Incidental MRI and CT findings in paranasal sinuses and mastoid cells

With increasing numbers of CT and MRI scans being performed, this has lead to an  increase in diagnosis of Sinusitis and Mastoiditis being made and referral to our department.
 Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic resonance imaging and often is interpreted as mastoiditis by radiologists. 

A recent study examined 28 consecutive cases of such erroneously diagnosed "mastoiditis" and documents the presence or absence of otologic symptoms and clinical signs. They found a very low prevalence of otologic symptoms or pathology and no cases of mastoiditis in these patients, and they determined that magnetic resonance imaging is not an effective screening modality for mastoiditis.

Another study showed 61 % of children had one or more salient findings in their paranasal sinuses or mastoid cells. 48 % had mucosal swelling in their paranasal cavities, 25 % in their mastoid cells. The prevalence was higher among children less than 10 years of age (60 % and 42 %) and among children with current upper respiratory tract infection (71 % and 35 %). There was no correlation to a history of headache, snoring, asthma and allergies, or to gender or place of residence.

CONCLUSION:

Mucosal swelling in paranasal sinuses and in mastoid cells is a frequent incidental finding in adults and more commonly in children. Even major mucosal swelling in a paranasal sinus is not necessarily a sign of infection. In radiological reports the terms "sinusitis" and "mastoiditis" should therefore be used with great caution. The initiation of treatment should be based on clinical symptoms and not on radiological abnormalities alone.

The Northern Cochlear Implant Programme (NCIP)

The Northern Cochlear Implant Programme (NCIP) is a publicly funded programme for profoundly deaf children and adults in the northern region of New Zealand.

They have opened a new web-site with information on referral criteria for adults and children. 

http://www.ncip.org.nz/health-professionals.html#who-can-refer-to-the-ncip






Chris Cairns shares a moment with daughter Isabel, who has just received a cochlear implant and can hear for the first time.(Courtesy of stuff.co.nz and Canberra times)

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Please refer patients for hearing aid services to the Audiology service rather than the ENT clinic. I also have added the criteria for the referral.

Information for Referrers (1)

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