Anterior Rhinoscopy Research Articles

A Challenging Case Of Giant Maxillary Ameloblastoma: Navigating Rarity And Complexity In Diagnosis And Treatment

Background: Ameloblastoma is a rare, aggressive, benign odontogenic tumor that most commonly occurs in the jaw. Maxillary occurrences are rarely reported. Case Presentation: We report the case of a 61-year-old male presenting with right-sided unilateral nasal obstruction, characterized by a mass occupying the entire right nasal fossa upon anterior rhinoscopy. A computed tomography (CT) scan, combined with magnetic resonance imaging (MRI), revealed a locally advanced mass centered on the right maxillary sinus. The patient underwent wide excision of the mass, and histopathological analysis confirmed the diagnosis of ameloblastoma. Discussion: Naso-sinus ameloblastomas are rare, benign, and slow-growing tumors, accounting for approximately 0.11% of nasal and sinus tumors. More common in men, they typically present between the ages of 20 and 30. Symptoms include nasal obstruction and epistaxis, with occasional facial swelling or headaches. These tumors often originate in the posterior maxillary region and extend into the maxillary sinuses and nasal cavity. Diagnosis is facilitated by imaging, where the tumors appear as solid, radio-opaque masses. Radical surgical resection is the preferred treatment, as it is essential for preventing recurrence. The prognosis is generally favorable, with no documented cases of malignant transformation or metastasis, and recurrences are rare when appropriate surgical management is performed. Conclusion: Medical imaging plays a crucial role in diagnosis and allows for the evaluation of tumor dissemination and anatomical involvement. The treatment of maxillary ameloblastoma typically involves surgical excision, with the complexity of management often linked to the extent of tumor spread.

The value of objective methods for assessing nasal breathing function in the diagnostic algorithm for allergic rhinitis

The visual analogue score (VAS) is recommended to assess the severity of symptoms of allergic rhinitis (AR), but despite its advantages, it is a tool for subjective assessment of symptoms and often does not correlate with the true state of nasal patency. Anterior active rhinomanometry (AAR) is the method to objectify obstructive changes in the nasal cavity in patients with AR and is the most accurate method to assess nasal breathing function from a physiological and aerodynamic point of view. In addition, AAR with a decongestant test allows a differential diagnosis of the causes of nasal obstruction. Our study showed that there was no correlation between VAS and AAR scores. In addition, we found the importance of performing AAR with a decongestant test and subsequent assessment of unilateral flow and resistance parameters, which allowed us to suspect the presence of structural changes in the nasal cavity in patients with AR, as recorded as a result of anterior rhinoscopy and/or endoscopic examination. Thus, in addition to the use of VAS, it is necessary to include AAR in the diagnostic algorithm for AR, which allows not only to confirm the presence or absence of nasal breathing impairment, but also to differentiate the causes of its occurrence for the subsequent selection of the optimal management of patients with AR.

Medical education during the COVID-19 pandemic: An online-only course can achieve good to medium psychomotor skill level of basic head and neck examination

Background/ObjectivesNew teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities. MethodsThe study was designed as a prospective, single-institution medical education cohort study. Medical students (n = 54; 3rd/4th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1–14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales). ResultsStudents achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students’ underestimation of their own abilities. ConclusionsOnline training of head and neck examination skills is a cost- and resource-efficient introduction to skill training and was inevitable during the pandemic. However, it cannot replace practical hands-on training, especially in tasks with high psychomotor requirements. Refresher-courses could compensate for cancelled skill training during the pandemic.

Integrated Health Solutions: Addressing the Co-occurrence of Otitis Media With Effusion and Early Childhood Caries in Preschool Children.

Introduction: Otitis media with effusion (OME) is a common middle ear condition, which frequently affects children and can lead to hearing impairment, speech delays, and developmental issues. Early childhood caries (ECC) is another prevalent pediatric condition defined by the presence of decayed, missing, or filled tooth surfaces in children under six years old. Objectives: This study aims to determine the prevalence of OME and ECC, the association between these two conditions, and the risk and severity of ECC among preschool children with OME. Methodology: A prospective cross-sectional study was conducted at a single tertiary center. A total of 206 preschool children aged six and below with hearing impairment or speech delay were recruited. They were grouped as follows: with OME (n= 129) and without OME (n = 77). Demographic and socioeconomic data were obtained, followed by otoscopy, anterior rhinoscopy, and tympanometric assessment. The subjects were further stratified into having ECC or not by conducting a dental examination for caries detection, whose findings were documented using Dental Charting and Caries Risk Assessment (CRA). Tympanometric width (TW) was also analyzed to measure its association with tympanic membrane appearance. Results: 51.5% (n=106) of children with OME were found to have ECC. They predominantly had mild ECC (49.1%), and most (51%) were at moderate risk for caries based on the CRA (P < 0.001). A significant association between OME and ECC was observed (p < 0.001). Tympanometry results documented a strong correlation between TW greater than 200 daPa and abnormal tympanic membrane findings in OME (P< 0.001). Conclusions: The association between OME and ECC in preschool children necessitates integrated healthcare approaches for early detection and management. Reliable diagnostic tools, such as tympanic width measurement for OME and CRA for ECC, are crucial in addressing these health issues. Early intervention and comprehensive care can mitigate the risks and improve health outcomes for affected children.

Naso-mucociliary Clearance Time among Patients with Chronic Rhinosinusitis in Ilorin, North-central Nigeria.

The mucociliary clearance system is an important component in the prevention of chronic inflammation of the nasal and paranasal sinus. The study aims to establish the normal values of mucociliary clearance in our region and to study the variation in mucociliary activity in patients with chronic rhinosinusitis in Ilorin, North-central Nigeria. This was a prospective, cross-sectional study using consecutive consenting participants in both the control and study groups carried out at both family medicine and otorhinolaryngology clinics among patients attending the clinics. After ethical approval was sought, informed consent was obtained from patients, a modified version of the validated health questionnaire was filled, semi-structured questionnaires were also filled after which patient undergo anterior rhinoscopy, nasal patency test and spirometry was done. The saccharine test has been used to measure nasal-mucociliary clearance time in the past. All information were entered into SPSS version 20 and analysed descriptively, and results were presented in tables and figures. Consecutive consenting 125 patients with rhinosinusitis (study group) and those without rhinosinusitis (control group) underwent naso-mucociliary clearance test. There were 34 males and 91 females with a male:female ratio of 1:2.6 among the study group and 55 males and 70 females with a male:female ratio of 1:1.3 for the control group. The age range was from 18 to 68 years with 18-40 years constituting the modal age group. The mean age for the studied group was 35.7 years while that of the control group was 33.1 years. The mean naso-mucociliary clearance time among the study group was 35.1 min standard deviation (SD = 12.32 ± 1.63), while among the control group, it was 14.8 min (SD = 5.59 ± 0.43). Compared to the control group, there was a roughly 200% prolonged increase in the duration of naso-mucociliary clearance time among patients with rhinosinusitis. There was also a positive correlation with increasing age. Future studies comparing the pre-operative and post-operative treatment of rhinosinusitis will contribute to knowledge.

Deviated Nasal Septum: A Comprehensive Review

Abstract Deviated nasal septum (DNS) is a condition where the nasal septum, the partition between the two nasal cavities, is misaligned from the midline. This deviation can significantly impact airflow, leading to various respiratory disorders such as nasal obstruction, sinusitis, and impaired breathing. DNS is diagnosed through clinical examination, including anterior rhinoscopy, nasal endoscopy, and imaging methods such as computed tomography (CT), magnetic resonance imaging, and cone-beam CT. These diagnostic tools help to assess the severity of the deviation and its impact on the nasal structures. The classification of DNS is crucial for defining the appropriate treatment plan. Various classification systems have categorized DNS depending on the type, location, and extent of the deviation. Treatment choices of DNS range from conservative nonsurgical remedies such as nasal decongestants and corticosteroids to surgical interventions like septoplasty, which aims to realign the septum and restore normal nasal airflow. This article reviews the prevalence of DNS, different classifications, and various diagnostic approaches for accurate determination and symptoms of DNS. The article also explores the most effective treatment strategies, highlighting the importance of accurate diagnosis and personalized treatment approaches to improve patient outcomes.

The benefit and clinical value of CT scan as preoperative assessment for structural functional septorhinoplasty

&lt;b&gt;Introduction:&lt;/b&gt; Structural functional septorhinolplasty is an operation designed to achieve both aesthetic and functionalgoals, which were the most important success parameters for patient satisfaction. Different preoperative examination toolsare available for assessment.&lt;b&gt;Aim:&lt;/b&gt; To evaluate the diagnostic benefit and clinical value of a CT scan, and compare it with other examination tools, such as nasal endoscopy and anterior rhinoscopy for structural functional septorhinoplasty&lt;b&gt;Material and Methods:&lt;/b&gt; A prospective randomized controlled study of 148 consecutive patients seeking for a solution to their primary problem of nasal obstruction, and also for a cosmetic effect within the same operation (structural functional septorhinoplaty). They were divided into 3 groups; CT scan group, endoscopic group, and control group (anterior rhinoscopy). The subjective postoperative assessment was carried out with the Nasal Obstruction Symptom Evaluation scale (NOSE), Rhinoplasty Outcome Evaluation scale (ROE), Visual Analogue Scale (VAS), and SNOT-22 score. Those outcomes at 12-month follow-up were compared to preoperative values.&lt;b&gt;Results:&lt;/b&gt; Among 148 patients, there were 77 males (52.02%) and 71 females (47.97%), age range between 19 to 52 years (mean age 23.4 2.7 SD). In all 3 groups, there was a significant clinical improvement in nasal symptoms and structural functional septorhinoplasty outcomes, as well as better ROE, NOSE, VAS, and SNOT-22 scores in the CT scan group when compared to the other two groups, with the P-values being 0.01, 0.01, 0.03, and 0.04, respectively.&lt;b&gt;Conclusions:&lt;/b&gt;CT scan is of greater benefit than nasal endoscopy and anterior rhinoscopy and constitutes the method of choice as a part of preoperative assessment in detecting any nasal pathology and assessing nasal anatomical structures prior to structural functional septorhinoplasty.

A Comparative Study of Correction of Caudal Septal Deviations.

There are multiple surgical approaches for the correction of caudal septal deviation. To compare the surgical outcomes of the widely used techniques of correction of caudal septal deviation. In a prospective study done over a period of 3 years, 36 patients with caudal septal deviation were selected and randomly divided into 3 groups of 12 each who underwent surgery by the following techniques: Group A - Swinging Door technique. Group B- Tongue-in-groove technique. Group C- The cutting and suture technique with unilateral bony batten grafting. The preoperative and postoperative (at 6 months) NOSE score, anterior rhinoscopy and subjective assessment were used to measure surgical outcomes and the techniques were compared. Out of the 36 patients, the mean NOSE score preoperatively and postoperatively were as follows. For Group A- 72.5 and 23.33. For Group B- 73.75 and 19.17. For Group C- 72 and 22. A significant improvement of mean 49.17, 54.58 and 50.00 with p-value of < 0.05 respectively. Anterior rhinoscopy done at 6 months postoperatively showed that 30 patients (83%) had a straight septum while 6 patients (17%) had some residual deviation. Subjective patient satisfaction was "much improved" in 17 (47.2%) patients, and "improved" in 19 (52.8%) patients. Four patients had postoperative synechia which were managed conservatively. Surgical correction of caudal septal deviation resulted in significant improvements in nasal airway. The tongue-in -groove technique was found to be the most effective among the three.

Assessment of olfactory and gustatory functions in COVID-19 patients

BackgroundOlfactory and gustatory disorders are common problems encountered during the COVID-19 pandemic with a significant impact on the patient’s quality of life: The aim of this study was to assess the olfactory and gustatory functions in COVID-19 patients with correlation between them and clinical and laboratory markers. This was a cross-sectional study conducted on 63 subjects recruited from the COVID-19 clinics at Police Authority and Menoufia University hospitals. The patients were assessed using history taking, anterior rhinoscopy, endoscopic examination, computed tomography, and polymerase chain reaction (PCR) test. Olfactory functions were assessed using the alcohol threshold test. Gustatory functions were assessed using the three-drop method. The olfactory and gustatory functions were correlated with age, gender, and laboratory parameters. Also, the recovery of smell and taste disorders was correlated with our assessed laboratory markers.ResultsThe prevalence of olfactory dysfunction among study participants was 41 patients (65%) of the participants including 12 patients (19.1%) having mild hyposmia, 10 patients (15.8%) having moderate hyposmia, 9 patients (14.3%) having severe hyposmia, and 10 patients (15.8%) having complete anosmia. The prevalence of gustatory dysfunction among study participants was 24 patients (38.1%). Age, gender, and laboratory parameters did not show any statistically significant difference between those who experienced olfactory dysfunction or gustatory dysfunction and those who did not. However, there was a significant positive correlation between the total leucocytic count, serum level of CRP, and serum level of D-dimer and the degree of olfactory dysfunction (0.049, 0.03, and 0.02, respectively). There was a nonsignificant correlation between recovery of olfactory and gustatory dysfunction and laboratory markers.ConclusionOlfactory and gustatory dysfunction are established clinical presentations among COVID-19-positive patients. The laboratory markers had no correlation with the incidence of these dysfunctions or their recovery. However, TLC, serum CRP, and serum D-dimer had a significant positive correlation with the severity of olfactory dysfunction.

Role of nasal endoscopy in evaluation and management of epistaxis

Background: Epistaxis is the most common ENT emergency. The localization of bleeding site and its control in profuse epistaxis is of major concern for the ENT surgeon. Nasal endoscope has proved to be a boon for the otolaryngologist and is an important tool in diagnosing these bleeding points and their immediate management which reduces the incidence of nasal packing either anterior or posterior. Aim was to study the importance of nasal endoscopy in diagnosing the cause and site of epistaxis and managing them appropriately. Methods: It was a prospective study conducted in 187 patients of epistaxis visiting ENT emergency at SMGSH, Jammu after getting IEC clearance. Results: 139 (73.8%) had anterior and 48 (26.2%) posterior epistaxis. Dry nasal septum and mass lesions were the common local causes followed by deviated nasal septum. Anterior part of septum (little’s area) was the common site of bleeding followed by woodruff’s area. The overall success rate of diagnosing the local cause and site of epistaxis was 99% with nasal endoscopy and only 47% with combined anterior and posterior rhinoscopy. Thus, eliciting the importance of nasal endoscopy over conventional anterior and posterior rhinoscopy. Conclusions: Nasal endoscopy helps in detecting the site and cause of epistaxis and also aids in its appropriate management. It helps in endoscopic guided direct pressure packing, bipolar electrocautery, endoscopy assisted mass excision and endoscopic guided foreign body removal. However, nasal endoscopy is not a substitute for nasal packing.

Evaluation of computed tomography (CT) findings in patients with symptomatic deviated nasal septum and their correlation with intraoperative findings

AimTo evaluate the computed tomography (CT) findings in patients having a symptomatic deviated nasal septum (DNS) and their comparison with intraoperative findings.MethodsCross-sectional, observational study done in the department of ENT and HNS at a tertiary care center, over a period of 16 months. Patients presenting with nasal obstruction as the chief complaint and findings of deviated nasal septum on anterior rhinoscopy without clinical features of chronic rhinosinusitis (CRS) were included in the present study. All patients underwent CT scans of paranasal sinuses (PNS) as per the govt. scheme for approval of surgery. Surgery was planned as per the indication based on history, clinical examination, and non-contrast CT scan PNS findings. The average duration from CT scan to surgery was 4.5 weeks.ResultsAll 200 (100%) patients had DNS with inferior turbinate hypertrophy in 103 (52.5%), concha bullosa in 22 (11.0%), pneumatized superior turbinate in 6 (3.0%), and PMT (paradoxical middle turbinate) in 22 (11.0%). On comparing CT scan findings with intraoperative findings, it was found that maxillary sinus involvement had been seen in 28 (14.0%) patients on CT scan and only 8 (4.0%) patients intraoperatively. Similarly, CT scan involvement compared to and intraoperative involvement of anterior ethmoidal sinus was seen in 20 (10.0%) compared to 6 (3.0%) patients intraoperatively, posterior ethmoid in 12 (6.0%) compared to 3 (1.5%) frontal sinus in 4 (2.0%) compared to 1 (0.5%), sphenoid in 11 (5.5%) compared to 2 (1.0%), and osteomeatal complex (OMC) in 27 (13.5%) compared to 6 (3.0%) patients intraoperatively. Involvement of PMT, enlarged inferior, and concha bullosa was similar on CT scan and intraoperatively.ConclusionFrom this study, we concluded that a preoperative CT scan is a poor tool in predicting sinus disease in patients without clinical features of sinus disease and has a limited role in patients with symptomatic DNS. Insurance companies and government agencies should review their policies of ordering CT scans for approving septal surgeries.

Эффективность и безопасность терапии мометазона фуроатом в сравнении с цетиризином у взрослых пациентов с сезонным аллергическим ринитом в условиях реальной клинической практики

Background: both H1-histamine blockers and intranasal corticosteroids are recommended as step 2 pharmacotherapy for allergic rhinitis (AR). Aim: to compare cetirizine and mometasone furoate (nasal spray) for AR treatment in patients requiring step 2 therapy in real-world clinical practice. Patients and Methods: this study enrolled 160 patients aged 18–75 years suffering from AR with pollen sensitization and requiring step 2 of therapy. The study was observational, open-label, comparative, and non-interventional. The patients were divided into two groups: main group (MG; n=80) who received over-the-counter medicine mometasone furoate (nasal spray) 200 μg/day regimen and comparison group (CG; n=80) who received cetirizine 10 mg/day orally for 1 month±2 days. Patients had three office visits. Each visit included a physical examination, anterior rhinoscopy, and self-assessment using the visual analog scale (VAS). Both patients and physicians completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results: treatment efficacy was excellent (0-1 VAS score) in 52 (65%) patients in the CG and in 76 patients in the MG (95%, p&lt;0.05). Treatment efficacy was good (2-5 VAS scores) in 12 (15%) patients in the CG and in 4 (5%) patients in the MG. The study found that 5% of patients in the CG reported satisfactory results compared to 0% in the MG. Additionally, a significant difference (p&lt;0.001) in the reduction of the RQLQ score was reported among patients who experienced an improvement in quality of life by day 14 of treatment in the CG (-80.3±19.3) and MG (-113.3±34.7). The effectiveness of mometasone furoate (200 μg/day) as a monotherapy for 4 weeks was found to be superior to cetirizine treatment (10mg/day). Additionally, it was associated with a greater improvement in quality of life and better treatment tolerability due to fewer adverse events. Conclusions: mometasone furoate (nasal spray) can be recommended as a monotherapy for adults with mild to moderate AR. KEYWORDS: seasonal allergic rhinitis, mometasone furoate, cetirizine, intranasal corticosteroids, oral antihistamines. FOR CITATION: Churyukina E.V., Gamova I.V. Efficacy and safety of mometasone furoate therapy versus cetirizine in adults with seasonal allergic rhinitis in a real-world clinical setting. Russian Medical Inquiry. 2024;8(3):132–142 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-3-3.

The Presence and Severity of Inferior Turbinate Hypertrophy in Patients with Hypertrophic Scars.

This study aimed to investigate the presence and severity of inferior turbinate hypertrophy (ITH) in patients with hypertrophic scars (HTS). This case-control study was conducted with patients diagnosed with HTS during dermatologic examination and a control group without HTS. An otolaryngologist evaluated the presence and severity of inferior turbinate hypertrophy by anterior rhinoscopy. ITH was more common in patients with HTS compared to the control group (64%, and 34%, respectively) (p=0.014). In the HTS group, 48% of patients had grade 2, and 16% had grade 3 ITH; in the control group, 24% had grade 2, and 10% had grade 3 ITH (p=0.046). Also, ITH was higher in patients who complained of pruritus or pain (83%, and 80%, respectively) in the HTS than in asymptomatic HTS patients (p=0.020). A higher number of patients with HTS had ITH compared to the control group, especially those who reported pruritus or pain associated with scar. Given the limited understanding of the full pathogenesis and treatment of HTS and ITH, their association potentially provides new insights into these related conditions.

Rhinoscope‐assisted management of nasal hirudiniasis in a dog

AbstractA mixed‐breed mesocephalic male dog, weighing 25 kg, was presented with a medical history of nasal leeches (Dinobdella ferox) affecting both nostrils with the symptoms of laboured breathing, reverse sneezing, intermittent epistaxis and a reduced appetite. The dog underwent a standard clinical examination, haematological and biochemical assessments and radiographic studies to systematically diagnose any anomalies and evaluate its suitability for general anaesthesia. A Karl Storz video‐otoscope featuring a 15 Fr instrument channel was used to conduct anterior rhinoscopy under general anaesthesia. The endoscope was introduced sequentially into each nostril to visualise the nasal cavities and pinpoint the presence of leeches therein. Grasping forceps, guided through the endoscope's integrated instrument channel, were used to extract the leeches from both nasal cavities within a brief timeframe (18 leeches in 16 min) and without encountering substantial challenges. Following the leech removal, a post‐retrieval minor capillary bleeding within the nasal cavities, which was seen from both the nostrils, was controlled by flushing the nostrils with a 1:10,000 adrenaline tartrate solution.

ORBITAL COMPLICATIONS OF SINUSITIS–RETROSPECTIVE ANALYSIS

Objective: The objective of this study is to consider and analyze patients who were treated for these complications in the last 2 years in our hospital, comparing with another 2 tertiary care hospitals. Methods: It is a retrospective study. Out of the total number of ear, nose, and throat ENT cases attending our outpatient department, cases treated in the hospital with rhinosinusitis where surgical intervention is necessary, or those with a suspicion of complications. Between 2017 and 2019, there were 25 cases from three tertiary care hospitals, the clinical charts of which were reviewed. Consent has been taken from all the participants. The cases that are excluded from this study are those involving soft tissues, bone, and with intracranial complications. The diagnoses were determined based on history, anterior rhinoscopy, radiological imaging of the paranasal sinuses (X-ray), or computed tomography scan taken where there was a suspicion of a complication. In all cases, intensive treatment was initiated with a combination of cephalosporins and aminoglycosides and nasal irrigation with saline sprays. Results: In our study, in GITAM Institute of Medical Sciences and Research we encountered 6 cases the average time that patients remained in hospital was 4–5 days; for those with orbital complications this was 7 days. Similarly in other two tertiary care hospitals Andhra Medical College Visakhapatnam encountered around 15 cases and Konaseema Institute of Medical Science, Amalapuram, encountered 4 cases total constituting of 25 cases. Conclusion: The appearance of edema in the corner of the eye should be evaluated immediately, and the means to exclude acute sinusitis should be taken under serious consideration. Early diagnosis and aggressive treatment are important steps to be taken to avoid orbital complications like loss of vision.

Clinical Evaluation of &lt;i&gt;Pippalyadi Avapeeda Nasya, Elakanadi Kashaya&lt;/i&gt; and &lt;i&gt;Vyoshadi Ghrita&lt;/i&gt; in Chronic Rhinosinusitis: Case Series

Introduction: Chronic Rhino Sinusitis (CRS) is an inflammatory disease of the nose and sinuses with clinical features such as nasal blockage, nasal discharge and hyposmia. Current treatment modalities are antibiotics, corticosteroids and surgical interventions but the recurrent rate is high. In classics, dushtaprathisyaya features are similar to chronic rhinosinusitis. Materials and Methods: To analyze the effect of pippalyadi avapeeda nasya, elakanadi kashaya and vyoshadi ghrita in reducing the symptoms of chronic rhino sinusitis using nasal signs and symptom score, anterior rhinoscopy, X-ray Para Nasal Sinus (PNS) Waters view and nasal endoscopy. The study discusses the Ayurvedic intervention of 30 cases diagnosed as CRS. Pachana - deepana with astachoorna, snehapana with vyoshadi ghrita and virechana with nimbamritadi eranda taila for kayashodhana followed by shira shodhana with pippalyadi avapeeda nasya. Orally Elakanadi kashaya and vyoshadi ghrita was administered. Results and Discussion: Combined use of sodhana and samana aushadhi showed significant reduction in nasal obstruction, nasal discharge and hyposmia with an improvement of 100, 100 and 56.66 % respectively. Statistical analyses were performed with SPSS software and are clinically significant with p &lt; 0.0001. Conclusion: A combination of kayasodhana and sirasodhana is effective in improving subjective symptoms like nasal blockage, nasal discharge and hyposmia which was evident with anterior rhinoscopy, endoscopy and X-ray PNS Waters view.

The Nasal Microarchitecture: How Does Tracheostomy Affect it?

This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.

Sinonasal Hamartoma and Chronic Laryngeal Edema Causing Severe Dyspnea.

Sinonasal hamartomas, according to the 5th edition of the World Health Organisation classification of head and neck tumours are divided into respiratory epithelial adenomatoid hamartoma (REAH), seromucinous hamartoma and chondromesenchymal hamartoma. Seromucinous hamartoma are benign proliferations of small eosinophilic glands surrounded by fibrous stroma and cuboidal cells. Hamartomas of the nasal cavity and paranasal sinuses are rare entities, clinically presenting as sinonasal polyposis. A 79- year-old female patient was referred to our emergency room due to severe dyspnea. Anterior rhinoscopy revealed unilateral greyish polypoid mass obstructing the middle, inferior and common nasal meatus. Systemic corticosteroids and oxygen therapy were administered under observation. Computerized tomographic imaging of the paranasal sinuses with contrast on all three planes showed an opacified polypoid mass in all meatus and the maxillary, anterior ethmoidal and sphenoidal sinus posteriorly extending to the choanae. On the coronal plane a widening of the olfactory clefts about 12mm was described. FESS visualized that the polypoid mass originated from the posterior septum and extended to all meatus anteriorly and to the choanae posteriorly. The polypoid lesion was endoscopically completely excised. Histopathological analysis revealed a seromucinous hamartoma. Seromucinous hamartoma are rare benign tumors of the sinonasal region with potential of malignant alteration. Unfortunately, they share symptoms and clinical appearance with other benign conditions of the sinonasal region. Therefore, it is even more important to consider them as a differential diagnose.

Immediate reconstruction of nasal alar defects after malignant skin tumor excision without mohs surgery

Objectives: The National Comprehensive Cancer Network guidelines state that any nasal region with squamous or basal cell skin cancer is at high risk. Although Mohs surgery is the gold-standard procedure for many types of skin cancer, it is not applicable worldwide. A mean of 1.7 Mohs surgery stage is performed in cases of tumors. Nasal obstruction is a problem with Mohs surgery. In this study, we aimed to investigate nasal alar region nonmelanoma malignant skin tumor excision using immediate reconstruction without Mohs surgery. Methods: Ten patients underwent reconstruction surgery between 2018 and 2022. The inclusion criterion were ulcerated lesions in the nasal alar region measuring less than 1 cm in diameter, the lesions which were suspected either as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on dermatoscopic examination, the patients who had intact nasal mucosa during anterior rhinoscopy. Results: The mean follow-up duration was 26 months. No patient required re-operation because of an excisional biopsy result that involved border proximity. We observed no serious complications or long-term recurrences. Conclusion: We recommend our algorithm for patients for whom Mohs surgery is not applicable.

Role of Diagnostic Rigid Nasal Endoscopy in the evaluation of bleeding points and management of Epistaxis

Introduction: Epistaxis is one of the most common ENT emergencies. Causes of epistaxis can be idiopathic, local, or associated with systematic conditions. Anterior rhinoscopy gives a limited view of the nasal cavity. Difficulty in the localization of bleeding points on anterior rhinoscopy is commonly encountered. We often face difficulty in the localization of bleeding points, especially the hidden areas. Nasal endoscopy helps to identify the hidden bleeding points and specifically control the bleeding.&#x0D; Objective: The main aim of our study was to visualize bleeding points and demonstrate the efficacy of nasal endoscopy in identifying the bleeding site and controlling epistaxis without nasal packing.&#x0D; Methodology This is a cross-sectional study done on patients who presented to the ENT Outpatient Department with complaints of nasal bleeding. They were evaluated by rigid nasal endoscopy for localization of bleeding points as well as control of epistaxis.&#x0D; Results: Highest number of cases were seen in the 26-35 years of age group. 69.7% (n=53) patients presented with anterior epistaxis and 28.9% (n=22) had posterior epistaxis. Most of the patients i.e.,57.9 %(n=44) had no obvious abnormality associated with epistaxis, followed by Deviated Nasal Septum with septal spur i.e.,34.2%(n=26). On localizing the bleeding points, 77.6% (n=59) of bleeding points were seen on the septum. 57.9% (n=44) of patients developed epistaxis on the right side. 58% (n=52) of patients were managed with endoscope-assisted chemical cauterization followed by endoscope-associated electro-cauterization using bipolar cautery.&#x0D; Conclusion: Rigid nasal endoscopy not only helps in localizing bleeding points but also in managing the cases and is gradually replacing conventional techniques like anterior and posterior nasal packing.