Improvement In Nasal Obstruction Research Articles

Management of Nasal Polyposis in Pediatric Patients With Cornelia de Lange Syndrome: A Case Series and Literature Review.

Cornelia de Lange syndrome (CdLS) is a rare genetic multiple malformation disorder with many otolaryngologic comorbidities. Patients with CdLS appear to have an increased prevalence of chronic rhinosinusitis (CRS) and chronic rhinosinusitis with nasal polyposis (CRSwNP), however, there is limited literature describing the presentation, evaluation, and management of CRSwNP within the CdLS population. Here we performed a literature review from Embase, PubMed, Cochrane Library, and Google Scholar and reported a case of CRSwNP with concomitant CdLS that was identified at our institution. We describe an 8-year-old male with CdLS and CRSwNP confirmed by history, physical exam, nasal endoscopy, and computed tomography. Symptoms of nasal obstruction were refractory to medical management and required repeat surgical management with improvement in nasal obstruction. Literature review identified 2 additional cases of nasal polyposis with similar management strategies. Additionally, one case series showed 33% of CdLS patients had recurrent sinusitis while a second series identified 39% of CdLS patients with CRS and 12% with CRSwNP. These data suggest that CRSwNP is more prevalent in patients with CdLS compared to the general public and can be both safely and effectively managed with a combination of medical and surgical therapy.

Office-based blue laser therapy for inferior turbinate hypertrophy: a pilot study.

To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction. Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale. A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34. Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.

A COMPARATIVE STUDY ON NASAL BONE FRACTURE ASSOCIATED WITH SEPTAL DEVIATION CORRECTED WITH SEPTOPLASTY VERSUS CLOSED REDUCTION

Objective: The dorsum of the nose formed by nasal bones helps to maintain the airway and esthetic appearance of the nose. Faciomaxillary trauma is associated with a nasal bone fracture with or without nasal septal fractures. Nasal bone fractures can lead to deviation of the external nose and nasal obstruction. The management includes correction of nasal bone deformity with either septoplasty or reduction of nasal septal deviation by the non-surgical method. A study was conducted to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction.The aim of this study was to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction. Materials: Sixty-two patients with nasal bone fractures with varying degrees of external nose deformity and nasal septal deviation were divided into two groups. Group A consisted of patients treated with septoplasty and nasal bone fracture correction and Group B consisted of patients treated with non-surgical reduction of septal deviation and nasal bone fracture correction. Type I, II, and II nasal bone fractures were included with all types of septal deviations. The subjective improvement in nasal obstruction was assessed using the visual analog scale in both groups. Results: There were 26 males (81.25%) and 06 (18.75%) females in Group A and 25 (83.33%) males and 05 (16.67%) females in Group B. In Group A, 12 (37.5%) patients were aged between 18 and 27 years, 10 (31.25%) patients were aged between 28 and 27 years, 07 (21.87%) patients were aged between 38 and 47 years, and 03 (09.37%) patients were aged between 48 and 57 years. The mean age was 23.54±2.30 years. Conclusion: Nasal bone fractures cause not only esthetic facial deformity but also functional airway obstruction. A thorough clinical examination, computed tomography scan, and patient counseling are necessary. There is no statistically significant difference in the final outcome between the septoplasty and closed reduction of the septal deviation undertaken to relieve nasal obstruction in patients with associated nasal bone fractures.

The Effectiveness of High-Intensity Focused Ultrasound in Treating Nasal Obstruction Caused by Inferior Turbinate Hypertrophy: A Clinical Study.

Background Nasal obstruction due to inferior turbinate hypertrophy is a common medical complaint among ENT clinic patients, which can significantly affect thepatient's quality of life, and some are compelled to use topical intranasal decongestants. Conservative management is the first line of treatment; however, surgical reduction of the inferior turbinate becomes necessary if the symptoms persist after three months of treatment. The optimal surgical technique is controversial. High-intensity focused ultrasound (HIFU) is a minimally invasive surgical option that targets tissue volume precisely and minimally impacts surrounding tissue. This study aimed to assess the effectiveness and safety of HIFU in treating patients suffering from nasal obstruction due to inferior turbinate hypertrophy. Methods This prospective study was conducted from February to December 2016. The study lasted over six months. Patients with a history of allergic and non-allergic rhinitis participated in this study. It included 43 patients who had been experiencing chronic nasal obstruction due to bilateral inferior turbinate hypertrophy and had not shown improvement after three months of medical treatment. The patients underwent Ultrasound Volumetric Tissue Reduction (UVTR) surgery using the D & A Ultrasurgdevice (Diamant Medical Equipment Ltd., Amman, Jordan) under local anesthesia.The effectiveness, safety, and tolerance of HIFU were assessed subjectively for six months using a well-designed questionnaire utilizing a visual analog scale (VAS) and nasal endoscopy after the surgery. Results The study included 43 patients, 22 male and 21 female, aged 13 to 65 years. The study found that 40 (93%) patients showed significant improvement in nasal obstruction within a month of the surgery. However, three (7%) patients continued to experience persistent nasal obstruction even after six months of follow-up. The procedure was well-tolerated, with low rates of complications after surgery and reasonable pain control. During the surgery, 20(46.5%) patients reported mild pain described as a pressure-like sensation, and 10 out of 43 patients (23%) required paracetamol after the procedure. Four patients (9.3%) had mild bleeding, which was treated with an ultrasound nasal probe without nasal packing. All patients experienced crusting of the nasal cavity during the first week, but no crustation was observed after the first month. There were no reported cases of synechia among the patients. Conclusion This study confirms that HIFU treatment is a reliable and effective treatment for improving short-term nasal obstruction caused by inferior turbinate hypertrophy. The procedure is easily applied and well-tolerated in outpatient clinics.

Decision-making in the treatment of chronic rhinosinusitis with nasal polyps in the era of biologics

Chronic rhinosinusitis is one of the most common chronic diseases in the population. Chronic rhinosinusitis with nasal polyps (CRSwNP) in adults is predominantly characterized by atype2 inflammatory endotype. If sufficient control cannot be achieved through primary drug therapy, surgical intervention is usually recommended as the next stage of treatment. Nowadays, various biologics are available that have been or will be approved for use in these patients. This review summarizes the presentations from the 29thCongress of the European Rhinologic Society in Sofia 2023 and the latest findings on decision-making in the treatment of CRSwNP. Standard therapy with medication and sinus surgery fails in some patients with CRSwNP. Biologics that act on the type2 inflammatory pathway led to areduction in the nasal polyp score (NPS), an improvement in nasal obstruction, and an improvement in quality of life without significant side effects. Biomarkers such as total IgE, serum eosinophils, and Osteoprotegerin (OPG) can provide indications of the success of the treatment. In summary, it can be said that for many patients with recurrent CRSwNP, acombination of paranasal sinus surgery and treatment with abiologic that is precisely tailored to the patient's endotype is the best option. However, the question of which surgical approach and which biologic at which time and for which patient is still ongoing and requires further studies.

Evaluation of Nasal Obstruction Following Septoturbinoplasty Using the VAS and NOSE Scale.

Patient satisfaction with septoturbinoplasty was measured using the subjective visual analogue scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) scale. In addition, those factors that impacted satisfaction were confirmed. We conducted an observational study of patients who underwent septoturbinoplasty. Age, sex, smoking habit, duration of improvement, postoperative complications, type of packing and surgeon were analysed. The results were compared using the VAS and NOSE scale. The improvement experienced with surgery corresponded to 69.80±26.97 points on the VAS 42.65±22.9 points (p <0.01) on the NOSE scale. A strong, direct correlation between the two scales (r = 0.79; p <0.01) was achieved. Surgeon, presence of complications, smoking habit and type of packing were not associated with the improvement experienced on the VAS or NOSE scale. Patients under 30 years of age and patients with permanent improvement achieved higher levels of satisfaction on both scales (p <0.01). Women showed a stronger tendency to perceive their improvement as temporary (p <0.01). Patients who underwent septoturbinoplasty experienced a subjectively measured improvement in nasal obstruction. The VAS and the NOSE scale were strongly correlated with one another. Sex, age and duration of improvement (temporary versus permanent) impacted patient perception; surgeon, smoking habit and type of packing did not.

Assessment of Nasal Obstruction in Patients Undergoing Functional Endoscopic Sinus Surgery.

Aim & objectives-To assess and compare the nasal obstruction in patients before and after undergoing FESS using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy. Introduction- Chronic Rhinosinusitis with, or without nasal polyps can lead to nasal obstruction. Patients refractory to medical treatment undergo Functional endoscopic sinus surgery (FESS). FESS has been shown to improve subjective quality of life outcomes and objective endoscopic improvement. Material & methods- A prospective study conducted in the department of Ear, Nose & Throat, of a tertiary care medical college and associated Hospital between January 2021 and October 2022. Subjective and objective assessment of nasal obstruction was done using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy before and after surgery at 1st, 3rd and 6th month. Results- Post FESS, there was a significant improvement in nasal obstruction on Visual analogue scale, sinuses were healthy and drainage was adequate on Diagnostic nasal endoscopy, statistically significant (P < 0.05) decrease in nasal resistance was seen on Rhinomanometry. Conclusion- A good subjective outcome on Visual analogue scale and a good objective outcome on Diagnostic nasal endoscopy and Rhinomanometry can be obtained with FESS in patients with Chronic Rhinosinusitis.

Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study.

Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. Retrospective study. Tertiary level craniofacial hospital. 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.

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.

Radiofrequency Ablation for Inferior Turbinate Hypertrophy: Predictive Factors for Short and Long-Term Outcomes.

Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated. A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use. Study A: There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS -1.3, P < .001), trouble exercising (VAS -1.5, P < .001), trouble sleeping (VAS -0.9, P < .001), snoring (VAS -1.1, P< .001), and hyposmia (VAS -0.6, P = .004). Smoking (R2 = .065, P = .047) was a predictor for less optimized and previous use of decongestive nasal spray (R2 = .135, P = .005) for better short-term outcome. Study B: Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS -1.5, P < .001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P = .036). Allergy (R2 = .066, P = .006), asthma (R2 = .068, P = .005), and previous use of corticosteroid nasal spray (R2 = .050, P = .016) were associated with a less optimized and older age (R2 = .217, P < .001) with better long-term outcome. RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome.

33615 Nasosinusal mucosal melanoma

A 73-year-old man, former tobacco smoker, with a personal history of cardiac arrhythmias and hypertension and a first-degree relative with colorectal cancer, consulted for 2 months of epistaxis associated with left nasal obstruction, proptosis, epiphora and ipsilateral diplopia. Previous rhinoscopy showed a polypoid tumor, occupying the left nostril and extending to the pyriform aperture, blackish and with a visible vascular pattern that displaced the septum towards the right nostril. A simple CT scan of the craniofacial mass showed lytic tumor lesions in the left nostril with extension into the maxillary sinus, involving turbinates, nasal septum, ethmoidal cells, orbital lamina and left frontal sinus. The diagnosis was complemented with histopathology, revealing nasal mucosal melanoma, ulcerated, without presence of mitosis, lymphovascular or neural invasion. MRI and PET did not show distant metastasis. The patient required multidisciplinary management and was staged as T4aN0M0, clinical stage Iva (according to AJCC TNM classification) and stage I (according to Ballantyne classification). Surgery was ruled out, indicating management with radiotherapy and pembrolizumab 200 mg every 21 days in the current follow-up, with partial improvement of nasal obstruction, without evidence of clinical progression. The interest of this case lies in the infrequent and aggressive presentation of melanoma of the nasal mucosa, being an oncologic entity of low prevalence that corresponds to 1% of the total melanomas and <5% of the neoplasias of the nasosinusal tract, having worse prognosis than cutaneous melanoma due to its recurrence and high metastatic potential.

33615 Nasosinusal mucosal melanoma

A 73-year-old male, former tobacco smoker, with a personal history of cardiac arrhythmias and hypertension and a first-degree relative with colorectal cancer, consulted for 2 months of epistaxis associated with left nasal obstruction, proptosis, epiphora and ipsilateral diplopia. Previous rhinoscopy showed a polypoid tumor, occupying the left nostril and extending to the pyriform aperture, blackish and with a visible vascular pattern that displaced the septum towards the right nostril. A simple CT scan of the craniofacial mass showed lytic tumor lesions in the left nostril with extension into the maxillary sinus, involving turbinates, nasal septum, ethmoidal cells, orbital lamina and left frontal sinus. The diagnosis was complemented with histopathology, revealing nasal mucosal melanoma, ulcerated, without presence of mitosis, lymphovascular or neural invasion. MRI and PET did not show distant metastasis. The patient required multidisciplinary management and was staged as T4aN0M0, clinical stage IVa (according to AJCC TNM classification) and stage I (according to Ballantyne classification). Surgery was ruled out, indicating management with radiotherapy and pembrolizumab 200 mg every 21 days in the current follow-up, with partial improvement of nasal obstruction, without evidence of clinical progression. The interest of this case lies in the infrequent and aggressive presentation of melanoma of the nasal mucosa, being an oncologic entity of low prevalence that corresponds to 1% of the total melanomas and less than 5% of the neoplasias of the nasosinusal tract, having worse prognosis than cutaneous melanoma due to its recurrence and high metastatic potential.

Study of nasal packing versus quilting following septoplasty surgery

Introduction: Nasal packing is a commonly performed procedure after septoplasty. Quilting is alternative procedure which reduces the complications of nasal packing. This study aims to compare the post-operative outcome of quilting and nasal packing following septoplasty. Methods: This is a prospective comparative study carried on 80 patients divided into two equal groups who had undergone quilting and nasal packing randomly after septoplasty surgery for symptomatic deviated nasal septum. Post-operative nasal outcome score, pain, haemorrhage, anxiety, infection was compared between two groups at 1st, 3rd, 7th and 30th post-operative days. Results: There was significant improvement in nasal obstruction post-operatively in quilting group (p&lt;0.05). Polyvinyl acetate sponge nasal packing group patients experienced significantly higher intensity of pain on 1st and 3rd post-operative days (p&lt;0.05). Post-operative bleeding was also relatively higher in nasal packing group compared to quilting group at 3rd post-operative day. Patients had significantly higher levels of anxiety in the nasal packing group throughout a week post-operatively compared to the quilting group. Similarly, no statistically significant difference was noted in terms of adhesion between group A and group B on 7th and 30th post-operative day. Conclusions: Quilting technique following septoplasty showed higher improvement of post-operative nasal obstruction compared to Polyvinyl acetate sponge packing. It also decreased post-operative pain, bleeding, anxiety and adhesion. Quilting suturing following septoplasty can be recommended as an effective and comfortable alternative to nasal packing.

A New Technique of Open Septal Reduction Using Polydioxanone Plates for Nasoseptal Fracture: Three-Dimensional Volumetric Analysis.

In this study, we designed a new technique for open septal reduction using a polydioxanone (PDS) plate and compared it with closed reduction (CR). This study included 19 consecutive patients with nasoseptal fracture: 10 receiving open reduction with a PDS plate (PDS group) and 9 undergoing CR group. Open septal reduction was performed after CR for nasal bone fracture. A mucoperichondrial flap was unilaterally elevated, and the deviated septal cartilage was reduced. The PDS plate was inserted horizontally above the vomerine suture. Surgical outcome was analyzed with three-dimensional volumetry and with a quality-of-life scale for nasal obstruction (Nasal Obstruction Symptom Evaluation scale). Complications included 1 case of septal perforation in the CR group and 1 case of PDS exposure and septal hematoma in the PDS group. In the three-dimensional volumetric analysis of the PDS group, the median value of the nasal cavity change significantly differed between 1.14 mL (interquartile range; 0.46-2.4) at the preoperative computed tomography scan and 0.33 mL (interquartile range; -0.22 to 1.29) at the postoperative computed tomography scan (∗∗P = 0.0039). The Nasal Obstruction Symptom Evaluation scale revealed significant improvement in nasal obstruction postsurgically (median value, 42.5-7.5; ∗P = 0.0139) in the PDS group. Polydioxanone plates potentially present a new concept of open septal reduction in terms of septal reinforcement compared with the subtractive approach of open septal reduction.

Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum – A Randomized Clinical Trial

Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 ( p = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group ( p = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively ( p = 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

The Effect of Turbinate Injection of Botulinum Toxin A on the Symptoms of Idiopathic Rhinitis.

Introduction Idiopathic rhinitis is a nonallergic and noninfectious rhinitis characterized mainly by nasal obstruction and rhinorrhea, resulting from an autonomic imbalance. Botulinum toxin type A (BTX-A) demonstrated its action in reducing rhinorrhea and nasal obstruction when injected into the nasal turbinates or septum. Objective To analyze the effects of intranasal BTX-A injection to control the symptoms of idiopathic rhinitis and its possible adverse effects. Method Patients with idiopathic rhinitis were divided into two groups. Group A had 15 participants (8 female and 6 male), of ages from 47 to 84 years (mean 66.57 years), and these received 60 U of Dysport (Ipsen Ltd, Maidenhead, Berkshire, UK) in each inferior nasal turbinate; group B had 12 participants (1 male and 11 female), of ages from 50 to 76 years (mean 60 years), and they received 1 ml of 0.9% saline. The individuals were reevaluated in the 1 st , 2 nd , 4 th , 8 th , and 12 th weeks after injection by a questionnaire, accompanied by nasal inspiratory peak flow and acoustic rhinometry. Results Group A showed significant improvement, mainly regarding the symptoms of sneezing/itching and nasal obstruction, over time and when compared to group B. Acoustic rhinometry confirmed the improvement in nasal obstruction. There was no relationship between the nasal peak flow data and the nasal obstruction score. No major adverse effects have been reported. Conclusion The injection of botulinum toxin in the inferior nasal turbinates of patients with idiopathic rhinitis reduces the symptoms of sneezing, itching, nasal obstruction, and runny nose without significant adverse effects, suggesting that it is an option in the treatment of these patients.

Partial Maxillectomy for the Improvement of Nasal Obstruction Can Be Combined with Septorhinoplasty.

We describe the (anteromedial) partial maxillectomy technique which can be used to address impaired nasal breathing in cases of significant protrusion of the frontal process of the maxilla into the nasal cavity, narrowing the nasal pathway. It fits to nasal physiology avoiding mucosal resection. It can be combined with surgery of the inferior turbinate. The described technique can be used in all forms of rhinoplasty.

Comparison of Fluticasone Furoate and Cetirizine Versus Fluticasone Furoate and Montelukast in Allergic Rhinitis

Background: The complexity of treatment in allergic rhinitis remains to be a global challenge. The medical treatment option for moderate-severe persistent allergic rhinitis is the combination of intranasal corticosteroid (INCS) and oral antihistamine or leukotriene receptor antagonist (LTRA). The combination INCS with LTRA is selected based on the presence of asthma. Purpose: To determine the effect of fluticasone furoate plus cetirizine administration comparing fluticasone furoate plus montelukast on nasal eosinophils count and clinical improvement in patients with moderate-severe persistent allergic rhinitis. Method: This study was purely experimental research with the study design randomized clinical trial, double-blind, pre and post test control. Patient were divided into two group. Group-1 received intranasal fluticasone furoate 110 μg once daily and oral cetirizine 10mg and Group-2 received intranasal fluticasone furoate 110 μg once daily and Montelukast 10mg. The treatment efficacy is assessed from nasal eosinophil count and total five symptoms score (T5SS) based on Visual Analogue Scale (VAS) before and 4 weeks after treatment. Result: Both groups show a decrease in the nasal eosinophil count and T5SS score based on VAS before and after treatment (p&lt; 0.05). The group-2 shows a statistically significant improvement in nasal obstruction and rhinorrhea compare to the group-1 (p &lt;0.05). The decrease in nasal eosinophil count and T5SS is higher in the group-2 than the group-1, however, it is not statistically significant. Conclusion: The combination of fluticasone furoate and montelukast is more effective in reducing nasal obstruction and rhinorrhea than the combination of fluticasone furoate and cetirizine.

The role of fiberoptic sinoscopy in evaluation the effect of surgically rapid maxillary expansion on the nasal airways

Aim : To evaluate the effect of surgically assisted rapid maxillary expansion on the nasal airway assissted by nasofibroscopy. Subjects and methods: Nine Patients were included in the present study. They were consecutive patients selected from the oral and maxillofacial surgery department that referred from orthodontic department Faculty of Dental Medicine, Al-Azhar University, Assuit branch in the period from September 2017 to October 2019 . They were adult patients of both sexes (3 males and 6 females). All patients were subjected to history taking , sinoscopic nasal examination. All patients had maxillary transverse deficiency associated primarily with functional impairments, such as posterior uni- or bilateral cross bite, dental crowding, reduced nasal respiratory function or anterior-posterior skeletal anomalies and they were indicated for surgically assisted rapid maxillary expansion. Preoperative intracanine and intramolar distances (C1, C2, M1, M2 ) was measured by digital caliper on Study cast. Measuring area of both nasal cavities by nasofibroscopy were done in ENT department of Al Azhar university hospital, Assuit. The operation was conducted under general anesthesia. After surgery, clinical evaluations ware done at intervals of 2, 4, 7 and 15 days and then all data obtained from nasofibroscopy by pixels and transformed by typography program in to millimeters. Result: Results of the current study have indicated that nasofibroscopy showed that was improvement in nasal obstruction after maxillary expansion. Conclusion: Surgically assisted rapid maxillary expansion is an effective method of widening the nasal passages and reducing nasal resistance that assisted by nasofibroscopy.