Publications
139 results found
Naik RM, Khemani S, Saleh HA, 2013, Frontal silent sinus syndrome., Otolaryngol Head Neck Surg, Vol: 148, Pages: 354-355
Stephens JC, Saleh HA, 2013, Evaluation and treatment of isolated maxillary sinus disease., Curr Opin Otolaryngol Head Neck Surg, Vol: 21, Pages: 50-57
PURPOSE OF REVIEW: The maxillary sinus may be involved in a wide variety of disorders. Many of these share common presenting symptoms but some have unique features. This article reviews some of the recent publications in this area. RECENT FINDINGS: The majority of isolated maxillary sinus disease has been previously described. Some recent data on the microbiology of sinusitis have been published. The review also highlights the growing role of endoscopic surgical management due to improved instrumentations and techniques. SUMMARY: On the basis of the review, diagnosing isolated maxillary sinus disease can still be delayed due to late presentation. When suspected, it is advisable to investigate early with computed tomography scanning and proceeding to MRI if needed. Often these will show certain features with clues to the diagnosis. Final diagnosis is frequently only obtained on histological examination. The majority of these disorders can now be managed by endoscopic techniques alone with open surgery required in a small number of cases.
Muirhead N, Benjamin E, Saleh H, 2013, Is the University of Pennsylvania Smell Identification Test (UPSIT) valid for the UK population?, Otorhinolaryngologist, Vol: 6, Pages: 99-103, ISSN: 1752-9360
Aims: UK publications base evidence on University of Pennsylvania Smell Identification Test (UPSIT) results, yet UPSIT normative values are not transferrable outside the USA. This study was designed to (a) Estimate normative scores for the UK population and (b) Identify smells causing cultural bias. Methods: The UPSIT test was applied to 44 healthy individuals in the UK. Results: Results showed a mean score of 32.36(males) and 33.27(females), equivalent to an UPSIT olfactory diagnosis of 'mild microsmia' (p<0.05, p <0.0005 respectively). Six smells were identified as culturally biased and removed resulting in diagnosis of 'normosmia'( p=0.1). Conclusions: The present UPSIT test needs to be adapted to produce a reliable, validated and culturally appropriate olfactory test for use on the UK population.
Fokkens W, Saleh H, 2013, Non-Allergic Rhinitis, Rhinology and Skull Base Surgery, Editors: Georgalas, ISBN: 978-3131535412
Saleh H, Nouraei R, 2013, Basic Surgical Techniques in Endoscopic Sinus Surgery, Rhinology and Skull Base Surgery, Editors: Georgalas, ISBN: 978-3131535412
Saleh HA, 2013, The Nose and Sinuses, Ear, Nose and Throat and Head and Neck Surgery: An Illustrated Colour Text, Editors: Dhillon, ISBN: 978-0702044199
Rimmer J, Saleh HA, 2012, Partial extracorporeal septoplasty using polydioxanone plate: A reliable technique for the correction of severe anterior septal deviations, Otorhinolaryngologist, Vol: 5, Pages: 147-149, ISSN: 1752-9360
Background: Septoplasty is commonly undertaken to improve nasal airways or to correct cosmetic septal deviation. The most difficult areas to correct are the caudal and/or superior regions. Methods: We describe our technique of partial extracorporeal septoplasty using polydioxanone plate to support the cartilage, allowing correction of very anterior and/or superior deviations without affecting the stability or shape of the nose. Discussion: The senior author has been using this technique routinely since 2004 with excellent results and no increase in complication rates. PDS plate supports the repositioned cartilage and stimulates cartilage regeneration; we discuss the experimental evidence for its use. Conclusion: Adequate correction of caudal deviations is difficult. This reliable technique allows complete correction of the deviation. Copyright © 2012 Rila Publications Ltd.
van Griethuysen J, Kuchai R, Taghi AS, et al., 2012, Nasal sarcoidosis: a cause for a medical rhinoplasty?, J Laryngol Otol, Vol: 126, Pages: 1073-1076
OBJECTIVE: We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty. CASE REPORT: A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Flexible nasoendoscopy revealed red nasal plaques typical of nasal sarcoidosis, together with significant widening of the nasal bridge. Triamcinolone, a long-acting corticosteroid, was injected both intralesionally and subcutaneously over the nasal dorsum, at zero, three and eight months, resulting in long-lasting improvement of the nasal shape. CONCLUSION: Sarcoidosis is a non-caseating, granulomatous, epithelioid inflammation. Otorhinolaryngological manifestations occur in approximately 10 per cent of patients; however, there is little published experience of nasal reconstruction in such patients. We describe a quick, simple and relatively cost-effective technique, with little or no co-morbidity, with which to improve the aesthetic and symptomatic outcomes of nasal sarcoidosis.
Taghi AS, Ali A, Kuchai R, et al., 2012, Rare sarcoma presented as sinusitis., BMJ Case Rep, Vol: 2012
Myxofibrosarcoma (MFS) also known as myxoid variant of malignant fibrous histocytoma is one of the most common soft tissue sarcomas of the extremities in adult and elderly patients with rare occurrences in head and neck region. Low-grade MFS is unusual among low-grade sarcomas because it often recurs relentlessly and multiplies despite wide local resection with gross negative margins. We report a case of extreme rarity and a tumour of aggressive nature in the maxillary sinus, which presented with non-specific sinonasal symptoms and we present a review of the radiological and histopathological characteristics of this rare tumour and recent evidence of management.
Saleh H, Durham S, Sandhu G, 2012, The Upper Respiratory Tract, Sarcoidosis, Editors: Mitchell, ISBN: 978-0340992111
Rimmer J, Ferguson LM, Saleh HA, 2012, Versatile applications of the polydioxanone plate in rhinoplasty and septal surgery., Arch Facial Plast Surg, Vol: 14, Pages: 323-330
BACKGROUND: Rhinoplasty and septal surgery often require the use of cartilage grafts. Autologous cartilage may be thin or deviated, and the use of an absorbable scaffold material to support the reimplanted cartilage during healing can improve technique and outcomes. OBJECTIVE: To describe the use of a polydioxanone plate not only as a template in extracorporeal septoplasty but also for various other grafts commonly used in rhinoplasty and for the repair of septal perforations. METHODS: A retrospective case note review was performed between November 1, 2007, and February 28, 2011, for all patients treated using a polydioxanone plate. Surgical outcomes are discussed. RESULTS: A polydioxanone plate was used in septal and/or rhinoplasty surgery in 102 patients treated during a 40-month period. Follow-up was 9 to 18 months (mean, 12 months), with 96 patients reporting a good cosmetic or functional result. Up to 15% of patients experienced temporary septal swelling, but there were only 2 postoperative infections and no other significant complications. CONCLUSIONS: The polydioxanone plate is a safe and reliable absorbable implant that has many different applications in rhinoplasty and septal surgery. It not only acts as a scaffold but also stimulates and guides cartilage regeneration.
Vaezi A, Snyderman CH, Saleh HA, et al., 2011, Pseudomeningoceles of the sphenoid sinus masquerading as sinus pathology., Laryngoscope, Vol: 121, Pages: 2507-2513
OBJECTIVES/HYPOTHESIS: To describe the clinical presentation, pathophysiology, and treatment of spontaneous cerebrospinal fluid (CSF) leaks of the sphenoid bone, with an emphasis on a previously undescribed form in this location, in which CSF is trapped under the mucosa of the sinonasal cavity or in the soft tissue of the skull base. STUDY DESIGN: Case series and literature review. METHODS: Analysis of cases through medical records and literature review. RESULTS: Four examples of unusual spontaneous CSF leaks of the skull base are presented. In each case, a CSF collection was contained behind the sinonasal mucosa of the sphenoid sinus, resembling a nasal polyp or mucocele on exam or imaging. In one case, the fluid collection was also associated with significant bone resorption and extravasation into the soft tissue of the infratemporal fossa. In each case, small defects of the ventral skull base (sphenoid bone) were the source of the CSF leaks. Successful treatment was achieved after transnasal endoscopic repair of the skull base defects using a combination of free abdominal fat grafts, free fascial grafts, and pedicled nasoseptal flaps. Postoperatively, a ventriculoperitoneal shunt was placed if the intracranial pressure was elevated. CONCLUSIONS: Spontaneous CSF leaks arising in the sphenoid sinus may not always present with overt CSF rhinorrhea but with a submucosal fluid collection (pseudomeningocele) that may mimic a mucocele or nasal polyp. These bona fide pseudomeningoceles of the skull base may be associated with elevated intracranial pressure and can be managed using endoscopic endonasal surgery.
Keh SM, Facer P, Yehia A, et al., 2011, The menthol and cold sensation receptor TRPM8 in normal human nasal mucosa and rhinitis., Rhinology, Vol: 49, Pages: 453-457, ISSN: 0300-0729
BACKGROUND: Menthol and cold sensation trigger symptoms and reflex responses in the upper airway, but the underlying molecular mechanisms are unknown. We have therefore studied nerve fibres expressing the menthol and cold receptor TRPM8 in normal human mucosa, and in rhinitis. TRPM8 nerve fibres were compared with those expressing other TRP receptors including TRPV1 (capsaicin and heat receptor), and TRPA1 (mechano-cold receptor). METHODS: Immunohistology and image-analysis were used to study TRP receptors in biopsies of nasal turbinate from control subjects, patients with allergic rhinitis, and non-allergic rhinitis. RESULTS: TRPM8-immunoreactive nerve fibres were observed in the sub-epithelium, and were profuse around blood vessels in deeper regions, where they were markedly greater in number than TRPV1+ fibers. Image analysis of TRPM8 in sub-epithelial and vascular regions showed no significant differences between control and the rhinitis patient groups. TRPA1-immunoreactivity was weak and seen rarely in nerve fibres. CONCLUSION: We show that TRPM8 nerve fibres are abundant in nasal mucosa particularly around blood vessels, and may mediate neurovascular reflexes. TRPM8 antagonists deserve consideration for therapeutic trial in rhinitis.
Punekar YS, Ahmad A, Saleh HA, 2011, Estimating the effect of nasal steroid treatment on repeat polypectomies: survival time analysis using the General Practice Research Database., Rhinology, Vol: 49, Pages: 190-194, ISSN: 0300-0729
BACKGROUND: Intranasal steroids are effective in preventing or delaying recurrence of nasal polyps. However, their effectiveness in delaying a need for repeat polypectomy in clinical practice is unknown. OBJECTIVES: To compare time to a repeat polypectomy between post-polypectomy intranasal steroid users and non-users. METHODOLOGY/PRINCIPLE: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for up to 4 years and the time to next polypectomy was estimated. Cox`s proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment. RESULTS: The cohort consisted of 1,675 patients with a mean age of 59 years and 68% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy compared to steroid non-users. This difference was consistent among subgroups of females and concomitant rhinitis treatments users. Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk whereas other confounders were not significant. CONCLUSIONS: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a prospective design is necessary to quantify the benefit of ongoing steroid treatment.
Hull S, Mace AD, Lalchan S-A, et al., 2011, Orbital floor abscess secondary to sinusitis in an immunocompromised patient., Ophthalmic Plast Reconstr Surg, Vol: 27, Pages: e139-e141
A 65-year-old man with a history of renal transplantation presented with facial pain, purulent nasal discharge, and periorbital swelling. Signs of optic nerve compromise developed and persisted despite medial orbital wall decompression. Further imaging revealed an orbital floor abscess secondary to direct communication of a maxillary pseudomonal sinusitis. Full recovery was achieved after further surgical drainage via an endoscopic endonasal approach. Failure to improve after surgical decompression is an indication for repeat imaging. Immunocompromised patients can present atypically. Orbital floor abscess secondary to sinusitis without an underlying odontogenic or traumatic cause has not previously been reported. The authors highlight the importance of clinical vigilance, serial imaging, microbiological investigations, and early surgical intervention in high-risk patients.
Saleh HA, 2011, Extracorporeal Septorhinoplasty, Rhinoplasty Cases and Techniques, ISBN: 978-1604066807
Al Yaghchi C, Ali A, Saleh H, 2010, The use of dissolvable nasal packs in the management of depressed unilateral nasal bone fractures., Clin Otolaryngol, Vol: 35, Pages: 440-441
Jaberoo M-C, Hassan A, Pulido M-A, et al., 2010, Endoscopic endonasal approaches to management of cholesterol granuloma of the petrous apex., Skull Base, Vol: 20, Pages: 375-379
Cholesterol granulomas are the most common lesion of the petrous apex. Traditionally, lesions of the petrous apex have been accessible via open, infracochlear, and transtemporal approaches. We describe two cases in which the endoscopic transsphenoidal approach was used to manage this lesion. The design of this study is as a review of new endoscopic approaches. The setting of the study is a tertiary referral unit in a London teaching hospital. Case 1: A 53-year-old man diagnosed with bilateral cholesterol granulomas of the petrous apices. Case 2: A 32-year-old woman diagnosed with a right-sided cholesterol granuloma of the petrous apex. The main outcome measures were symptom resolution and postoperative complications. An endoscopic transsphenoidal approach was used in the first case. In the second case, the lesion was approached through the nasopharynx, an approach that has not been described previously. Both patients' symptoms resolved and no complications occurred. Transsphenoidal endoscopic removal of cholesterol granulomas is a recent advance in the extended applications of sinus surgery. It allows for a less invasive procedure with markedly less associated morbidity.
Ragab SM, Lund VJ, Scadding G, et al., 2010, Impact of chronic rhinosinusitis therapy on quality of life; A prospective randomized controlled trial, RHINOLOGY, Vol: 48, Pages: 305-311, ISSN: 0300-0729
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- Citations: 50
Lund VJ, Stammberger H, Nicolai P, et al., 2010, European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base., Rhinol Suppl, Vol: 22, Pages: 1-143, ISSN: 1013-0047
Tumours affecting the nose, paranasal sinuses and adjacent skull base are fortunately rare. However, they pose significant problems of management due their late presentation and juxtaposition to important anatomical structures such eye and brain. The increasing application of endonasal endoscopic techniques to their excision offers potentially similar scales of resection but with reduced morbidity. The present document is intended to be a state-of-the art review for any specialist with an interest in this area 1. to update their knowledge of neoplasia affecting the nose, paranasal sinuses and adjacent skull base; 2. to provide an evidence-based review of the diagnostic methods; 3. to provide an evidence-based review of endoscopic techniques in the context of other available treatments; 4. to propose algorithms for the management of the disease; 5. to propose guidance for outcome measurements for research and encourage prospective collection of data. The importance of a multidisciplinary approach, adherence to oncologic principles with intent to cure and need for long-term follow-up is emphasised.
Ramotar H, Jaberoo M-C, Koo Ng NKF, et al., 2010, Image-guided, endoscopic removal of migrated titanium dental implants from maxillary sinus: two cases., J Laryngol Otol, Vol: 124, Pages: 433-436
OBJECTIVE: We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy. METHOD: Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach. RESULTS: One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach. CONCLUSION: Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.
Saleh HA, Lund VJ, 2010, Benign maxillary sinus masses, The Maxillary Sinus: Medical and Surgical Management, Editors: Becker, Krouse, ISBN: 978-1604062809
Durham SR, Saleh HA, 2010, Allergic rhinitis ('hay fever'), Oxford Textbook of Medicine, Editors: Warrell, ISBN: 978-0199204854
Macedo P, Saleh H, Torrego A, et al., 2009, Postnasal drip and chronic cough: An open interventional study, RESPIRATORY MEDICINE, Vol: 103, Pages: 1700-1705, ISSN: 0954-6111
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- Citations: 22
Taghi AS, Khalil SS, Mace AD, et al., 2009, Balloon Sinuplasty™: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis, EXPERT REVIEW OF MEDICAL DEVICES, Vol: 6, Pages: 377-382, ISSN: 1743-4440
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- Citations: 10
Saleh H, 2009, Rhinosinusitis, laryngopharyngeal reflux and cough: an ENT viewpoint., Pulm Pharmacol Ther, Vol: 22, Pages: 127-129, ISSN: 1094-5539
Chronic cough is a common presentation. Postnasal drip (PND) and gastro-oesophageal reflux are mostly implicated in the aetiology. Directly examining the larynx can often help to demonstrate laryngitis or inter-arytenoid oedema that is mostly attributed to reflux. Although "the syndrome of postnasal drip" is considered as a major cause for chronic cough, evidence of its existence is mostly difficult to elicit on examination. Furthermore, the majority of patients with "postnasal drip" seen in ENT outpatients do not complain of cough. Evidence does suggest there is a link between postnasal drip and cough. The fact that some patients present with cough in association with this syndrome and others do not is still not well understood.
Anverali JK, Hassaan AA, Saleh HA, 2009, Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak., J Laryngol Otol, Vol: 123, Pages: 145-147
OBJECTIVE: To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure. METHOD: Case report of new technique, with reference to the world literature. RESULTS: An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up. CONCLUSION: Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.
Koo Ng NKF, Jaberoo MC, Pulido M, et al., 2009, Image guidance removal of a foreign body in the orbital apex., Orbit, Vol: 28, Pages: 404-407
Retrieval of foreign bodies lodged in the orbit present a challenging surgical problem. The trans-nasal approach when combined with image-guided navigation allows clear identification of structures and increased safety. We report a case of a successful removal of a foreign body under image-guidance using a trans-nasal approach.
Nouraei SAR, Pulido MA, Saleh HA, 2009, Impact of rhinoplasty on objective measurement and psychophysical appreciation of facial symmetry., Arch Facial Plast Surg, Vol: 11, Pages: 198-202
OBJECTIVES: To determine the impact of rhinoplasty on the objective measurement and subjective appreciation of facial symmetry and to investigate whether perceptual shifts are correlated with objective changes in facial proportions. DESIGN: Frontal view photographs were used to measure bilateral symmetry ratios of the medial and lateral canthi, tragus, ala, and oral commissure in 100 patients before and 6 months after rhinoplasty. Gestalt dichotomous impressions of facial symmetry were also obtained in all cases. Paired t tests and chi(2) tests were used to compare facial proportions and the proportion of faces perceived as symmetrical, respectively, before and after surgery. The receiver operating characteristic and analysis of variance were used to assess whether perceptual shifts in symmetry could be correlated with objectively measurable changes in facial proportion. RESULTS: The number of faces perceived as symmetrical increased from 42 to 62 after rhinoplasty (P < .001, chi(2) test). Objectively, midline-to-ala symmetry increased from an average of 91.1% (5.5%) (mean [SD]) to 93.8% (4.5%) after rhinoplasty (P < .001, paired t test). Other facial proportions did not change significantly (P > .10). The degree of change in midline-to-ala symmetry was the only objective measure that was significantly associated with the subjective perception of the face as symmetrical or asymmetrical (P < .01, 1-way analysis of variance). Most positive perceptual shifts were associated with an objective improvement in nasal symmetry that was greater than 2%. Conversely, most negative perceptual shifts were associated with minimal postoperative improvement or loss of nasal symmetry. CONCLUSION: Rhinoplasty leads to objectively measurable changes in nasal symmetry that correspond with psychophysical modifications in the perception of a face as symmetrical or asymmetrical.
Joseph JA, Moorthy R, Saleh H, 2009, Endoscopic management of inverted papilloma of the sphenoid sinus., BMJ Case Rep, Vol: 2009, ISSN: 1757-790X
We present the case of a rare sinonasal tumour originating in a rare location in close proximity to vital structures. We describe how the patient was managed, including detailed description of how the mass was removed.A 54-year-old man presented with a long history of nasal blockage, recently complicated by severe headaches and a left VIth nerve palsy. CT scan showed complete opacification of the left sphenoid sinus.Symptoms improved following administration of steroids and nasal decongestants. Histology from endoscopic debulking of the mass confirmed the presence of inverted papilloma. Fine-cut CT showed the course of the carotid artery and optic nerve, closely related to the tumour, allowing for complete removal during a second endoscopic procedure. Five years following the procedure, the patient remains symptom free.With appropriate imaging, isolated sphenoid sinus tumours can be removed endoscopically even when in close relation to vital structures.
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