No abstract

We studied the effect of antileukotriene therapy for the relief of sinus sympto ms in patients with aspirin triad disease (ATD). We reviewed the charts of18 ATD patients who had received antil eukotriene therapy. All patients had undergone pr evious sinus surgery. We then designed a questionnaire to determine the level of each patient's symptoms of chronic rhinosinusitis bef ore and after antileukotriene therapy. Responses were converted to symptom scores. For each patient, the role of therapy in the relief ofsinus symptoms was evaluated in three ways: by total symptom scores, by self-reports of overall benefit , and by fi ndings on endoscopic nasal examination. Fifteen of the 18 pati ents completed the questionn aire. Symptom scores fo r both major and minor symptoms indicated that nine patients had improved f ollowing antileukotriene therapy; three other patients reported some overall benefit from therapy, despite no improvement in their symptom scores. Endoscopic nasal examinationfi ndings were consistent with the report s of overall benefit. We conclude that antileukotriene therapy is an effective treatm ent f or most pati ents whose symptoms of chronic rhinosinusitls persist fo llowi ng sinus surgery.

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Primary squamous cell carcinoma of the parotid gland is an uncommon malignancy. It can be diagnosed only after squamous cell carcinoma metastatic to the parotid gland has been excluded. Histologic evaluation must differentiate primary squamous cell carcinoma from high-grade mucoepidermoid carcinoma or adenocarcinoma. Retrospective review of parotid gland neoplasms seen in the Department of Otolaryngology and Communicative Disorders between 1972 and 1987 identified eight cases for an incidence of 1.8%. The majority of these patients had advanced disease and were treated with both surgery and radiation therapy. Fifty percent of the cases demonstrated no evidence of disease at an average follow-up of 29 months.

Bone marrow transplantation (BMT) is used in the treatment of a wide range of malignancies. It involves immunosuppression and increased risk of infections such as sinusitis. However, the risk of infection is much higher in allogeneic transplants than those who are replaced with their own bone marrow (autologous). Immunodeficient patients may develop fungal sinusitis with a high mortality rate. An aggressive approach to evaluation and surgical intervention for fungal sinusitis in BMT patients at the Indiana University Medical Center was used for 2 years (from 1991 through 1992). This approach encouraged surgery on any BMT patient who was clinically septic or had any changes on a sinus CT scan. In 1993, a more medically oriented approach with radiologic and nasal endoscopic monitoring was adopted. During 1991 to 1992, 12 of the 21 allogeneic transplant patients (57%) who had sinus surgery died. The four autologous BMT patients operated on during this period all survived. Three allogeneic transplant recipients had surgery in 1993 and survived. No autologous cases had sinus procedures in 1993. No fungal sinus infection occurred in any BMT patient during the 3-year review. Careful patient selection, evaluation, and preventative measures can be successful in dealing with this rare but potentially fatal complication without performing unnecessary surgery on patients who have a poor prognosis unrelated to their sinuses.