London ENT Surgeons

New surgical technique in the management of Chronic Sinusitis by Mr N Salama

Chronic Sinusitis is defined as more than 12 weeks of nasal obstruction and one or more of the following symptoms:

• Facial pain of pressure
• Discoloured discharge
• Reduction of sense of smell

Chronic sinusitis affects several million people in the UK. Some 20% of these patients do not respond to medical treatment and will require surgical intervention.
For patients unresponsive to medication functional endoscopic sinus surgery (FESS) is often the next step forward toward finding relief.
In the case of the frontal sinuses there is a new technique which is a new minimally invasive technique which is called Balloon Sinuplasty, that can be used to enlarge the natural opening of the sinuses, allowing drainage, whilst preserving the anatomy.

Clinically supported
Published, peer-reviewed results indicate:

• Proven safe: no serious adverse events in 2 years
• Proven effective: 91.6% functional patency in observed sinuses after 2 years
• Clinically and statistically significant improvement in patient symptoms 

The typical recovery period with the use of balloon sinuplasty technology is 48 hours, resulting in return to normal activity for patients within this time.
If your patients are suffering from chronic or recurrent acute sinusitis and have not found adequate relief from medical therapy, they may be candidates for surgery using the Balloon Sinuplasty system.

Guide catheter is introduced into frontal sinus and guide wire is introduced through the catheter (Fig 1), the sinus balloon is introduced over the sinus guide wire and positioned across the blocked ostium (Fig 2). The balloon is gradually inflated to open and remodel narrow or blocked ostium. The sinus is irrigated (Fig 3). The irrigation catherter is removed leaving ostium open allowing return of normal sinus drainage (Fig 4).  

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How to investigate Neck Lumps by Mr R Simo 

Clinical Management and Investigations of Neck Lumps.
The management of patients with neck lumps should have a systematic and uncompromising approach and should include a thorough history, examination and relevant investigations.

History
This should include the patient’s age, sex, the duration of the mass and associated symptoms including dysphonia, dysphagia, odinophagia, sore throat, referred otalgia, nasal obstruction, cranial nerve palsies, weight loss, anorexia, malaise and night sweats.

Examination
This should include an inspection of the skull, face, ears, nose, oral cavity and oropharynx. The fibre-optic scope should be used to inspect the nasal cavity, nasopharynx, oropharynx, larynx and hypopharyx. The neck should be examined in a systematic fashion noting the number, size, site, shape and texture of the neck lump, as well as the involvement of the skin and the deep cervical structures. Additionally a general examination should be performed.

Investigations
This should be tailored to each individual case and it would not be  appropriate for all patients to have the all investigations. All patients with neck lumps should at least have: Full Blood Count, Chest XR and ultrasound scanning with or without FNAC where appropriate.

Inflammatory Masses
If an inflammatory mass is suspected, especially in a young patient the above investigations together with a ESR, CRP, Epstein Barr and Cytomegalovirus titres, LFT, LDH, Brucella and Toxoplasma serology may be advisable.

Metastatic Carcinoma
If metastatic carcinoma of the upper aerodigestive tract has been clinically suspected in the initial examination, a staging Computerized Axial Tomography scan (CT) or Magnetic Resonance scan (MR) of the neck and chest followed by a rigid endoscopic examination and biopsy of the index tumour should be performed. If the  patient complains of dysphagia and no focal lesion is detected, a barium swallow may be helpful before referral to gastrointestinal tract surgeon is made.

Salivary Gland Mass
If the patient gives a history of intermittent painful swelling which occurs during oral intake that suggests sialoadenitis, then a sialogram, that can be diagnostic as well as therapeutic, should be performed. For any other salivary gland swellings an USS guided FNAC/FNB, with either CT or MRI scan where appropriate, should be performed.

Thyroid Mass
These patients should be investigated with a thyroid function test, thyroid autoantibodies levels together with the USS guided FNAC. Additionally the patient may be investigated with a thyroid isotope scan if felt appropriate.