Ho, ho, ho! Gather ’round, my dear friends, as I tell you a tale from the world of surgical pathology, as fascinating as the twinkling stars on a clear Christmas Eve. Picture, if you will, the lateral recess of the sphenoid sinus, a place as elusive as the North Pole itself. CSF fistulas in this area are as rare as a reindeer with a red nose, accounting for a mere 7.7% of all leaks from the skull base.

In this tale, we have three brave patients, each with a spontaneous cerebrospinal fluid leak from this very recess. Their journeys took them through the frosty landscapes of transsphenoidal and transpterygoid endoscopic approaches, each with varying postoperative results, as unpredictable as the Christmas weather.

Now, here’s the crux of the story, my friends. The success of the plastic surgery for these CSF fistulas doesn’t depend on the type of endonasal surgical approach, much like how the success of Christmas doesn’t depend on the size of the tree, but on the quality of the decorations and the preoperative level of CSF pressure.

So, remember, my dear friends, it’s not about the journey, but the quality of the plastic and the pressure of the CSF that truly matters. And with that, I wish you a Merry Christmas and a healthy New Year!

Ho ho ho! Gather ’round, my dear friends, as I tell you a tale from the frosty lands of Russia, where a group of pediatric audiologists, as busy as Santa’s elves, have been working on a clinical protocol for audiological assessment in infants. Their goal, as noble as the star atop the Christmas tree, is to unify approaches to audiological diagnosis in these little bundles of joy.

Just like Santa checks his list twice, this protocol has been developed with meticulous care, following the principles of evidence-based medicine. They’ve reviewed the latest scientific publications, as if they were letters to Santa, and considered the order of providing medical services and other clinical practice guidelines. When direct evidence was as elusive as Rudolph on a foggy night, they turned to indirect evidence and consensus practice to guide their sleigh.

Now, don’t mistake this for a strict list of rules, as rigid as a candy cane. No, this guideline is more like a Christmas stocking, filled with evidence-based recommendations from which clinicians can pick and choose, tailoring their approach to each individual patient.

The first part of the protocol, as packed as Santa’s sack, covers a range of sections: from equipment and staff requirements, to the timing of diagnostics, case history and risk factors. It even includes tips on preparing the child for the appointment, like leaving out cookies and milk for Santa. It discusses sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, and even the nitty-gritty details of skin preparing and electrode montage.

So, my dear friends, as we approach the end of our tale, remember that this protocol, like a well-wrapped Christmas present, is filled with valuable insights on choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, and combined correction factors. Ho ho ho!

Ho ho ho! Gather ’round, my friends, as we delve into the frosty world of modern otorhinolaryngology, a field as challenging as guiding my sleigh through a blizzard! The surgical treatment of inflammatory diseases of the frontal sinus, nestled as close to the skull base, the orbit, and the anterior ethmoid artery as a snug stocking on a fireplace, presents a challenge as big as the Grinch’s heart before it grew three sizes.

The limited visibility and instrumentation, akin to trying to wrap presents in the dark, and the high risk of frontal recess scarring, as unwelcome as a lump of coal in a stocking, make both endoscopic and external approaches to the frontal sinus as tricky as navigating a rooftop on a foggy Christmas Eve. Yet, just as Rudolph’s red nose lights the way, the endoscopic approach is seen by many of my fellow elves in the medical field as the preferred method for surgically treating frontal sinusitis.

The introduction of extended approaches, like the unexpected joy of finding an extra present hidden behind the tree, has allowed for a significant decrease in the need for external frontal sinus procedures. These include the drill-out of the frontal sinus floor and interfrontal sinus septum, and superior septectomy with common drainage pathway formation, as innovative as the latest toy from Santa’s workshop.

In this paper, we’ll journey through the history of endonasal approaches to frontal sinuses, like a sleigh ride through Christmases past. We’ll explore the current debates surrounding the proper selection of extent and methods of frontal sinus surgery, as lively as a debate over who makes the best Christmas cookies. And finally, we’ll summarize endoscopic and external approaches to frontal sinuses, wrapping up our discussion as neatly as a present under the tree. So, buckle up, my friends, and let’s take a magical ride through the world of otorhinolaryngology!