Practical Aspects of Interface Application in CPAP Treatment

While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.

Isolated Sphenoid Sinus Disease- A Unique Case of Sphenoidal Mucocoele

Introduction Isolated Sphenoid Sinusitis and sinus lesions is a rare entity accounting for just 1-3% of all Sinus afflictions. Most have occurred in men between the ages of 30 and 40 years. Case Report A case of right sphenoid sinus mucocele is reported in a male patient aged 68 years, with size of the lesion (35 x 34 mm) detected by CT & MRI scans. The patient presented with a 3 weeks history of unilateral ptosis, diplopia, and photophobia. He also complained of bilateral nasal obstruction, nasal stuffiness, and a mucoid nasal discharge. Endoscopic decompression of the right sphenoid sinus was performed, and approximately 160 ml of thick, sterile mucoid secretion was aspirated. Despite the size of the mucocele, no significant destruction of the sphenoid walls was evident. Postoperatively within 15 days the patient's symptoms improved significantly. Conclusion The Nasal Endoscope has revolutionised sphenoid sinus mucocele treatment. An adequate sphenoidotomy and drainage give excellent results.

Primary nasal meningioma- a case report

Extracranial meningiomas may be subdivided into primary and secondary types based on absence or presence of intracranial attachments respectively. Primary sinonasal tract meningiomas are rare with unknown etiopathology and non-specific clinical presentation. Of these PEMs only 11.5% are in the nasal cavity and nasal septum. To our knowledge less than 50 cases of PEM of nasal cavity have been reported in the literature. We report a case of a 22 years old male who presented with epistaxis and increasing nasal stuffiness for the last one year.

Can we always trust rhinomanometry?

Objectives: Rhinomanometry before and after decongestion distinguishes a nasal airway organic stenosis from congestion of nasal mucosa in patients with nasal stuffiness. Together with rhinoscopy and patient history, it is used to decide if nasal surgery would benefit the patient. Rhinomanometry measurements should thus be reliable and reproducible. Materials and methods: We performed repetitive active anterior rhinomanometry in 9 persons during 5 months to test reproducibility of nasal airway resistance (NAR) over time. We also did test-retest measurements in several participants. Xylometazoline hydrochloride was applied in each nasal cavity to minimize effects of mucosal variation and the nasal cavity was examined with rhinoscopy. The participants evaluated subjective nasal stuffiness on a visual analogue scale (VAS). Results: The long term mean coefficient of variation (CV) of NAR over time was 27% for the whole group while the short term CV was 7 - 17% for test-retest within an hour. Mean NAR reduction after decongestion was 33%, but 13% of NAR values were not reduced after decongestion. Participants had difficulties estimating stuffiness on a VAS in 15% of the assessments, but there was no correlation between the VAS estimates and NAR. Conclusion: We found a high NAR variation over a period of five months. This implies low long-term rhinomanometry reproducibility and we suggest future research on standardised decongestion to increase the reproducibility.

Nasal mucosal congestion during the menstrual cycle

A relationship between the reactivity of the nasal mucosa and changes in female sex hormones have been debated for a long time, although no evidence has been presented to prove or disprove this relationship. Nasal patency was therefore measured by nasal expiratory peak-flow in 26 women for two months in order to study changes in nasal mucosal congestion during the menstrual cycle. In another eight women, nasal congestion was measured by acoustic rhinometry, and symptoms of nasal stuffiness were registered during periods when there were various levels of plasma oestradiol and progesterone. Finally, nasal mucosal biopsies were taken for preparation of receptors for oestradiol and progesterone. This study could not verify the effects of female sex hormones on the nasal mucosa. This could be explained by the fact that no receptors for oestradiol and progesterone were found.