Chronic Rhino Research Articles

Study of Facial Nerve Palsy in Maharashtra Population

Background: Facial nerve palsy is uncommon mainly lower motor Neuron palsy but had significant involvement of Oto-laryngeal and Opthalmic complications too. Surgical innervations are the most viable way to overcome complications of Facial Nerve palsy.Method: 30 adults patients (17 left side, 13 right side) had facial palsy associated with ORL disorders were studied with CT scan, routine blood examination, to know any other pathogenesis. Examination was done to rule out tympanic membrane perforation, Herpes Zoster.Results: 13 (43.3%) Otalgia, 6 (20%) impaired hearing, 5 (16.6%) Ear discharge, 3 (10%) Dysphagia, 1 (3.33%) Jaw pain, 1 (3.33%) Nasal bleeding, 1 (3.33%) throat pain. The diagnosis involved 9 (30%) CSOM, 8 (26.6%) otitis media, 4 (13.3%) AOM, 4 (13.3%) otitis exterma, 1 (3.33%) Ramsay Hunt syndrome, 1 (3.33%) Herpes Zoster, 1 (3.33%) chronic Rhino- sinusitis uveitis / anterior, 1 (3.33%) acute tonsillitis, 1 (3.33%) sensorineural hearing loss.Conclusion: These associated complications need surgical corrections and onset of proper antibiotic treatment to have better prognosis because, it is LMN (lower Motor Neuron) palsy.

Randomised Comparison of Safety Profile and Short Term Response of Itraconazole, Voriconazole and Amphotericin B in the Management of Chronic Invasive Fungal Rhinosinusitis.

Chronic invasive fungal rhino sinusitis (CIFS) is a well described clinical entity characterized by mucosal and sub mucosal infiltration of mycotic organisms and angio-centric extension into orbital and intracranial structures. Itraconazole, Voriconazole and Amphotericin B are commonly used for CIFS. In the present study we have evaluated short term clinical response of these drugs. Thirty diagnosed patients of CIFS who presented to us from January 2011 to December 2015 were divided into three groups randomly. Group A, B and C received Itraconazole, Voriconazole and Amphotericin respectively. Visual Analogue scale (VAS), Lund Mackay (LM) radiological scores and Kupferberg's nasal endoscopic grades were seen and compared in all patients before treatment, after primary surgical debridement and biopsy and after post biopsy antifungal drug treatment. We assessed the serum drug levels using HPLC assay at 4 and 8weeks of therapy and correlated them for efficacy and safety. All the groups had significant improvement after treatment compared to beginning of study. Inter group comparison showed that mean LM, NE and VAS scores were significantly better in Voriconazole group compared to Itraconazole and amphotericin B therapy. The reduction of these objective parameters with treatment was also significantly high in Voriconazole group compared to the other two groups. Voriconazole has shown to be the most effective treatment modality for chronic invasive fungal sinusitis compared to other commonly used drugs such as Itraconazole and Amphotericin B.

Sinonasal Sarcoidosis: A Case Report

Sarcoidosis is a chronic granulomatous disease of unknown etiology which principally affects the lower respiratory tract & lungs. Sarcoidosis in the head & neck region is infrequent. Isolated sino nasal sarcoidosis without pulmonary involvement is rare.Case: An 18 years old male patient presented with the complaints of nasal blockage, purulent nasal discharge which was occasionally blood stained for 6 months, deformity of nose, swelling of face & lips for 4 months & watering of eyes for same duration. Endoscopy of nose revealed intra nasal mucosal thickening which was friable & bleeds on touch. The diagnosis of sino nasal sarcoidosis was made by histopathological examination of nasal biopsy specimen.Conclusion: Sino nasal sarcoidosis is a disease of diagnostic challenge to the clinician as its mimicking clinical features may be misleading & cause delay in definitive diagnosis. In the current case report, we presented a case of sino nasal sarcoidosis presenting as chronic rhino sinusitis.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.648-650

Analytical Study of Anatomical Variations of Nose And Pns in Ct Scan And Chronic Sinusitis

Back Ground: Sinusitis affects millions of people each year and is a major cause of concern worldwide. Chronic rhino-sinusitis is an inflammation of Nose and Paranasal sinuses and the aetiology of it is multifactorial. Anatomical variations of nose and paranasal sinuses are one of the most important aetiological factor for chronic sinusitis. The approach to patients with chronic rhinosinusitis is endoscopic surgery which aims at removing the obstruction of the main drainage pathway. The Osteomeatal complex based essentially on the concept that obstruction perpetuates the sinus disease. This in turn requires the surgeon to have detailed knowledge of the anatomy of the lateral Nasal wall, Paranasal sinuses and surrounding vital structures and of the large number of anatomical variants in the region. CT Scan of Para Nasal Sinuses has become mandatory for all patients undergoing Functional Endoscopic Sinus Surgery. It depicts the anatomical complexities of Osteomeatal complex in a simpler way and acts as a road map for endoscopic sinus surgery. Aim: the Aim of the study was to 1. Detect prevalence of anatomical variations of Nose and PNS in Chronic Rhino - Sinusitis in Computed Tomography. 2. Study the association of anatomical variations of Nose and PNS in Chronic Rhino-Sinusitis. Materials And Methods: Descriptive cross sectional studies in which 144 consecutive cases of chronic rhinosinusitis patients attending ENT Out –patient department, who had chronic sinusitis for more than 3 months duration not responding to the medical line of treatment and who were willing to undergo functional endoscopic sinus surgery satisfying the inclusion criteria were studied. The results were expressed in percentage and proportions. The retrospective study was conducted in patients at the Government ENT Hospital, Andhra Medical College, Visakhapatnam, who had presented between October 2012 – September 2015. Results: In our study it was observed that 1 or more types of anatomical variants were observed in 112 cases out of 144 cases. The most frequent being the Deviated Nasal Septum (73.2%) and the choncha bullosa (45.5%), and the other less common anatomical variants observed were paradoxical middle turbinate, Aggar Nasi cells, Haller cell, Onodi cell and Septal Cell. Conclusion: Prevalence of multiple anatomical variations are more in our study in comparision to single anatomical variation. Deviated Nasal Septum was the most common anatomical variation encountered in our study followed by Choncha Bullosa.

Topical Mitomycin C in functional endoscopic sinus surgery

In recent literature, there has been an interest in the use of Mitomycin C to reduce post-operative complications following endoscopic sinus surgery. We report our results on a prospective, randomized controlled trial involving 50 patients with chronic bilateral rhino sinusitis. We eliminated various confounding factors by studying a single group of patients, with symmetrical disease, without pre-existing gross anatomical abnormalities. Patients requiring revision sinus surgery were excluded. On completion of the surgery, a cotton pledget soaked in Mitomycin C was placed in one nostril (test) and saline-soaked pledget (control) was placed in the other side of the nose, both in the middle meatus. The side of the nasal cavity receiving the topical Mitomycin C was randomized. The patients were assessed periodically (first week, first month, third month and sixth month) for synechiae formation and presence or absence of their symptoms. At the first week follow up, there was a statistically significant difference in the incidence of synechiae between the saline and Mitomycin C side. Furthermore, there was a statistically significant improvement with regards to patient symptoms (nasal block and discharge) in the Mitomycin C side when compared to the saline side. At the third and sixth month, there was no difference between the two groups. The incidence of adverse tissue reaction (granulation, discharge, polypoidal mucosa and crusting) was less in the Mitomycin C side when compared to the saline side at the first month follow up. Topically applied Mitomycin C reduces the incidence of synechiae in the immediate post-operative period in patients undergoing endoscopic sinus surgery. There is also an improvement in nasal obstruction and discharge with a reduction in the incidence of adverse tissue reaction in the early post-operative period.