.

Abstract: Introduction and aim Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. Materials and methods The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were calculated based on resource use and personnel input at the participating hospital. The cost of work-related disability for both treatments was measured based on a questionnaire filled in by 275 parents of children undergoing a tonsillectomy. Data from two Belgian institutions (NIS and FOD) were used to calculate the cost of parents' absenteeism. Results An episode of acute tonsillitis in the child results in a longer period of parents' work absenteeism (mean of 3.1 +/- 0.3 days) compared to tonsillectomy (2.2 +/- 0.2 days). The cost of economic productivity loss amounts to 613 Euros (NIS) or 759 Euros (FOD) for acute tonsillitis and 435 Euros (NIS) or 539 Euros (FOD) for a tonsillectomy. The medical costs linked to the surgical procedure at the local department correspond to 535 Euros and for an acute tonsillitis to 46 Euros. Conclusions From societal perspective, a tonsillectomy costs the equivalent of 1.4 times the cost of a severe throat infection. This indicates that in children suffering from recurrent acute tonsillitis, watchful waiting results in a higher cost compared to tonsillectomy, given the cumulative costs of parents' absenteeism.

Abstract: Schwannomas are rare tumours arising from the peripheral nerve sheath. Nearly half of all schwannomas occur in the head and neck region, but the sinonasal tract is rarely involved. We report on an extremely rare case of vidian nerve schwannoma accompanied by mucopyocele with symptoms of oculomotor palsy and CSF leakage. An exclusively endoscopic endonasal approach was performed to excise the tumour and the dural defect was repaired. To our knowledge, this is the first time a vidian nerve schwannoma has been excised in an exclusively endoscopic approach. We first review the literature and then discuss the benefits for patients undergoing this type of operation.

Abstract: UNLABELLED PROBLEMS/ OBJECTIVES: Septoplasty and septorhinoplasty are two important surgical operations in otorhinolaryngology. Tension pneumocephalus is a rare, but potentially fatal, intracranial complication of these operations. METHODOLOGY We present two cases of tension pneumocephalus following nasal surgery. Both patients had tension pneumocephalus, meningitis, and defects in the skull base. RESULTS One patient underwent endoscopic repair of the defect, while the second case expired despite medical and neurosurgical management.

Abstract: PROBLEM Syphilis is a sexually-transmitted disease caused by the spirochete Treponema pallidum, and is transmitted either through sexual contact or vertically across the placenta. Rates of infection were at a low point in the early 1990s. Since then, increasing numbers of new cases of infections have been observed in all Western countries. AIM Presentation of three patients with syphilis who presented within a short period of time in an ENT outpatient clinic. CONCLUSIONS One must be aware of the increasing incidence of syphilis, even in head and neck disciplines. Typical symptoms of an early infection are an ulcerous lesion in the mouth, with or without cervical lymphadenopathy. The main therapy is high doses of penicillin G administered intramuscularly. Other simultaneous sexually-transmitted diseases, especially HIV infection, must be excluded. Unnoticed and untreated patients may develop late and life-threatening complications.

Abstract: Here we present a case report of a patient suffering from occupational rhinoconjunctivitis and asthma due to IgE-mediated carmine red allergy. This is the first description of carmine red allergy in a screen-printing worker in which the diagnosis was documented by quantification of specific IgE antibodies, by skin tests, by a flow-assisted basophil activation test, and by a carmine red challenge test.

Abstract: A 68-year-old female presented with a right parotid mass and partial frontal peripheral facial nerve palsy. Pre-operatively, the mass was thought to be benign. Surgical intervention consisted of parotidectomy with sacrifice of the facial nerve due to the nerve's involvement in the tumoural process and its intrapetrosal course. Immediate nerve reconstruction was performed by an interposition graft of the great auricular nerve. Pathological examination revealed a schwannoma of the facial nerve. Review of the literature on this rare parotid gland tumour is reported.

Abstract: The preferred setting for the treatment for vestibular schwannoma these days is multidisciplinary and multimodal. A balance has to be struck between a wait-and-scan attitude and a more active approach (surgery or radiotherapy). An initial wait-and-scan attitude is a reasonable management option because many tumours do not grow during a prolonged period of observation. The different surgical approaches may or may not involve attempts to preserve hearing. Stereotactic radiotherapy as treatment of choice is often considered in the elderly patient presenting with a vestibular schwannoma smaller than 2.5 cm with documented growth. This paper will review current treatment modalities and the respective pros and cons. A decisional algorithm as currently adopted by our skull base team is presented at the end of the paper.

Abstract: OBJECTIVES The aim of this study was to determine the prevalence and significance of traditional risk factors associated with sensorineural hearing loss (SNHL) in a population of 615 neonates who attended the neonatal intensive care unit (NICU) of the University Hospital in Leuven, Belgium between January 2005 and December 2007. METHODOLOGY Auditory brainstem response (ABR) audiometry using 40 dB stimuli was performed in all 615 neonates. A retrospective medical database analysis was performed to evaluate the influence of 14 predetermined risk factors. The evaluated risk factors were ototoxic medication, hyperbilirubinemia, in utero infections (including CMV, rubella, syphilis, herpes, and toxoplasmosis), craniofacial anomalies, syndromes associated with SNHL, low birth weight (< 1,500 g), low Apgar score, mechanical ventilation lasting for 5 days or longer, bacterial meningitis, family history of hereditary childhood SNHL, endocranial hemorrhage, hypoxic ischemic encephalopathy, convulsions, and sepsis RESULTS Uni- or bilateral hearing impairment was diagnosed in 25 out of 615 neonates (4.1%). In utero infections (especially CMV), craniofacial anomalies, and syndromes known to include SNHL were significant risk factors. For the remaining risk factors, no significant correlation with SNHL was found. CONCLUSIONS In this study, only in utero infections (especially CMV), craniofacial anomalies, and syndromes known to include SNHL were significant risk factors associated with SNHL. Adequate management of hyperbilirubinemia and ototoxic drug administration may eliminate some of the major historical risk factors associated with SNHL in NICU neonates.

Abstract: OBJECTIVE In Belgium, thyroidectomy is currently an inpatient procedure because of potential life-threatening post-operative complications that include hypocalcemia, laryngeal nerve damage and haemorrhage. Thyroidectomy can only be performed on an outpatient basis if the complication rate is low. The purpose of this study was to determine the feasibility and safety of outpatient hemithyroidectomy. METHODOLOGY Between March 2008 and September 2010 we selected 54 patients who met our inclusion criteria for outpatient hemithyroidectomy. The procedure was carried out through a standard cervicotomy under general anaesthesia. No drains were used. We analysed patient outcome based on complications, unplanned admissions and readmissions. RESULTS The mean age of the 54 patients was 46 years, and most of them were women (81%). The mean duration of surgery was 64 minutes, and there were no intra-operative complications. After an observation period of at least 3 hours, 44 patients (81.5%) were discharged as planned. Ten patients (18.5%) required admission for urine retention (n = 1), social circumstances (n = 1), persistence of nausea (n = 3), delayed anaesthesia recovery (n = 4) and patient preference (n = 1). All 10 were discharged the next day, and none were readmitted. CONCLUSIONS Our study shows that outpatient hemithyroidectomy performed by experienced surgeons in carefully selected patients can be safe and is associated with a low complication rate. However, this series is small and larger studies are needed to confirm the results.

Abstract: Objectives: Sudden sensorineural hearing loss is a perplexing entity in otology. Susac's syndrome (also called retinocochleocerebral vasculopathy) is a rare disorder that consists of microangiopathy of the brain, retina, and inner ear, and usually affects women in young adulthood. We describe the clinical aspects, radiographic findings, and management of one such case. Case report: A 30-year-old woman was admitted to the hospital because of sudden onset of bilateral deafness and headache. During her hospitalization, she developed discrete right hemiparesis and hypoesthesia. Results: Magnetic resonance imaging revealed multiple signal hyperintensities and atrophy of the corpus callosum. The differential diagnosis was a myelinating condition, such as multiple sclerosis or acute demyelinating encephalomyelitis. Conclusion: Retinal fluorescein angiography helped the diagnosis of Susac's syndrome.

Abstract: This paper outlines the normal functioning of the child's upper airway: defending the lower airway by means of air conditioning, filtration, initiation of inflammatory reactions or immune responses. We investigate the hypothetical mechanisms that explain the influence of, and interrelations between, mouth breathing and obstructive sleep apnoea on craniofacial development. We advise orthodontic diagnosis and/or intervention at a young age.

Abstract: OBJECTIVES Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the surgeon's ability to achieve good nasal and lacrimal mucosa apposition. The aims of this study were to assess the long term safety and efficacy of intra-operative use of adjunctive mitomycin C (MMC) treatment in endoscopic revision DCR surgery over 12-24 (mean 17) months. METHODOLOGY This was a prospective, nonrandomized consecutive case series that included 20 adult patients (20 eyes) with failed primary external DCR who underwent revision surgery under assisted local anaesthesia. During revision endoscopic DCR, intra-operative adjunctive MMC (0.2 mg/mL) was applied to the osteotomy site of the lacrimal sac and scar tissue surrounding the surgical osteum for 5 minutes. RESULTS The surgical success rate was determined based on the patency of the nasolacrimal system by irrigation and resolution of patient symptoms. Endoscopic revision DCR surgery with MMC was successful in 90% of cases (18 of 20 cases). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed. CONCLUSIONS Adjunctive intra-operative MMC application with endoscopic DCR surgery had a good success rate in patients with nasolacrimal duct obstruction that required revision surgery. Further large, double blind, placebo controlled, randomized studies are needed to confirm these findings.

Abstract: Leiomyosarcomas (LMSs) of the sinonasal tracts are rarely reported. We present a case of an LMS of the left inferior nasal concha, and discuss the management options with review of the literature. A 72-year-old female patient presented with epistaxis. Clinical examination and medical imaging showed a tumour arising from the left inferior nasal concha. An endoscopic resection was performed. Anatomopathological and immunohistochemical analyses revealed the tumour to be a grade 3 LMS with uncertain posterior margins. The patient was a Jehovah's Witness and refused more radical surgical resection due to religious beliefs; therefore, adjuvant conformal radiotherapy (60 Gy) was performed. LMS of the nasal cavity is a rare and locally aggressive tumour with a high tendency of recurrence, requiring radical surgical resection and long-term follow-up. The prognosis of a nasal cavity LMS is better than that of an LMS located in the paranasal sinuses.

Abstract: Introduction The present study was performed to evaluate the efficacy of Ericksonian hypnosis in reducing the impact of tinnitus on patients' quality of life. Patients and methods A controlled prospective longitudinal study was designed. The severity of tinnitus was assessed with Tinnitus Handicap Inventory (THI) before hypnotherapy and then 1 week, 1 month, 3 months, and 6 months after therapy. Health Survey SF-36 was used to assess health-related quality of life before and after hypnotherapy. Thirty-nine patients with severe idiopathic subjective tinnitus were enrolled in the study. Results The mean SD age of the patients was 44.5 +/- 12.5 years, ranging from 21 to 65 years; 48% were female. Mean THI scores assessed at the beginning and 4 times after commencement of therapy were evaluated. The changes in THI scores were significant. Health Survey SF-36 was assessed separately. The greatest increases were seen in physical role followed by emotional role difficulty. Conclusion The preliminary results of our study demonstrated the effectiveness of Ericksonian hypnosis in the study group.

Abstract: OBJECTIVES To evaluate the presence of Helicobacter pylori (HP) in middle ear effusion from Chinese adult patients with otitis media with effusion (OME). METHODOLOGY A total of 60 aspiration samples collected from adult patients (ranging from 19 to 73 years old) were included in the study. The effusion samples aspirated from the patients' middle ears were analyzed with polymerase chain reaction (PCR) assay and cultured for 7 days under microaerobic conditions. Subsequently, Gram staining and urease testing were performed to identify HP. RESULTS Of the 60 middle ear effusion samples, 24 (40%) were shown to be HP-positive by PCR assay. Of these, seven specimens were confirmed HP-positive by both culture and urease test. CONCLUSIONS The present study clearly demonstrates the presence of HP in the middle ear effusion of some Chinese adult patients with OME. This finding suggests that HP may be involved in the etiology of OME. Additional studies are needed to investigate the exact role of HP in the pathogenesis of OME.

Abstract: OBJECTIVE To compare anatomical variations in sinusitis patients and control subjects. SUBJECTS AND METHODS We reviewed and compared the computed tomography (CT) scans of 87 sinusitis patients after adequate medical treatment and scans of 103 healthy subjects. All images were scored for sinusitis severity using the Lund-Mackay scoring system. Anatomical variations such as septal deviation, concha bullosa, presence of the Haller's cell, paradoxical middle turbinate, prominent agger nasi cell, and Onodi cell were also recorded. RESULTS Of the 190 evaluated CT images, 55.2% of the cases and 47.6% of the controls had septal deviation (p > 0.05). The prevalence of concha bullosa was 68% in patients and 61% in controls (p > 0.05). CONCLUSION There were no significant differences in the evaluated anatomical variations between cases and controls in this study. Mucosal inflammation may play a more essential role than anatomical variation in the development of sinusitis.

Abstract: Objective To present the management of a rare case of progressive bilateral sensorineural hearing loss in a patient with superficial siderosis secondary to a cavernoma. Method A case report and a review of the literature concerning superficial siderosis. Results The patient benefited significantly from a cochlear implantation. Conclusions Careful assessment and adequate counselling is necessary to determine the best approach to hearing rehabilitation in patients with superficial siderosis of the central nervous system. Cochlear implantation in patients with superficial siderosis is controversial due to the retrocochlear origin of the hearing loss and, although the case presented had a successful outcome, the results might deteriorate with time.