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

Odontogenic Sinusitis

A patient presented to us today with sinus symptoms following dental treatment.
The scan clearly showed a foreign body in the right maxillary sinus.

Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. An odontogenic source should be considered in individuals with symptoms of maxillary sinusitis with a history of odontogenic infection, dentoalveolar surgery, periodontal surgery, or in those resistant to conventional sinusitis therapy.

 Diagnosis usually requires a thorough dental and clinical evaluation including appropriate radiographs. The most common causes of odontogenic sinusitis include dental abscesses and periodontal disease that had perforated the Schneidarian membrane, irritation and secondary infection caused by intra-antral foreign bodies, and sinus perforations during tooth extraction.

 An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes outnumbering the aerobes. The most common isolates include anaerobic streptococci and gram-negative bacilli, and Enterobacteriaceae. 

Surgical and dental treatment of the odontogenic pathological conditions combined with medical therapy is indicated

Submandibular Gland stones

Saw this patient today with a huge submandibular duct stone easily visible in the floor of the mouth. Must have been there a long time as it is over 3cm in length. Our poor patients just don't go to the doctor!
It was easy to remove with a little local anaesthetic and a snip with scissors along the direction of the duct.

Submandibular calculi are common because stasis in the duct is encouraged both by the submandibular glands lying below the opening of the duct on the floor of the mouth, and the large mucous content of the secretions of the submandibular gland. They may be found anywhere along Warthin's duct, including its course within the gland. They vary in size from several millimetres to centimetres in diameter. Those in the distal part tend to have an elongated 'date stone' shape.

They should be differentiated from a stenosis of the duct orifice due to repeated trauma and fibrosis, e.g. following irritation from a sharp tooth, or a bite of the cheek. They can be palpated, and 80% are radio-opaque on x-ray.

• the majority of salivary calculi (80% to 95%) occur in the submandibular gland, whereas 5% to 20% are found in the parotid gland
• sialothiasis rarely affects the sublingual gland and the minor salivary glands are rarely (1% to 2%) (1)
• sialolithiasis can occur at any age - however most cases occur in patients in their third to sixth decade. Sialothiasis rarely occurs in children

Topical chemotherapeutic treatments for non melanoma Skin Cancer

With our aging population we have lots of patients who have had multiple skin cancers, who we sometimes call 'frequent flyers' . They require many costly surgical removals in the hospital. There is good evidence to suggest that prevention by the use of chemotherapeutic treatments is a very cost effective alternative to surgical procedures.
Our ENT House surgeon has just presented an excellent resume of medical options particularly comparing Efudix (5FU) and Aldara (Imiquimod) and when they are best used. I hope GP's will find it helpful.

Topical chemo therapeutic treatments for non melanoma skin cancer