Limitations of balloon sinuplasty in frontal sinus surgery

Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6 months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.

Emotions, Arousal, and Frontal Alpha Rhythm Asymmetry During Beethoven's 5th Symphony

Music is capable of inducing emotional arousal. While previous studies used brief musical excerpts to induce one specific emotion, the current study aimed to identify the physiological correlates of continuous changes in subjective emotional states while listening to a complete music piece. A total of 19 participants listened to the first movement of Ludwig van Beethoven's 5th symphony (duration: ~7.4 min), during which a continuous 76-channel EEG was recorded. In a second session, the subjects evaluated their emotional arousal during the listening. A fast fourier transform was performed and covariance maps of spectral power were computed in association with the subjective arousal ratings. Subjective arousal ratings had good inter-individual correlations. Covariance maps showed a right-frontal suppression of lower alpha-band activity during high arousal. The results indicate that music is a powerful arousal-modulating stimulus. The temporal dynamics of the piece are well suited for sequential analysis, and could be necessary in helping unfold the full emotional power of music.