Anterior Rhinoscopy Research Articles

Prevalence of ear, nose and throat disorders in children at government district hospital Vizianagaram

<p class="abstract"><strong>Background:</strong> Ear, nose and throat (ENT) problems are very common among the children, there is a lack of data on paediatric otorhinolaryngology from various Indian populations. This study was conducted to determine the hospital based prevalence of ENT disorders in paediatric population.</p><p class="abstract"><strong>Methods:</strong> A record based, retrospective study conducted at government district Hospital, Vizianagaram, Andhra Pradesh, India. 1818 children between the ages of 0-15, attending the ENT department in our hospital were included in the study. General demographic details taken, and examination for common ENT complaints and disorders was taken for all patients. Otoscopy for ear examination for ear perforation and ear discharges. Anterior rhinoscopy for nasal discharge and airway obstruction. Throat examination was performed for any sign of tonsillitis or pharyngitis and adenoids. </p><p class="abstract"><strong>Results:</strong> ENT diseases in our study population were found to be more common among male children (57.97%). Majority of the paediatric patients belonged to age group 5-14 years (65.7%), were from lower socioeconomic status (57.53%), living in nuclear family (62.81%) and had illiterate mothers (68.5%). Diseases of ear system (44%) were the most common group of ENT problems among the paediatric population, followed by nasal (30.9%) and throat (25.1%) disorders. The most common ENT disorders were otitis media (22.1%), tonsillitis (11.66%).</p><p class="abstract"><strong>Conclusions:</strong> Our study provides basic information of the prevalent disorders in ENT in our area suggests that otitis media, tonsillitis and rhinitis are the most common otorhinolaryngological problems in paediatric population visiting the ENT Department of this hospital and contribute significantly to paediatric morbidity.</p>

Possibilities of osteopathic correction of somatic dysfunctions in children with chronic adenoiditis

Introduction. Chronic adenoiditis is one of the most frequent ENT diseases. It is comparatively resistant, and in advanced cases, the pathological process is hardly reversible. Despite the big number of publications on chronic adenoiditis, in a high percentage of cases specialists still encounter frequent recurrence of the disease. That is why issues of standard treatment, especially conservative, the search for adequate and effective methods of medical rehabilitation of patients with chronic inflammatory diseases, including in frequently ill children, are timely and relevant. Osteopathic methods of correction can potentially improve blood circulation and the innervation of adenoids, which will increase the clinical effectiveness of conservative treatment, reduce medication period and achieve a longer remission. However, studies on the influence of osteopathic correction on the course of chronic adenoiditis have not been found in the literature available to us. That is why it was necessary to conduct this study. The goal of research — to justify the possibility of using osteopathic correction in the complex treatment of frequently ill children with chronic adenoiditis.Materials and methods. From January 2018 to March 2019, a prospective controlled randomized study was performed at the MEDSI Clinic (Moscow). Thirty patients with chronic adenoiditis at the age of 4 to 10 years were examined. Patients were divided by the method of simple randomization using a random number generator into two equal groups of 15 people: the main group and the control group. Children of the main group received osteopathic correction along with drug and irrigation therapy for 2 months. In total, 3 osteopathic sessions were conducted with a frequency of 1 time in 14 days. Children in the control group received only pharmacological and irrigation therapy. All patients before the start of treatment and 2 months after the start of treatment were examined by an otorhinolaryngologist with an endoscopic examination, and by an osteopath with the assessment of the main somatic dysfunctions. Otorhinolaryngological examination included history taking and collecting of complaints with fi lling out a special questionnaire, anterior and posterior rhinoscopy, as well as an endoscopic examination of the nasopharynx with the assessment of the revealed changes in points.Results. After the treatment, the number of complaints and the main symptoms of the disease, the number of changes in the nasopharynx and oropharynx, revealed by the results of endoscopic examination, decreased statistically significantly in patients of both groups. The study showed that regional biomechanical disorders are common for children with chronic adenoiditis. Dysfunctions of head region, neck region (visceral component), thoracic region (structural component) were the most frequent. Against the background of the treatment, patients of the main group presented a decrease in the number of regional somatic dysfunctions. Statistically significant differences were obtained in the frequency of occurrence of somatic dysfunctions: head region, neck region (visceral and structural components), thoracic region (visceral and structural components) (p<0,05). In patients of the control group, a statistically significant decrease in the number of somatic dysfunctions was detected only in the head region (p<0,05). A follow-up assessment of the results of the treatment showed that the inclusion of osteopathic correction in the complex therapy of children with chronic adenoiditis contributes to a longer remission (p<0,05).Conclusion. Based on the study, it can be concluded that the direct results of osteopathic correction in the complex treatment of frequently ill children with chronic adenoiditis are comparable with the results of isolated pharmacological and irrigation therapy (reduction in the number of complaints and positive changes in the results of endoscopic examination of the nasopharynx). However, the inclusion of osteopathic correction in the complex therapy of such children contributes to a longer remission, which is of great importance for this group of patients. The results of the research suggest a further study of the possibilities of osteopathic correction of somatic dysfunctions in frequently ill children with chronic adenoiditis.

Pleomorphic Adenoma of the Nasal Vestibule – A Rare Case

Pleomorphic adenomas arising in the nasal cavity are extremely uncommon, despite the large numbers of minor mucous and serous glands in the region. We present a rare case of a pleomorphic adenoma arising from the right nasal vestibule in a 65-year-old man complained of right nasal obstruction for 6 months. Anterior rhinoscopy showed a reddish, firm, polypoid mass in right nasal cavity which is free from the nasal septum and from the inferior tubinate but it was attached to the nasal vestibule. Flexible nasal endoscopy showed no extension of the mass towards the posterior choana or nasopharynx. The mass was completely excised from the nasal vestibule through intranasal approach and sent for histology which confirmed a pleomorphic adenoma with a predominant stromal component. The main treatment modality is surgical resection with histological clear margins. Recurrences and evolution to malignancy are not frequent, but long tern follow-up is recommended. In our case, the patient demonstrated satisfactory cosmetic results with no evidence of recurrence.
 Bangladesh J Otorhinolaryngol; April 2017; 23(1): 88-91

Advantages of Computed Tomography (CT) in Endoscopic Septopasty

Background and objective: Nasal obstruction is the most frequent presentation to the otolaryngologist all over the world. Symptoms are multisystem involvement such as headache, epistaxis, ophthalmological, otological, upper and lower respiratory tract infections; and many more. Septoplasty is commonly performed for nasal septal deviation as a primary indication of nasal airway obstruction. Physical examination, anterior rhinoscopy and nasal endoscopy are considered the gold standard for detecting septal deviation. Computed tomography (CT) can also be used to evaluate the nasal septum, anatomical variants and unveils the associated sinonasal diseases. This study aimed to find out the advantages of CT in endoscopic septoplasty for all out benefits to the patients. Patients and methods: 168 patients of nasal septal deviation were selected from 2015 to 2018 in the Bangladesh Medical and Popular Medical College Specialized Hospital. Age ranged between 10 years to 70 years of age. CT scanning in both coronal, axial and sagittal sections had been done in all patients after proper history taking, physical examination, anterior rhinoscopy and nasal endoscopy. Endoscopic septoplasty alone and/or other ancillary procedures were performed in all 168 patients under general anesthesia. Results: Amongst 168 patients, male was 116 (69%) and female was 52 (31%) with a ratio 2.2:1. Maximum 58 (35%) reported in 31 to 40 years and 48 (29%) was found in 21 to 31 years of age. Hypertrophied inferior turbinate (HIT) 54 (32%) and 48 (29%) concha bullosa (CB) were associated with 168 septal deviation. Associated pathologies like maxillary antral cyst 68 (40%) and maxillary sinusitis 62 (37%) were documented. Conclusion: CT scanning unveils the abnormal anatomic variants and associated sinonasal pathologies along with nasal septal deviation. Endoscopic septoplasty, correction of the anatomical variants and complete surgical clearance of the sinonasal pathologies can give the patient a grand success.

Assessment of upper airway obstruction in children with specific learning disorder

Aim: A growing number of findings suggest that there is an important relationship between upper airway obstruction (UAO) and specific learning disorder (SLD). However, existing evidence is limited to very few studies. We, thus, aimed to explore chronic UAO conditions in children with specific learning disabilities.Materials and Methods: This study involved seventy-seven children aged 7 to 10 years with SLD and eighty-six healthy children matching in age and gender. Psychiatric disorders were diagnosed through the Diagnostic and Statistical Manual of Mental Disorders (DMS-5) Criteria. Porteus Maze Test and Kent-EGY test were used to assess the intelligence of the participants. The diagnoses of UAO were made by a physical examination, a detailed otorhinolaryngologic examination, the anamnesis and clinical history, anterior rhinoscopy, and flexible endoscopic nasopharyngoscopy according to the type of UAO.Results: The rates of having at least one pathology causing UAO and secondary sleep difficulties due to UAO were significantly higher in children with SLD compared to controls. The severity of SLD was significantly associated with the severity of UAO and the presence of secondary sleep difficulties, but not the presence of UAO. The verbal and total IQ scores were significantly affected by the presence and severity of UAO, while the presence of secondary sleep difficulties significantly impacted all IQ scores.Conclusion: Parents, teachers, otorhinolaryngologists, child psychiatrists, and pediatricians should be aware that the association between learning disorders and UAO. It also would be advisable to screen children with learning disorders in terms of UAO, and vice versa.

Clinical Practice Guideline: Nosebleed (Epistaxis).

ObjectiveNosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity a...

Malignant melanoma of the nasal cavities: A case report

The malignant melanoma of the nasal cavities is a rare tumor characterized by an absence of specific clinical signs but confirmed by the contribution of immunohistochemistry. However, poor prognosis remains, requiring a complex radiosurgical support. We present a case of malignant melanoma in a 48 years old male patient, chronic smoker, who is consulting for a nasal obstruction left unilateral evolving for 18 months complicated by anosmia and epistaxis repeatedly. The anterior rhinoscopy objectified a blackish fleshy polypoid mass at the expense of the nasal septum and the bottom left turbinate. The facial CT scan showed an aggressive tumor of the left nasal cavity with lysis of the upper maxilla. A biopsy of the mass had been done. The anatomopathological examination supported by the immunohistochemistry confirmed the diagnostic of malignant melanoma of the nasal cavity. The treatment featured a surgery by the paralateronasal way with large excision and followed by adjuvant radiotherapy. An endoscopic control after 6 months was done marking the satisfying evolution without any sign of local recurrence.

Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary.

ObjectiveNosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the great majority of nosebleeds are limited in seve...

Inferior turbinate neoplasms

The main aim of the work was to describe a rare clinical case of osteoma of inferior turbinate. The interest of the case is that such tumors are extremely rare. A female patient of 63 years old attended an ENT clinic. She complained on absence of nasal breath at the right side and headache. After a full ENT-examination, anamnesis, and a thorough analysis of the radiation examination results (computed tomography data), a decision was made to surgical treatment. Under general anesthesia, controlled hypotension surgery was done. First step was septoplasty, then the dense bone tumor was reduced and removed. At the control examination in 3 months, the complete removal of the formation of the inferior turbinate on the right is determined. There were no signs of continued or recurrent tumor growth. Neoplasms of the nasal cavity, in particular the inferior turbinate, are extremely rare pathologies. They are mainly detected when performing anterior rhinoscopy, endoscopic examination of the nasal cavity. The result of histological examination is compact osteoma. The gigantic size of the inferior turbinate osteoma in our case is probably due to the patient's failure to consult a specialist (otorhinolaryngologist) for a long time. Surgical treatment of this pathology should consist in an endoscopic endonasal approach: this approach allows the most complete and minimally traumatic removal of the tumor.

Determining the main reasons for difficult nasal breathing among children with primary and mixed dentition

Introduction: Difficult nasal breathing is the condition where there is a partial or full, temporary or permanent obstruction of the airways and the processes of inhalation and exhalation are carried out through the mouth. Aim: The aim of this paper is to define and analyse the reasons for mouth breathing among children with primary and mixed dentition. Materials and Methods: A total of 1 667 children between the ages 3 and 12 years were examined. We used the methods of anterior and posterior rhinoscopy, acoustic rhinometry, and rhinomanometry Results: Among all the studied mouth-breathing children with deciduous dentition, the main reason for the difficult nasal breathing was allergic rhinitis. The children with first degree of obstruction predominated (54.50%), The second cause in this studied age group was adenoid hypertrophy. In early mixed dentition, the percentage distribution of second and third degree of obstruction was the same (45.70%). In the early mixed dentition, the most common cause of difficult nasal breathing was adenoid hypertrophy. The percentage of children in late mixed dentition who were with adenoid hypertrophy was lower. Conclusion: The main reason for difficult nasal breathing in primary dentition is allergic rhinitis, but in early mixed dentition it is adenoid hypertrophy. Our results showed that of all the children with difficult nasal breathing 24% had first degree of nasal obstruction, 39.30% had second degree, followed by 36.70% children with third degree.

Rhinologic signs associated with snuff taking

ObjectiveTo study rhinologic signs associated with nasal tobacco (snuff) intake in Parakou, northern Benin. Materials and methodsA cross-sectional descriptive comparative study included 300 tobacco snuff takers and 300 subjects who did not use tobacco at all. The sampling technique was a stratified 4-stage random sample for non-users and a convenience non-random sample for snuff takers. ResultsThe sex-ratio was 0.92 in non-users and 41.9 in snuff takers. Duration of snuff taking was more than 20 years in 24.3% of cases. The symptoms studied were significantly more frequent in snuff takers than non-users (P<0.05). Snoring was reported by 58.3% of snuff takers, versus 5.7% of non-users (P=0.000). Nasal obstruction and rhinorrhea were reported by respectively 26.3% and 22.7% of snuff takers, versus 6.3% and 5.3% of non-users (P=0.000). Hyposmia was reported by 14% of snuff takers, versus 1.3% of non-users (P=0.000). Anterior rhinoscopy found abnormalities in 81.7% of snuff takers, compared to 10.67% of non-users. Nasal hypertrichosis was more frequent in snuff takers than non-users: 40% versus 5% (P=0.000). ConclusionNasal intake of tobacco is responsible for morbidity in snuff takers compared to non-users of tobacco.

Inverted papilloma: a study of 13 cases in the Oto-Rhino-Laryngology at the National University Hospital of Fann

IntroductionLe Papillome Inversé (PI) est une tumeur bénigne nasosinusienne rare caractérisée histologiquement par une invagination de l'épithélium de surface dans le chorion sous-jacent. Elle se distingue par une forte agressivité locale, une tendance à la récidive et par son risque imprévisible d'association à un carcinome épidermoïde. L'objectif de l'étude était de rapporter les données épidémiologiques, cliniques, paracliniques ainsi que d'évaluer les résultats de la chirurgie endoscopique endonasale.MéthodesIl s'agit d'une étude rétrospective portant sur une série de 13 patients colligés au Service d'Oto-Rhino-Laryngologie du centre hospitalier national universitaire de Fann, du 1er janvier 2012 au 31 décembre 2017. Ont été inclus dans l'étude tous les patients suivis pour un papillome inversé confirmé à l'examen anatomopathologique.RésultatsL'âge moyen de nos patients était de 44 ans et le sex-ratio (H/F) de 2,25. Tous les patients avaient présenté une obstruction nasale alors que la rhinorrhée était présente dans 53% des cas suivis de l'épistaxis dans 30% des cas. La symptomatologie était latéralisée à droite dans 69% des cas, 23% à gauche et 7% de façon bilatérale. La rhinoscopie antérieure avait permis de visualiser une masse endonasale chez tous les patients. Tous les patients avaient bénéficié d'une TDM; l'IRM avait été réalisée chez un seul patient. L'exérèse du PI par voie endoscopique endonasale avait été effectuée chez 10 patients (76,9%) alors que la voie externe avait été utilisée dans 23% des cas. La chirurgie avait permis de préciser la base d'implantation de la tumeur qui était de l'ordre de 46% dans le sinus maxillaire, 15% dans le cornet inférieur, 15% dans le cornet moyen, 7% dans la bulle ethmoïdale et 7% dans la paroi latérale de la fosse nasale. Un patient avait eu une récidive du papillome inversé après un délai moyen de 26 mois. L'association maligne s'était révélée par un cas de dégénérescence maligne en carcinome épidermoïde.ConclusionLe papillome inversé est une tumeur très agressive. La TDM fournit beaucoup de renseignements à propos de son extension, surtout osseuse. Le traitement est actuellement révolutionné par la chirurgie endoscopique qui offre d'excellents résultats. Mais, il existe néanmoins un risque de récidive après chirurgie qui doit motiver une surveillance au long cours.

Anthropometric and acoustic pharyngometric parameters in sleep-disordered breathing due to structural pharyngeal alterations

INTRODUCTION : Sleep-disordered breathing is a medico-social problem of rising importance worldwide. There are various clinical forms of sleep apnea such as obstructive sleep apnea (OSA) and central sleep apnea as well as snoring. Recently, there have been considerable advances in the diagnosis of OSA and snoring. А IМ : This study aimed at applying the method of acoustic pharyngometry for the diagnosis of pharyngeal alterations in subjects with sleep-disordered breathing within a preventive otorhinolaryngological programme in the city of Varna for the first time in Bulgaria. MATERIALS AND METHODS : Between January 1, 2016 and August 31, 2019, screening for sleep-disordered breathing was performed among 100 subjects, 62 males at a mean age of 48.82±11.45 years and 38 females at a mean age of 52.42±16.54 years in the Division of Otorhinolaryngology, St. Anna Hospital of Varna. Clinical inspections, anterior rhinoscopy, pharyngoscopy, indirect laryngoscopy, acoustic rhinometry, as well as acoustic pharyngometry by means of Eccovision ® acoustic pharyngometer were used. The t -test for independent variables and the correlation analysis were applied for statistical data processing. RESULTS : The acoustic pharyngometry identified several pharyngeal alterations. There were statistically significant changes of the anthropometric parameters (body mass index, neck circumference and adjusted neck circumference) and pharyngometric ones (pharyngeal cavity and vocal tract lengths and volumes) between males and females. There were statistically significant positive and negative correlations between the values of these parameters. CONCLUSION : Within the complex otorhinolaryngological examination of the pharyngeal structure and function in the subjects suspected for sleep-disordered breathing, acoustic pharyngometry could play an irreplaceable role as a cost-effective tool.

The Diagnostic Value of Traditional Nasal Examination Tools in an Endoscopic Era.

As the endoscope has become more common in the otolaryngologist's office, there is a need to reevaluate the value of traditional nasal examination methods. The objective of this study was to determine the sensitivity and specificity of traditional nasal examination tools compared to those of the rigid endoscope. A prospective diagnostic study was conducted. Eligible patients with nasal symptoms were recruited and examined using 4 tools: (1) a nasal speculum, (2) an otoscope, (3) a posterior rhinoscopy mirror, and (4) a rigid nasal endoscope. The diagnostic value of each tool was evaluated. There were a total of 53 patients eligible for inclusion in the study. The mean age of all patients was 40.9 years. The most common nasal symptom was nasal obstruction (90.6%). With regard to the tools used in anterior rhinoscopy, the nasal speculum had a sensitivity of 54.69% (95% confidence interval [95% CI]: 41.75-67.18) and specificity of 88.10% (95% CI: 74.37-96.02); and the otoscope had a sensitivity of 57.81% (95% CI: 44.82-70.06) and specificity of 85.71% (95% CI: 71.46-94.57). After application of topical anesthesia and decongestant, the nasal speculum had a sensitivity of 67.19% (95% CI: 54.31-78.41) and specificity of 85.71% (95% CI: 71.46-94.57); and the otoscope had a sensitivity of 65.62% (95% CI: 52.70-77.05) and specificity of 83.33% (95% CI: 68.64-93.03). The posterior rhinoscopy mirror had a sensitivity of 12.50% (95% CI: 5.18-24.07) and specificity of 94.00% (95% CI: 83.45-98.75). All adverse events in this study were minor. The traditional nasal examination tools exhibited excellent specificity. However, the sensitivity was only average, meaning that they may not be suitable for screening. We do not recommend routine use of topical anesthesia and decongestants when applying these tools, as the application of these agents did not improve the clinical sensitivity or specificity. The posterior rhinoscopy mirror had a lowest sensitivity. We thus do not recommend using a posterior rhinoscopy mirror to rule out pathologies of the posterior nasal cavity.

Evaluation of sleep quality and risk of obstructive sleep apnea in patients referred for aesthetic rhinoplasty.

ImportanceAesthetic rhinoplasty is the fifth surgical procedure most performed worldwide by plastic surgeons. With the growing demand for rhinoplasty, there is an unmet need for research into the profile of patients who seek aesthetic nasal surgery in an attempt to improve not only cosmetic dissatisfactions, but also the manifestations of other, possibly interrelated disorders, especially sleep disturbances. ObjectiveTo evaluate the sleep quality and the risk of Obstructive Sleep Apnea in patients referred for aesthetic rhinoplasty, as well as the association of these conditions with nasal symptoms. Design: Cross-sectional study performed at the period of June/2016 to August/2017. Setting: Department of Otolaryngology and Head and Neck Surgery - Universidade Federal de São Paulo. Participants: Patients of both sexes, aged 18 to 65 years, who were referred for aesthetic rhinoplasty. We evaluated 46 patients, two of whom were excluded because they were outside the inclusion age criteria. Main Outcome(s) and Measure(s): Anterior rhinoscopy and the following validated surveys were used. Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Nasal Obstruction Symptom Evaluation scale; Berlin Questionnaire. The visual analog scale for snoring was also used. ResultsOf the 44 participants, 18 (41%) were males and 26 (59%) were females. 82% had poor sleep quality. 46% presented excessive daytime sleepiness. There was a high risk for Obstructive Sleep Apnea in 27%. Regarding to nasal symptoms, the mean score in the Nasal Obstructive Symptoms Evaluation was 66.25±25.38. When comparing the groups with good and poor sleep quality, we observed a higher risk for Obstructive Sleep Apnea (p=0.05) in patients with poor sleep quality. Patients at high risk for Obstructive Sleep Apnea had higher scores on the Nasal Obstructive Symptoms Evaluation (p=0.001) and on the analogue snoring scale (p<0.001) compared to patients at low risk. ConclusionsWe observed a high occurrence of poor sleep quality in participants. All participants who were at high risk for obstructive sleep apnea were also classified as having poor sleep quality. An association was also observed between the presence of high risk for obstructive sleep apnea and presence of nasal symptoms.

When the nose will become a periscope

When the nose will become a periscope

Bilateral concha bullosa with right sided extensive rhinolith: a case report

&lt;p class="abstract"&gt;Anatomic variations of the paranasal sinuses can lead to various diseases per se. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery. Rhinolith is a mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. It is an uncommon disease that may present asymptomatically or cause symptoms like headache and nasal obstruction. A 24 year old woman was admitted in ENT department of GGS Medical College and Hospital, Faridkot with complaints of nasal obstruction, anosmia and headache persisting for 5 years. Right sided rhinolith was detected on anterior rhinoscopy. Bilateral concha bullosa with right sided rhinolith was reported on preoperative paranasal computed tomography scan. It is known that the paranasal sinuses have a number of anatomical variations. Sometimes severe anatomic variations predispose to rhinosinusitis. Herein we report a rare case, along with a review of the literature, to emphasize that severe anatomical variations should not be ignored.&lt;/p&gt;

A rare case of polyembolokoilamania of nose in a neuropsychiatry patient

&lt;p class="abstract"&gt;Nasal foreign body is common in children. In adults it is common among mentally retarded, psychiatric patients or is iatrogenic. As most of foreign body in a neuropsychiatry patient goes unnoticed, by the time the patient reaches the surgeon, it will be associated with its complications. So we as doctors should have this in back of mind when we examine a psychiatry or a mentally retarded patient and thorough clinical examination should be done irrespective of the patient’s complaints. We encountered a 25 year old male psychiatric patient presented with complaints of fullness and pain in both ears for three days. The patient had drug abused to cannabis, nicotine, alcohol and inhaling fevibond for four years. On examination bilateral tympanic membrane was intact with no signs of bleeding. Throat was clinically normal. Anterior rhinoscopy visualised a blackish hard mass with a yellowish green mucopurulent discharge in both the nasal cavity. On removal there were multiple variant foreign bodies and a large septal perforation in anterior aspect of septum was visualised. In psychiatry patients, there is a risk of foreign body insertions. This is a great challenge from clinical examination, diagnosing, removal to treating complications if any. Timely detection and prompt treatment will reduce medical morbidity. In this report we try to emphasize the importance of meticulous clinical examination in a psychiatric patient.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Intranasal findings in unilateral primary acquired nasolacrimal duct obstruction

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common entity with associated different types of intranasal abnormalities. The pathogenesis of PANDO is unknown. The objective of the study was to describe the intranasal findings in cases of PANDO and find out any association of these findings to the disease. &#x0D; Methods: A comparative cross-sectional study was designed consisting of 50 cases of unilateral PANDO with epiphora and 50 normal volunteers with no history of epiphora. Nasal Evaluation was done with anterior rhinoscopy and nasal endoscopy. Data was tabulated and analyzed using SPSS version 21. &#x0D; Results: The mean age in the unilateral PANDO group was 33.6 years and 34.5 years in the normal volunteer’s group (P-0.84). Left sided dominance of PANDO was observed in 64% (32/50) cases. The odds of having Nasolacrimal duct (NLD) obstruction was1.6 times more among individuals having septal deviation versus no deviation (95% CI, 0.907–2.78). The laterality of septal deviation was corresponding to the side of NLD obstruction in 91% (31/34) cases. High located DNS was more common in the PANDO group which was significant (P-value 0.012). Turbinate hypertrophy, the presence of septal spur or rhinitis had no significant association with NLD obstruction. &#x0D; Conclusions: Deviated nasal septum (DNS), turbinate hypertrophy, septal spur and rhinitis were the associated intranasal findings in cases of unilateral PANDO. A significant association exists between DNS and PANDO, although a cause and effect relation require further probing.

Large Foreign Body in Nose in Adult for a Long Time: A Rare Case

Otolaryngologists frequently encounter nasal foreign bodies, particularly among children and mentally retarded patients. Many unusual foreign bodies in the nose have been reported like nuts, plastic toy parts, beads and even button batteries. Several symptoms may be present in the case of a nasal foreign body which includes nasal discharge, epistaxis, infection, halitosis, foul breath or body odour and chronic sinusitis. We present a case of 19 years old girl with left sided nasal blockage, foul smell from left nostril and mouth with occasional nasal bleeding for last 13 years. She was treated conservatively but was not improved. On anterior rhinoscopy some blackish material covered with exudates was revealed which was very foul smelling and bleeds on touch. After nasoendoscopy we suspected that it would be an old foreign body which had already formed rhinolith. The large foreign body was fixed with floor, lateral and medial wall (nasal septum) and was removed by 0˚nasoendoscope and also through oral cavity under general anaesthesia.&#x0D; Delta Med Col J. Jan 2019 7(1): 49-52