Spongiotic bone
Hi Dr Houser, In a book called Functional Reconstructive Nasal Surgery (written by E. de Huizing and previewable online), they describe narrowing the nasal passage airway using spongiotic bone: Pg 289 - "Pieces of processed heterogeneic spongiotic bone are implanted in all tunnels to narrow the nasal cavity in all it's dimensions. When indicated, some material may also be implanted on the medial side of the middle turbinate..." There is also an accompanying diagram which depicts this scenario. Surely if they are describing it, someone is doing it or has done it right? What do you know about the use of spongiotic bone? Thanks, JR

link?

Sorry - here you go: http://books.google.co.uk/books?id=VTYLAD2MI5UC&dq=functional+nasal+huizing&pg=PP1&ots=5FMTQ_DsK_&sig=UItdiMu0qJn1-miionr98EO-AGo&hl=en&prev=http://www.google.co.uk/search%3Fhl%3Den%26q%3Dfunctional%2Bnasal%2B%252B%2Bhuizing%26btnG%3DGoogle%2BSearch&sa=X&oi=print&ct=title&cad=one-book-with-thumbnail#PPA289,M1 Scroll down till you get to page 289.

Sorry for the interruption, but I just wanted to thank JR for this find and state my opinion that I have read through the pages allowed in the pre-review of this book and it really seems like a top notch must book of functional reconstructive nasal surgery. Besides the chapter that reviews the history and contemporary techniques of surgeries for atrophic rhinitis - hence the relevance to ENS - it also gives a thorough review on page 278 of all the available methods for turbinate reduction. He begins with turbinectomy and writes a clear and damning accusation about it, which is most relevant for us as a collective group that is trying to enhance ENS awareness: "In our opinion, turbinectomy is a nasal crime. We feel that there is no reason (apart from malignancies) to resect more than one-third to one-half of the inferior turbinate." "A nasal crime" - what can be more damning and condemning than that?!!! Kudos to Professor Huizing.

The preview I was able to see only went up to page 79. It looks like a fantastic book though; I expect to purchase it. I wish page 64 were in the preview. He shows a CT of ENS (although one with mucosal disease as well which many will just attribute ongoing sx's to just that).

Seems spot on. Why do so many Europeans end up on this board asking for help?

Actually, considering that there are about half a billion people in Europe they are a minority here with the absolute majority being from the US and Canada. OK, fare enough, you could say that most European countries are non-English speaking countries. But still when you compare the rest of the English speaking world to North America you still see that the vast majority (by proportion) come from the US and Canada as there are only a handful from the UK which has a three times fold larger population than Canada does, and there are only perhaps 2 or 3 from Australia (population size of Canada), one from New Zealand, one from Ireland and one from South Africa. That concludes the English speaking countries. This means that the main producing ENS countries among the English speaking countries are the United States and Canada (at least as represented on this board). My guess is that the tendency to use high powered instruments and endoscopic surgery in the US and Canada causes surgeons to be a little too much trigger happy when it comes to surgeries and also not deter from doing repeated surgeries - cutting more and more as they go. I have noticed that many of the American patients here have resulted in ENS only after their second or third surgery, while the European ones seem to have not more than a single procedure suggesting that the same occured in one procedure, often during a more traditional form of turbinectomy (scissors, laser...), but all in all compared to the huge Americanmajority here the European seem to be a striking minority. You could say that one of the reasons is that most European countries are not English speaking countries, but, there are still by proportion much less ENS patients that come to this board from other English speaking countries too. It's perhaps somewhatsurprising, but it's how things have turned out so far. I think that generally speaking, because the Europeans favor traditionalism in all aspects of life they are relatively slower in favoring new technologies and are quite cautious and slow in adopting them, while in Northern America - it's all about getting the latest gizmo and using the latest cutting edge technology - which results often in too many surgeries (ala the Erasorama surgery phenomenon). France for instance has always been a country that took pride in adopting newer technologies faster than other countries around her (if you ever have the chance to take the Eurostar train from Paris to London through the La manche canal - you'll see what I mean - while the ride is so smooth on the french side thanks to the modern set of tracks, once you pass over into Britain you basically get your bones rattled all the way to London :lol: ). Therefore I am not surprised that France seems to be producing a fairly larger amount of ENS patients compared to most of her neighbors. But really, these are all wild speculations. We don't really have the tools and the right kind of exposure on this board to even begin getting close to a scientific assessment of whether there are countries that produce more ENS than others. For instance I don't know if there is a similar percentage of Europeans that connect to the Internet regularly like in North America... this can be an obvious factor for the differences too.

Well, you really explained that one well TE ... :wink:

I guess I am thinking of people that email away from the board as well This book speaks to an understanding/acceptance of ENS that is unheard of in the US There should be Americans flocking to Europe for ENS care! I have noted the Frech to be aggressive with old fashioned turbinate scissors. I think the healthcare finance factors determine the degree of new "toy" acceptance more than any other factors