Mycetoma Fungal Sinusitis

Fungal infections of the paranasal sinuses are uncommon and usually occur in individuals who are immunocompromised. However, recently, the occurrence of fungal sinusitis has increased in the immunocompetent population.

 There a number of different types of fungal sinusitis.
Allergic fungal sinusitis
Sinus mycetoma 
Acute invasive fungal sinusitis 
Chronic invasive fungal sinusitis 
Granulomatous invasive fungal sinusitis

Mycetoma Fungal Sinusitis produces clumps of spores, a "fungal ball," within a sinus cavity, most frequently the maxillary sinuses. Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An anti-fungal therapy is generally not prescribed. The other types of fungal sinusitis will be discussed in subsequent blogs.

Meningoencepholocoele- Endonasal treatment with nasoseptal flap

Meningoencephalocele is a type of encephalocele characterized by the protrusion of both meninges and brain tissue through a defect in the skull. 

There are two main types of meningoencephalocele. The more common frontoethmoidal type is located at the frontal and ethmoid bones while the occipital type is located at the occipital bone. Hydrocephalus, abnormalities of the eyeball and lacrimal duct  and other findings have been associated with the condition. Some affected individuals have intellectual disabilities .

 The condition is typically congenital  but rarely has been reported to occur spontaneously or after head trauma in older individuals (this occured in our patient shown in the video). The underlying cause of the condition is uncertain, but environmental factors are thought to play a role. 

Treatment depends on the size, location and severity of the defect but mainly includes surgery to repair the defect.
The video shows one of our authors (SS) using a local nasoseptal flap to seal the defect.

Thyroid Nodules management protocols

Nodular disease of the thyroid gland is prevalent. The lifetime risk for developing a palpable thyroid nodule is estimated to be 5-10%, and the condition affects more women than men. Roughly 5% of thyroid nodules are malignant; the remainder represent a variety of benign diagnoses, including colloid nodules, degenerative cysts, hyperplasia, thyroiditis, or benign neoplasms. A rational approach to management of a thyroid nodule is based on the clinician's ability to distinguish the more common benign diagnoses from malignancy in a highly reliable and cost-effective manner.below is the Northland DHB Imaging and management of clinically palpable Nodules.
Nodule V4 Dec 09 (1)

Hyperventilation Syndrome

The ENT clinic gets lots of referrals for patients with dizziness. Often hyperventilation syndrome is forgotten as a diagnosis. As always a good history is important.
Think of this diagnosis if patients symptoms and history are multiple and vague. The patient may have dizziness, vertigo, light-headedness. Below is a presentation by our registrar at a recent teaching session.


 

Hyperventilation syndrome from Jerry Gathercole