Complaints Of Nasal Obstruction Research Articles

Breaking New Ground: Unraveling Sinonasal Hemangiopericytoma Through a Rare Case Series on Endoscopic Excision and Postoperative Monitoring.

Hemangiopericytoma is a rare vascular neoplasm derived from pericytes, with uncertain malignant potential. It mainly occurs in the retroperitoneum and lower extremities, with a lower incidence in the head and neck region and nasal cavity. Diagnosis is aided by histopathological examination and immunohistochemistry. Surgical excision is the preferred treatment, with different approaches depending on tumour size. Endoscopic excision is suitable for small tumours, while larger ones may require external approaches. The recurrence rate is approximately 25%, emphasizing the importance of long-term follow-up. Our study aims to discuss a rare series of sinonasal hemangiopericytoma cases, their clinical presentation, and their management. In this study, we are discussing the prospective study of six cases of sinonasal hemangiopericytoma that were presented to a tertiary hospital, from June 2017 to June 2023, with complaints of nasal obstruction and bleeding episodes. They were assessed with a detailed history, blood investigations, radiological investigations, and diagnostic nasal examination, and underwent endoscopic surgical excision of the nasal mass, with the diagnosis confirmed by histopathological examination and immunohistochemistry. All cases were followed up for 1year postoperatively, except one case which missed follow-up after 6months and with no postoperative complications and recurrences. All six cases came with complaints of nasal obstruction and bleeding from the nasal cavity. All six cases underwent endoscopic surgical excision of the tumour and were followed for 1year in five cases; one case missed follow-up after 6months of postoperative follow-up, but no recurrence was noted in all the cases. For small-sized hemangiopericytoma tumours, endoscopic excision offers benefits such as improved visualization, easy resection, preservation of the normal anatomical structure, and maintenance of physiological function in the sinonasal cavities. With a recurrence rate of approximately 25%, surgical excision and long-term follow-up play essential roles in successful tumour management.

Extra nasopharyngeal angiofibroma: A deviant clinical presentation of angiofibroma

Nasopharyngeal angiofibroma is a benign vascular locally aggressive lesion that arises from a hamartomatous nidus, with nasopharynx being the most common and earliest site of presentation. However deviance to such presentation have been reported although rare, such as turbinates, nasal septum and retroantral space. Classical nasopharyngeal angiofibroma routinely presents with chief complaints of nasal obstruction and characteristic painless, recurrent and spontaneous epistaxis with choanal banking effect. Our case depicts the unique and rare presentation of angiofibroma as a progressive cheek swelling in an adolescent male without any nasal symptoms. Diagnostic nasal endoscopy revealed a normal bilateral nasal cavity and nasopharynx. Contrast Enhanced Computed Tomography (CECT) of PNS and face aided the diagnosis. Complete surgical clearance was achieved post embolization via maxillary swing approach. Diagnosis was confirmed on histopathology. Extra nasopharyngeal angiofibroma may be a rare entity however must be considered as a differential diagnosis in vascular skull base tumours.

Rosai Dorfman Disease of Nose and Paranasal Sinuses: An Incidental Discovery.

Rosai Dorfman disease is a benign lymphoproliferative disorder. Isolated extranodal involvement is rarely encountered. The causation has not been attributed to any particular factor and the clinical progress of the disease is varied. Treatment options range from observation to medical therapy to surgical excision. Long term follow up is advocated. We report an elderly female with complaints of nasal obstruction who underwent ESS and was diagnosed with this disease on account of histopathology. Follow up period has been uneventful. The case report illustrated here is aimed at highlighting high index of suspicion as well as creating awareness regarding diagnosis and management of a rarely seen pathology.

Algorithm for Nasal Breathing Impairment Evaluation.

Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations that could impair nasal airflow. Not infrequently, however, symptoms of nasal obstruction do not match the clinical examination of the nasal airway. Addressing this subset of patients may be a challenge to the surgeon. Evaluation of patients with symptoms of nasal obstruction should include a combination of a patient-reported assessment of nasal breathing and at least one objective method for measuring nasal airflow or nasal airway resistance or dimensions. This will allow distinction between patients with symptoms of nasal obstruction and low airflow or high nasal airway resistance and patients with similar symptoms but whose objective evaluation demonstrates normal nasal airflow or normal airway dimensions or resistance. Patients with low nasal airflow or high nasal airway resistance will require treatment to increase nasal airflow as a necessary step to improve symptoms, whereas patients with normal nasal airflow or nasal airway resistance will require a multidimensional assessment looking for less obvious causes of impaired nasal breathing sensation.

Feasibility and Utility of the Endonasal Septal Extension Graft in Rhinoplasty Surgery

Background: The endonasal septal extension graft (ESEG) was first introduced as a rhinoplasty technique to aid in nasal tip support. It has since been modified and adapted for its utility in functional nasal breathing through either an open or endonasal approach. Objective: To demonstrate the feasibility and utility of the ESEG grafting technique for cosmetic and functional nasal breathing. Methods: The video shows a patient undergoing the procedure with a chief complaint of nasal obstruction who subsequently underwent septoplasty, turbinoplasty, and endonasal septal extension grafting. Results: The video submission demonstrates the feasibility and utility of the ESEG technique. Conclusion: The endonasal septal extension grafting technique utilized in functional and cosmetic nasal surgery in patients complaining of nasal obstruction with septal deviation, and nasal valve collapse is a highly successful and reliable treatment option in patients who have failed maximum medical management. The study concept and design were developed by Dr. Barrera. The acquisition, analysis, and interpretation of data were done by Dr. Barrera. Article writing, administrative, technical, and material support were by Dr. Barrera. Video footage and editing was performed by Mr. Max Swiergol. Supervision was by Dr. Barrera. Consultant, Stryker, LLC. No funding was received for this article. Runtime of video: 3 mins 42 secs

Nasal septum deviation with severe obstruction

The nasal septum is a nasal structure that is anatomically and physiologically has a very important role. Various degrees of nasal septal deformity are present at birth and are thought to increase with age. The diagnosis of septal deviation is established based on clinical symptoms, physical examination and supporting examinations. Investigations such as nasoendoscopy, paranasal sinus X-ray, computer tomography, Peak Nasal Inspiratory Flow (PNIF), Rhinomanometry and Acoustic Rhinometry can be performed to assess the anatomical structure of the nose, nasal obstruction caused, as well as complications from septal deviation. An 18-year-old man came to the ENT clinic at Sanglah Hospital Denpasar with complaints of an aquiline nose since two years ago. Complaints are accompanied by complaints of nasal congestion and headaches. Two years ago, the patient was hit on the nose by his friend. Assess complaints of nasal obstruction using the Nasal Obstruction Symptom Evaluation (NOSE) score to get a score of 60. In this case, the open septoplasty technique was chosen because the patient had a severe degree of nasal obstruction, often had headaches, and the patient also complained of cosmetic problems because the deviation to the contralateral side was evident on the outside of the nose.

Primary Nasal Tuberculosis

Introduction:
 Tuberculosis, considered a major global and public health challenge, not only manifests in the lungs but also affects other sites. Tuberculosis primarily occurring in the nose, poses a diagnostic challenge, as the clinical presentations of other important pathologies such as infective and inflammatory diseases, granulomatous disorders and neoplastic conditions are similar, have an indolent course and are non-specific. Moreover, due to its rarity, it is often missed and not considered in differential diagnosis. It is hence felt that a series of three cases of Primary Nasal Tuberculosis, conclusively diagnosed within a year, merits reporting
 Case reports:
 A series of 03 cases, presented with complaints of nasal obstruction, crusting in nasal cavity, intermittent epistaxis, conclusively diagnosed as a case of primary nasal tuberculosis
 Conclusion:
 Primary nasal tuberculosis is rare. One should have a high index of suspicion in patients living in endemic areas not responding to routine treatment and presenting with nasal mass and crusting

Rare Case of Sino-Nasal Rosai Dorfman Disease

ABSTRACT :Introduction: Rosai-Dorfman disease (RDD) is a very rare nonneoplastic lymphoproliferative disease with unknown etiology and pathogenesis. It was originally described as sinus histiocytosis with massive lymphadenopathy(SHML). Approximately 43% of Rosai-Dorfman disease show extra nodal involvement wherein the possible sites are skin, CNS, ear, orbit and rarely nose and paranasal sinuses. Definitive diagnosis can be performed by histopathological examination, which shows emperipolesis. The sinus histiocytes are strongly reactive for S-100 protein and CD68, but negative for CD1a. Case Report: The current study presents the case of a 29 year old male patient who had complaints of nasal obstruction since 5 months. Diagnostic Nasal Endoscopy showed mass completely filling both nasal cavities. Histopathological examination concluded the diagnosis of Rosai-Dorfman Disease and Immunohistochemistry (IHC) stained positive for S-100 and CD68, while negative for CD1a, of the surgical specimen after surgical excision by Functional Endoscopic Sinus Surgery. Follow up was done after a week, monthly for 6 months and a year for recurrenceDiscussion: Extranodal RDD, although rarely seen, should be considered in nasal cavity. Even though there is no ideal protocol in the treatment, surgical excision should be considered if there is a functional disorder.

Unveiling the Enigmatic Nature of Disseminated Rhinosporidiosis: Insights and Challenges of the recurrent menace.

Rhinosporidiosis is an endemic condition in India that is difficult to treat when it is disseminated. This condition commonly affects the nasal cavity and nasopharynx mucosa, accounting for 75% of the clinical cases. Although rare, rhinosporidiosis can present with only cutaneous involvement without mucosal disease. Symptoms of this condition include complaints of nasal obstruction and episodic nasal bleeding. Diagnosis is achieved through histopathological examination of tissue and demonstration of the sporangium. Rhinosporidiosis tends to recur as it spreads through autoinoculation. Therefore, during endonasal endoscopic excision of the mass, it is essential not to injure the surrounding mucosa. A trial of medical therapy with dapsone is advised, but it is mostly ineffective in cases of disseminated disease. Here, we present a case report of a patient who underwent seven surgeries for the same condition over 12 years but was unable to get rid of the recurrent menace.

ROLE OF ADENOTONSILLECTOMY IN MANAGEMENT OF SNORING IN PAEDIATRIC PATIENTS

Adenotonsillitis is most common disease of paediatric age group. A prospective study was conducted on 21 Children with history of snoring, nasal obstruction and mouth breathing having adenotonsillitis. Conventional adenotonsillectomy was performed and patients were followed up 3 months after surgery. Most number of patients with snoring complaints of nasal obstruction. Most of the patients are male with mean age 7.1 years. Most of the patients with snoring had grade III adenoids along with grade III enlargement of tonsils. Most of the children showed improvement in clinical features after surgery

Does final intraoperative endoscopic control increase surgical success in conventional septoplasty?

Objectives: This study aimed to investigate the effects of the final endoscopic control performed intraoperatively in conventional septoplasty on operative time, residual deviation, and changes in Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) scores. Patients and Methods: One hundred twenty-five patients who applied with the complaint of nasal obstruction between June 2020 and May 2021 and were found to have isolated nasal septum deviation were evaluated in this prospective study. Patients with comorbidities were excluded from the study. Remaining 80 patients (55 males, 25 females; mean age: 30.1±8.9 years; range, 18 to 58 years) included in this study. The patients were divided into two groups of 40 individuals using the blocked randomization method. In the first group (CS-EC group; 26 male, 14 female; mean age: 31.7±8.3 year; range 18 to 58 year), after conventional septoplasty with head light, additional pathologies were corrected with the conventional method if it was detected by the endoscope. For the second group (CS group; 29 male, 11 female; mean age: 28.6±9.3 year; range 18 to 53 year), only conventional septoplasty was performed. The patients were evaluated with NOSE before and three months after the operation to evaluate the complaint of nasal obstruction. The groups were compared in terms of NOSE scores, operation time, and postoperative residual deviation. Results: The mean operation times in the CS-EC and CS groups were 44.9±9.3 and 39.0±7.7 min, respectively, and this difference was statistically significant (p=0.001). While there was no statistically significant difference between the CS-EC and CS groups in terms of preoperative total NOSE scores (p=0.211), the postoperative total NOSE score was found to be statistically significantly lower in the CS-EC group compared to the CS group (p=0.001). Conclusion: Final intraoperative endoscopic control of the nasal passage in classical septoplasty may be an effective method to detect septal deviations that cannot be adequately evaluated.

Septal extension graft use in the treatment of alar collapse.

In our study, we showed that the septal extension graft (SEG) technique, which we applied for nasal projection in rhinoplasty surgery, increases the tension of the lateral cartilage (LC) and alar structures. We also demonstrated that nasal congestion could be treated by applying this technique in patients with nasal obstruction due to bilateral dynamic alar collapse. This study was conducted retrospectively on 23 patients with nasal obstruction due to alar collapse. Bilateral dynamic nasal collapse and (+) Cottle test was present in all patients. Nasal lateral wall tissue was also found flaccid on nasal palpation and collapsed to the extent of obstruction on deep inspiration. Standard septal extension graft (SEG) and tongue-in-groove techniques were applied to all patients. Septal cartilage was used for SEG in all patients. No complaints of nasal obstruction on deep inspiration were noted by the patients at six months postoperative follow-up, and Cottle tests were negative. The patients' mean respiratory score was 152 postoperatively, compared to 66.5 preoperatively. This difference was statistically significant using the Wilcoxon signed ranks test (p<0.001). In evaluating postoperative cosmetic appearance due to nasal tip projection (NTP) and cephalic rotation changes, 16 men and four women reported that it was better, while two men felt that there was no change. One woman reported that her cosmetic appearance was worse than before; a revision surgery was performed for her at seven months postoperatively. This method is effective for patients with bilateral nasal collapse and thick-short columella. With the applied surgery, the caudal edge of the LC diverges from the septum, alar region tension and resistance increase, the columella increases in length, nasal projection increases, and the vestibule cross-sectional area is enlarged. In this way, a significant increase in nasal vestibular volume was obtained.

The Characteristics of Deviated Nasal Septum Patients and Computed Tomography Findings at Dr. Mohammad Hoesin General Hospital Palembang

Introduction. The deviated nasal septum is found in 80% of people in the world either with or without specific symptoms. Mladina has divided the classification of deviation of the septum nasi into seven parts based on the findings of the deviation to facilitate the determination of diagnosis, therapy, and which type often appears. This study aims to determine the characteristics of patients with a deviated nasal septum at Dr. Mohammad Hoesin General Hospital Palembang from January to December 2021. Methods. Data was obtained from medical records of patients with a deviated nasal septum at Dr. Mohammad Hoesin General Hospital Palembang from January to December 2021. Results. The majority of patients were in the age range of 16-25 years (37.8%) and male gender (64.9%). The most common etiology was congenital (86.5%). Clinical manifestation mainly is nasal obstruction (94.6%), and the most common secondary diagnoses found are concha hypertrophy (54%) and allergic rhinitis (16.2%). The most common pathological condition was narrowed cavum nasal (91.9%). The majority of patients had type III deviation (51.4%). All patients were treated with septoplasty (100%). Conclusion. Most patients are predominantly male aged between 16-25 years. Congenital factors primarily caused this condition, leading to complaints of nasal obstruction. Secondary diagnoses included concha hypertrophy and allergic rhinitis. Physical examinations often revealed a narrowed nasal cavity. Most patients exhibited type III septal deviation and all patients were treated with septoplasty

Olfactory neuroblastoma with rhabdomyoblasts: A rare case report and review of the literature

Herein we present a case of a 62-year-old male patient who was admitted with the chief complaints of nasal obstruction. The histopathological and immunohistochemical evaluation led to a diagnosis of olfactory neuroblastoma with rhabdomyoblasts. A review of the literature revealed that this is only the fourth case of olfactory neuroblastoma with rhabdomyoblasts. Thus, investigation of more cases and longer follow-up is necessary to understand the disease and identify the best treatment to improve prognosis.

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review.

Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.

Fibrosarcomas of the Paranasal Sinuses: A Systematic Review.

Fibrosarcomas are rare, malignant neoplasms of mesenchymal origin. Fibrosarcomas appear to be sporadic, but cases of fibrosarcomas secondary to radiation of nasopharyngeal carcinomas have been reported. Paranasal sinus fibrosarcomas (PNFS) are even rarer with few cases being reported since the 1950s. There have been several retrospective cohort studies examining PNFS; however, to our knowledge, no comprehensive review exists. This review aims to summarize the findings of all published cases of PNFS from the 1950s to the 2020s. We hope that a comprehensive review will assist in accurate and early diagnoses of PNFS, and help guide treatment as early treatment is associated with a favorable prognosis.This systematic review reports results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted on PubMed, Embase, and Cochrane Library. Studies were screened using established inclusion/exclusion criteria. A total of 26 studies were included for data extraction, and relevant data were collected and analyzed.In our study, the most common study type was case reports (n = 19). The most common presentation for PNFS included male gender (n = 17) with maxillary sinus (n = 57) involvement. Patients commonly presented with complaints of nasal obstruction (n = 15), epistaxis (n = 11), and facial fullness/pain (n = 9). Surgical resection was the mainstay treatment, with the use of chemotherapy or radiation depending on surgical margins and resectability. The diagnosis was commonly made with histological analysis. This review of the literature provides a summary and reference of important presenting factors, elements of diagnosis, and treatment options regarding PNFS to help bring awareness and guide the treatment of such a rare disease. Moving forward, there is a greater need for larger standardized studies that can further complement our findings, as well as more consistent reporting of cases.

Post Covid-19 Mixed Fungal Orbito-Pansinusitis Caused by Rhizopus Oryzae and Exophiala Jeanselmei-Review and Reports

We report a rare case of mixed fungal orbito-pansinusitis caused by Rhizopus oryzae and Exophiala jeanselmei in post-COVID-19 individuals. A 65-year-old patient was COVID-19-positive and treated as per the protocols. Following recovery after 3 weeks presents to the otorhinolaryngology outpatient department with complaints of nasal obstruction, stuffiness, pain over the maxilla, occasional fever spikes, and swelling over eyelids. He was diagnosed with a case of orbito-pansinusitis mucormycosis based on magnetic resonance imaging, nasal endoscopy, and microbiological findings. Intravenous (IV) fluconazole and amphotericin B were the conservative management initially followed by surgical debridement later. There was minimal residual deformity after patient recovery. Generally, secondary to immunosuppression or debilitating diseases leads to mucormycosis. The mode of entry for molds and spores of zygomycetes are through the respiratory tract through the nose and then reaches the sinuses, orbit, and intracranial structures. Hence, a good prognosis and to reduce morbidity by zygomycosis can be achieved by early clinical diagnosis, direct smears, and proper interventions. The diagnosis of fungal infections at the earliest is very important because the therapeutic management of fungal infection is quite challenging, especially in the case of R. oryzae and E. jeanselmei with immunocompromised state. The prophylactic drugs, steroids, and immunosuppressants for the treatment of COVID-19 should not be misused and must be used as per protocol and guidelines judiciously.

Clinicopathological Study of Sinonasal Malignancy-Experience in a Tertiary Level Hospital in Bangladesh

Objectives: To assess the clinical presentation and histopathological types and extensions of the disease at the time of presentation.&#x0D; Methods: Cross sectional observational study of 40 patients with sinonasal malignancy from the department of otolaryngology and Head neck surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet Bangladesh, period from May 2019 to April 2020. The patients were examined after admission into hospital pre-operatively and in the postoperative period. The surgical specimens were sent for Histopathology.&#x0D; Results: Majority patients were at 4th to 6th decade where male outnumbered the female with male female ratio was 3.4:1. Out of 40 patients, the majority of patients complaints of nasal obstruction followed by nasal discharge, facial pain, facial swelling and headache. About the site of the lesion maximum patients having the lesion in Maxillary sinus (60%) followed by nasal cavity (15%) multiple sinuses (12.5%) involvement in Ethmoidal sinus (10%) lateral wall of nose (2.5%)&#x0D; Conclusion: Sinonasal Malignancy is usually a disease of middle age and elderly people. Most of the patients (in this study 65% patients come at T3 &amp; T4 stage) presented late with multiple symptoms.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 37-42

Persistence of stapedial artery, our experience: A case report

Stapedial artery persistence is an uncommon issue to encounter in ordinary ENT practise. If they are, they typically show up as a pulsatile mass or as a sneaky discovery. Due to the condition’s rarity, most individuals are asymptomatic, but occasionally it can induce vertigo, pulsatile tinnitus, or conductive hearing loss in certain people. Hereby, we present a case of incidental discovery of persistent stapedial artery in a patient with complaints of nasal obstruction.

A REPORT OF MAXILLARY SINUS ACINIC CELL CARCINOMA

Introduction: Acinic cell carcinoma (ACC) is a rare malignant tumor of the salivary gland. It usually shows in parotid gland, and rarely shows in other site. Case Report: A 33 years old female from East Nusa Tenggara, came to our outpatient clinic with a complaint of nasal obstruction and recurrent epistaxis on her right nose 1 year ago. Biopsy for the tumor was done by the previous Ear-Nose-Throat (ENT)-specialist and resulted suggestive pleomorphic adenoma. During her visit, we found a red colored mass occupying the right nasal cavity, emerges from the middle meatus. Patient had not received medical nor non-medical therapy after the previously done biopsy, and declined of having any epistaxis episodes during the time. Nasal obstruction was her current complain and what brings her to seek medical care. We continued with a midfacial degloving surgery and removed the tumor, which aroused from maxillary sinus. Histopathology of the tumor shows an acinic cell carcinoma feature. Discussion: We searched all English and Non-English previously ACC reports in nasal cavity to compare with our case and our treatment plan. Conclusion: Sinonasal ACC are known as a rare, slow-growing and low-grade malignancy tumor with an excellent outcome, despite indistinct symptoms.