Anterior Rhinoscopy Research Articles

Fashioned Mucoperichondrial Flap Technique Versus Fishing Line Technique in the Repair of Septal Dislocation: A Prospective Comparative Study.

A nasal septal dislocation is a common form of septal deviation with many challenges and different surgical techniques for correction. To assess the efficacy of fashioned mucoperichondrial flap technique versus fishing line technique in the repair of septal dislocation. The study was a prospective comparative cohort study conducted on 88 patients aged above 18 years who have symptomatic mild to moderate caudal septal dislocation spanning the period from June 2021 to June 2022. Preoperatively, all patients were evaluated by the Nasal Obstruction and Septoplasty Effectiveness (NOSE) scale to assess the degree of nasal obstruction. Anterior rhinoscopy and endoscopic examination of the nose were done for every patient to assess the degree of obstruction, whether mild, moderate, or severe. Outcomes included an assessment of both techniques' efficacy in managing nasal obstruction as expressed by the NOSE scale and comparing both techniques regarding the operative and postoperative details. The current study showed a highly significant improvement in the NOSE scale postoperatively in both groups (P < .00001 for both groups). The mean operative duration for group I was significantly less than that for group II (P < .00001). There was a nonsignificant difference between both groups regarding the postoperative NOSE scale, and postoperative degree of obstruction (P = .066 and .56, respectively). Regarding postoperative complications, there was a nonsignificant difference between both groups except for patient discomfort as assessed 1 week postoperatively. Group II showed significantly more patient discomfort (P = .02), which improved 4 weeks postoperatively. Both techniques presented in this study effectively corrected mild and moderate caudal septal dislocation with significant improvement of nasal obstruction postoperatively. Both techniques produced good esthetic outcomes and were associated with few comparable complications in both groups.

PREGNANCY RHINITIS IN SOUTH INDIAN WOMEN

Background: Pregnancy rhinitis (PR) is a common condition which is misclassied and under-diagnosed. It is mainly attributed to changing levels of sex hormones during pregnancy which returns to normal once the pregnancy is over. Uncontrolled rhinitis during pregnancy may affect quality of life for mother and may have deleterious effect on fetus. Objectives of study: Objective of present study is to assess the prevalence, frequency of signs, symptoms and response to treatment in PR in South Indian women. Material and methods: In this prospective study, the pregnant patients with symptoms and signs of PR were enrolled. Anterior rhinoscopy was performed for signs of congestion, discharge and mucosal changes. Patients were followed during pregnancy upto two weeks post-partum. Results: Overall incidence of pregnancy rhinitis was 10% in pregnant women. Major presenting symptoms were nasal discharge, nasal obstruction, excessive sneezing and post-nasal drip. Quality of life was affected to variable extent in two thirds of patients. Response to the treatment was satisfactory to good in 79% of cases. Twenty one percent patients did not notice any subjective change in the symptoms. Conclusion: PR has signicant impact on quality of life. Safety of therapeutic measures, advice and conservative practice form the mainstay of treatment.

Antrochoanal polyp in pediatric age. A purpose of a clinical case

The antrochoanal polyp is a rare entity in the pediatric age; represents 4-6% of all nasal polyps in the general population, defined as a single, benign mass originating in the sinus maxilla, grows toward the posterior choana and may extend to the nasopharynx. Diagnosis is established by clinical findings and imaging studies; in particular, tomography. Most of the patients have a lesion visible on anterior rhinoscopy, as well as obstructive nasal symptomatology. During the early stages of development of a nasal polyp, when its size is still small, it is possible to make it disappear with corticosteroid treatment. The Surgical treatment remains the most effective and consists of surgical removal with Caldwell-Luc approach (antrostomy) or endoscopic. The objective of our work is to describe the diagnosis, therapeutic management, review the bibliography as well as the possible Differential diagnoses of a case of antrochoanal Killiam polyp.

Sinonasal Mucormycosis with an Unusual Involvement of Palate

Mucormycosis is caused by a fungal infection that belongs to the order of Mucorales and is one of the rapidly spreading infections of the human body. Rhizopus species are the most common etiological agent associated with mucormycosis. It is an emergency clinical condition and has a poor prognosis. The most common variant of the mucormycosis is rhinocerebral type which may spread to the orbit and brain. The identification of mucormycosis in the palatal region is often rare and late occurrence. A case of multiple ulcerations in the palatal region occurs due to sinonasal mucormycosis in a 55-year-old is reported. He was known case of diabetes mellitus and was diagnosed with coronavirus disease 2019 infection 1 year back but recovered with conservative treatment at home. Anterior rhinoscopy showed purulent discharge in both nostrils. He had no swelling in the face and neck. No tenderness was found in the head-and-neck region. He was successfully managed by surgical debridement combined with systemic liposomal amphotericin B for 6 weeks. The survival of patients is often dependent on early diagnosis and treatment.

Clinical study on the success rate of endoscopic dacryocystorhinostomy

Background: Endoscopic dacryocystorhinostomy (DCR) has advantages like excellent homeostasis, absence of scar, less post operative pain and edema. However, less literature is available on success rate. Aim and objectives: To evaluate the success rate of endoscopic DCR. After 3 months DCR success rate was estimated based on relief perceived by the patient, free flow of saline on syringing through the lower canaliculus and presence of patent stoma visualized on rigid endoscopy. Materials and methods: 25 Epiphora patients underwent anterior rhinoscopy, nasal endoscopy, syringing, CT scan and DCR. They were evaluated for the relief of symptoms at 2 week and 3 month respectively. Results: Mostly 76% females with mean age (females:54.4/Males:59) were present. Symptoms: watering of eyes (100%), swelling (92%) and mucopurulent discharge (68%). Disease on the right side- 40% and left side -56% only 4% were with bilateral disease. On follow up after 3months 96% patients reported symptomatic relief of complaints and 4% had granulations at the neoostium and synechiae between nasal and lacrimal mucosa which were removed and subsequent relief of symptoms and free flow of saline on syringing were seen. Conclusion: Endoscopic DCR is a safe, minimally invasive, surgical procedure with 96% functional success rate.

Study on Clinical Profile and Impact of Septoplasty in Patients Attending National Medical College Birgunj for Deviated Nasal Septum

Introduction: A deviated nasal septum is a common anatomic disorder that presents in up to 62% of the population but, not all are symptomatic. However, it may play a critical role in nasal obstruction symptoms, aesthetic appearance of the nose, increased nasal resistance and sometimes snoring. This study was done with an aim to determine the profile of subjects having deviated nasal septum and assess the impact of septoplasty on them. Materials and Methods: A cross-sectional study was done at National Medical College, Department of Otorhinolaryngology, Head and Neck Surgery, Birgunj from January 2022 to June 2022. Total 30 cases with symptomatic deviated nasal septum were included. Ethical clearance (F-NMC/579/078-79) was obtained from institutional review committee of NMC Birgunj. Details of nasal patency test followed by anterior rhinoscopy and nasal endoscopy were noted. Patients were followed up on 1st, 7th and 30th day post operatively after septoplasty. Pre and post operative comparison was done by using NOSE questionnaire. Wilcoxon signed rank test was done. Results: The ratio of male to female being 1.1:1. The age of the patients varied between 18 to 55 years, and the mean age was 29.07±10.409 years. most common type of deviation seen was type IV (30%). Nasal obstruction was seen in all the study cases which was followed by headache (76.7%) There was decline in the Nose scoring gradually from preoperative period to postoperative period. In anterior rhinoscopy spur (73.3%) was the most common finding. A significant (p&lt;0.001) improvement in nose score after septoplasty was seen. Conclusion: Significant improvement in NOSE score was seen in our study which was in accordance with similar studies conducted.

Symptoms Less Status of a Case of Bilateral Nasal Polyposis: A Case Report

Nasal Polyposis (N.P) is not simply mucosa oedema, but rather grape shaped, smooth, soft, freely mobile mucosal swellings that are often visible on anterior rhinoscopy. Polyps arise from the lateral wall of nose. N.P. may be present without clinically significant sinus disease and vice versa. In Ayurveda, polyposis can be understood with Nasa Arsha. Modern management includes antibiotic, systemic and topical corticosteroids, decongestants and surgery. And lot of chances for recurrence after surgery specially in Ethmoidal polyps. In Ayurveda, various treatment modalities have been proposed for the treatment of Arsha as Shastra karma (operative Procedure), Kshara karma (applying some alkaline drugs), Agni karma (cauterization) and Bhaishaja (conservative/medical treatment). Modern management includes antibiotic, systemic and topical corticosteroids, decongestants and surgery. And lot of chances for recurrence after surgery especially in Ethmoidal polyps. The reported case revealed that B/L ethmoidal polyps are high recurrence rate after surgery and can be managed with Ayurvedic medicine to give sustained relief from symptoms.

Incidence of nasal and nasopharyngeal obstruction by nasal examination and nasal endoscopy in patients with abnormal polysomnography: A prospective study

To assess the incidence of nasal and nasopharyngeal obstruction in patients with abnormal polysomnography. To correlate the levels of nasal and nasopharyngeal obstruction with degree of obstructive sleep apnoea (OSA). Polysomnography by RMS Quest 32 polysomnography machine. Anterior and posterior rhinoscopy using Thudicum’s nasal speculum and posterior rhinoscopy mirror respectively. Nasal endoscopy to visualise nasal and nasopharyngeal airway for obstruction using 0 Hopkin’s rod endoscope under topical anaesthesia using 4% Xylocaine. 31 patients had deviated nasal septum (DNS), 19 had hypertrophied turbinates, 4 had Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP). 21 patients had posterior DNS, 7 had postnasal drip. By Nasal Endoscopy 42 patients had DNS among which 20 had anterior, 15 had posterior deviation. 7 patients had both anterior and posterior DNS. 4 patients had CRSwNP, 7 CRSsNP (Chronic Rhinosinusitis sans Nasal Polyposis), 3 had concha bullosa. Retropalatal obstruction was classified according to Mullers grade, where we found 10% patients had grade I, 28.75% grade II, 28.75% grade III and 32.5% grade IV obstruction. P value of DNS was 0.60 whereas that of other types of nasal obstruction was 0.85. Correlation of Retropalatal obstruction was significantly high with severity of OSA with P value &amp;#60;0.0001. 1-year incidence of Nasal and Nasopharyngeal obstruction in patients with OSA is 0.67 per 1000 population. Degree of OSA has poor correlation with levels of nasal obstruction and strong correlation with grades of retropalatal obstruction.

Evaluation of squeal of otitis media with effusion in children

Objectives: The aim of study is to evaluate and assess squeal of otitis media with effusion in children.&#x0D; Methods: cross sectional retrospective study was admitted to children in age range 1 to 15 years old, all children who diagnosed as otitis media with effusion. patients who came to outpatient complaining of deafness, acute or chronic rhino sinusitis, snoring, sleep apnea, atopy and diagnosed as otitis media with effusion included in this study. full otolaryngological examination done for these patients including otoscopical examination, anterior rhinoscopy and nasal endoscopy. documented cases of OME by aural otoscopy included in this study Change of color and position of tympanic membrane, fluid level, retracted tympanic membrane considered as signs of otitis media with effusion. These patient submitted to tympanometry to confirm the diagnosis of effusion. Results: 252 kids have otitis media, mean age of them 9.2 ± 3.5 years old. (70.6%) of babies are males and (29.4%) are females. (42.9%) of babies are at age group 6-10 years. According to symptoms appear; (73%) of them have bilateral effusion. (43.7%) of babies have rhinitis. Just (9.9%) of them have atopy. (25%) of them have snoring. Just (7.5%) of babies have apnea. According to management types; (79.8%) have medical treatment and (20.2%) have surgical management. There is significant association between age groups and site of effusion. There is significant association between site of effusion and snoring, medical treatment, surgical procedure and recurrent of effusion. Conclusion: In current study males’ babies are more have OM with effusion. And most age group that have OM is 6-10 years old, most OM with effusion occur bilaterally and associated with rhinitis. There is association between site of effusion and snoring, medical treatment, surgical procedure and recurrent of effusion.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience.

Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction ( n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus ( n = 6), middle turbinate ( n = 3), posterior septum ( n = 3), sphenoid sinus ostium ( n = 1), and inferior meatus ( n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp ( n = 12), actinomycosis ( n = 1), and rhinosporidiosis ( n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

Frequency of Septal Perforation in Sub-Mucous Resection of Nasal Septum

Objectives: In this study, the efficacy of sub-mucous resection (SMR) in the management of patients presented with deviated nasal septum (DNS) was assessed with particular emphasis on the post-operative septal perforation. Methods: A descriptive study was carried out for six months (i.e., from October 2021 to March 2022) at the Ear, Nose and Throat (ENT) Department of Hayatabad Medical Complex, Peshawar, Pakistan. Results: A total of 203 patients who presented with DNS were included herein, where the male to female ratio was 1.39:1 while the mean age was 30 ±3.74 (range= 20-60) years. The majority patients presented with S type DNS (80; 39%), followed by C type DNS (75, 37%) while the spur type DNS was seen in only 48 (24%) cases. After SMR, 08 (4%) cases of septal perforation were observed with anterior rhinoscopy. Conclusions: These results demonstrate the fact that post-surgical septal perforation is a critical clinical complication. Keywords: septoplasty, DNS, sub-mucous resection, septal perforation, rhinoscopy

Safety, Tolerability, and Pharmacokinetic Study of 101BHG-D01 Nasal Spray, a Novel Long-Acting and Selective Cholinergic M Receptor Antagonist, in Healthy Chinese Volunteers: A Randomized, Double-Blind, Placebo-Controlled, Single-Dose Escalation, First-In-Human Study.

101BHG-D01 nasal spray is the first novel long-acting cholinergic M receptor antagonist under development to treat rhinorrhea in rhinitis. This first-in-human study aimed to evaluate the safety, tolerability, and pharmacokinetics of 101BHG-D01 nasal spray following single intranasal doses in healthy Chinese subjects. A randomized, double-blind, placebo-controlled, single-dose escalation study was conducted in healthy Chinese volunteers after intranasal doses of 101BHG-D01 nasal spray or placebo ranging from 40 µg to 960 µg (total of six doses). Blood samples were collected at scheduled time points, and plasma concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method. A non-compartmental method was used to calculate the main pharmacokinetic parameters, including the area under the plasma concentration-time curve from time zero to the time of the last measurable concentration (AUC0-t), the area under the plasma concentration-time curve from time zero to infinity (AUC0-∞), the maximum plasma concentration (Cmax), the time to maximum plasma concentration (Tmax), and the elimination half-life (t1/2). Safety was evaluated by monitoring adverse events, laboratory assays, vital signs, physical examinations, 12-lead electrocardiograms (ECGs), anterior rhinoscopy, ophthalmic examination, and ambulatory ECG monitoring. Following single intranasal dosing, 101BHG-D01 was rapidly absorbed with a median Tmax of 0.34-0.50 h and eliminated slowly with a mean t1/2 ranging from 4.29 to 46.76 h for different dose groups. The Cmax and AUC of 101BHG-D01 increased linearly across the examined dose range of 40-960 µg. 101BHG-D01 nasal spray was well tolerated, all AEs were mild, and no serious adverse events occurred during the study. 101BHG-D01 nasal spray was safe and well tolerated in healthy Chinese subjects when administered intranasally in single escalating doses. The mean Cmax and AUC increased proportionally to the studied dose. The pharmacokinetic, safety, and tolerability profiles of 101BHG-D01 nasal spray indicate that it is a good candidate for further development as a treatment for rhinorrhea in rhinitis.

The nasal cycle before and after nasal septoplasty.

Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions. We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24h. Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose. Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.

Risk of Chronic Rhinosinusitis With Nasal Polyps in Endotypes of Dermatophagoides pteronyssinus-Induced Rhinitis

Observation of the natural history of two emerging endotypes of allergic rhinitis, local-sensitization rhinitis (LAR) and dual-allergic rhinitis (DAR), compared with systemic-sensitization rhinitis (AR), could improve knowledge of the role of allergy in chronic rhinosinusitis with nasal polyps (CRSwNP). To test the hypothesis that endotypes of Dermatophagoides pteronyssinus (DP)-induced rhinitis were risk factors for CRSwNP and adult-onset asthma and to investigate whether delayed hypersensitivity to DP, assessed by atopy patch test, could be a contributing factor. We conducted a prospective observational study over 15 years on a cohort of 999 patients: 468 with AR, 333 with LAR, and 198 with DAR. The latter endotype was characterized by the coexistence of seasonal disease caused by systemic sensitization to pollen in patients with DP-induced LAR. The study design included a physical visit; ear, nose, and throat examination with anterior rhinoscopy; skin prick test; serum-specific IgE; DP-atopy patch test; nasal allergen provocation test with DP; paranasal sinuses computed tomography scan; nasal endoscopy; and spirometry. During 15 years of follow-up, 194 patients developed CRSwNP with a higher rate of LAR (28.2%) and DAR (22.2%) than AR (12%). For LAR and DAR, 7.5% and 10.6% of patients developed adult-onset asthma temporally linked to CRSwNP in 68% and 71.4% of cases, respectively. A total of 858 patients with rhinitis had delayed hypersensitivity to DP. Moreover, DP-ATP was an independent predictive factor for CRSwNP and had elevated positive and negative predictive values for localized allergic disease of the nasal mucosa. Endotypes of DP-induced allergic rhinitis represent risk factors for CRSwNP. Patients with local-sensitization rhinitis and DAR are more at risk than those with AR. In these emerging endotypes, progression toward CRSwNP is often associated with the development of adult-onset asthma. Chronic rhinosinusitis with nasal polyps shows several possible indicators for type 2 endotype. Delayed hypersensitivity to DP is an independent predictive factor for CRSwNP.

Deviated nasal septum in children

Abstract Background: Nasal obstruction is a common symptom among children with numerous causes. Congenital or acquired nasal septal deviation may cause nasal obstruction in children. Deviated nasal septum (DNS) may also result in sinusitis, headache, epistaxis and hyposmia which increase the morbidity of the child and hamper the quality of life. The present study investigated the clinical details of the DNS among children at a tertiary care teaching hospital. Methods: This is a retrospective study was conducted at a tertiary care teaching hospital between November 2016 and December 2021. History of nasal obstruction, mouth breathing, nasal bleeding and sinusitis among children with DNS was noted. Anterior rhinoscopy, fiberoptic endoscopic examinations of both nostrils and imaging such as computed tomography were done in all participating children with DNS. Results: Out of 652 children who attended the outpatient department of otorhinolaryngology, 128 (19.6%) were diagnosed with DNS. Out of 128 children with DNS, 72 (56.3%) were male; male:female ratio was 1.28:1. Out of 128 children, 54 (42.2%) children showed C-shaped DNS, 27 (21.1%) showed anterior dislocation, 21 (16.4%) showed S-shaped DNS, 15 (11.8%) showed spur and 11 (8.6%) showed nasal septal thickening. Conclusions: DNS and its impact on nasal breathing impairment in children are often underestimated by clinicians. Clinicians often are unaware on the impact of DNS and its clinical manifestations in children and its appropriate management. Early intervention for DNS in children is helpful to prevent morbid symptoms and their complications.

Leech infestation: Our experience at Government Medical College, Rajouri

Leech invasion into a bodily cavity or orifice is known as hirudiniasis. This article’s objective is to explain an uncommon cause of epistaxis brought on by a leech infestation in the nasal cavity, nasopharynx, or oropharynx in the hilly Rajouri district of Jammu and Kashmir, as well as how to manage it. This retrospective case series consisted of seven cases. All the cases present with unilateral epistaxis. Anterior rhinoscopy with or without endoscope reveal smooth, grayish-black mobile leech inside nasal cavity, nasopharynx, or oropharynx which was removed by suction or forcep.

Turbinate surgery: which rhinitis are most at risk.

Background and aim:Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs.Methods:The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients.Results:Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a “pure” allergy. NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively.Conclusion:Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology. (www.actabiomedica.it)

Excision of squamous papilloma of the nasal vestibule with high-frequency electrosurgery

Benign nasal tumors represent an uncommon pathology with various histopathological types. Squamous papilloma of the nasal vestibule, also called verruca vulgaris, is a benign epithelial tumor, sessile or pedunculated, small in size, unique or comprising multiple lesions, which can present with intermittent epistaxis or nasal obstruction. We chose to explore a case of squamous papilloma of nasal vestibule excision using high-frequency electrosurgery. A 38-year-old woman presented with one-month history of intermittent right nasal bleeding. The anterior rhinoscopy and the endoscopic examination revealed an 1x0.5 cm sized, unique, sessile and irregular shaped mass in the right nasal vestibule. An excisional biopsy was performed under local anesthesia, using high-frequency electrosurgery. The follow-up period consisted of two years, without any recurrence.

Non Indigenous Rhinoscleroma

Rhinoscleroma (RS) is a granulomatous illness of the upper respiratory tract caused by Klebsiella rhinoscleromatis. It is a rare, chronic, granulomatous disease. RS develops in the nasal mucosa subepithelium and can spread to the eustachian tube, maxillary antrum, oral cavity, larynx, orbit, trachea, and bronchi. The present case is of a 29-year-old female who came to the Ear Nose and Throat (ENT) outpatient department with chief complaints of bilateral nose block for six months. Examination by anterior rhinoscopy revealed pink nasal mucosa and a swelling arising from both sides of nasal septum, that was soft, non tender, did not bleed on touch. Diagnostic nasal endoscopy showed a midline septal mass which was present just posterior to mucocutaneous junction and a second septal mass was present posterior to first mass at level of posterior part of inferior turbinate. She underwent submucosal resection of septal mass and the same was sent for histopathological examination and it was diagnosed as features suggestive of RS. The patient was treated with a course of tablet ciprofloxacin, analgesics, antihistamines. There has been no recurrence during the one year follow-up period. Patient improved symptomatically and had no further complaints.

Septocolumellar Suture Technique for Correction of Septal Caudal Dislocation

Objective: To describe this technique for treatment of caudal septal dislocation and to evaluate the effectiveness of this technique in terms of correction of cosmetic deformity and relief of nasal obstruction.Methods: This was a descriptive case series study performed at ENT department of Services Institute of Medical Sciences (SIMS), Services Hospital, Jail Road, Lahore. 30 Cases of mild to moderate degree of septal caudal dislocation were selected and operated. The septum was fixed by sutures to the anterior nasal spine. Columellar pocket was made and septum was sutured in the pocket by two sutures at upper and lower levels to increase the stability of corrected septum.Results: We performed this suturing technique on 30 septoplasty cases during 3 years from Jan-2016 to Jan-2019. Among them 12 (40%) were male and 18 (60%) were female. Total follow up period ranged between 3 to 6 months. Anterior rhinoscopy showed no persistence of deviation or dislocation in 25 patients. 5 cases had mild deviation of septum on non-operated side.Conclusion: Two level septocolomellar suture technique is very effective, easy to learn &amp; perform and shows long term reliability in correction of caudal septal dislocation. This is effective in improving cosmesis and nasal air flow.