Middle Meatus Research Articles

Study on the consistency between CBCT image features of sphenopalatine foramen and those seen in nasal endoscopy

Objective:To study the clinical anatomy of the sphenopalatine foramina by dissecting the sphenopalatine foramina during Vidian nerve branch neurotomy. The anatomy and CBCT images of sphenopalatine foramen were analyzed to facilitate the navigational of clinical operation using CBCT images. Methods:From October 2017 to September 2023, 84 cases（168 sides） of Vidian nerve branch neurotomy in our department were collected. The clinical summary was made according to the anatomy of sphenopalatine foramen during the operation. Preoperative CBCT imaging findings of the sphenopalatine foramina were also studied. Results:The clinical anatomy of sphenopalatine foramen could be divided into four types: middle meatus type（1.19%）, trans-meatus type（62.29%）, superior meatus type（33.33%） and double foramen type（1.19%）. The incidence of ethmoidal ridge was 98.81%. The distance from sphenopalatine foramina to posterior nasal canal were（14.63±2.66） mm to left and（14.65±2.63） mm to right, The position Angle ∠a of lower margin of sphenopalatine foramina were（62.36±10.05）° to left and（61.51±11.82）° to right, respectively. Axial CT images can be used to divide the sphenopalatine foramen into five levels: the upper edge of the sphenopalatine foramen level, the Vidian nerve level, the basal plate interaction level, the lower edge of the sphenopalatine foramen level and the pterygopalatine canal level. The agreement between endoscopic anatomy of sphenopalatine foramen and imaging navigation was 100%. Conclusion:The sphenopalatine foramina exhibit various anatomical types. The preoperative navigational CBCT reading can effectively identify the type of sphenopalatine foramina, guide the choice of surgical method, and help avoid serious complications. This has significant clinical application value.

Factors influencing residual plus moist HS-W calcium alginate packing material after endoscopic sinus surgery

ObjectiveThis study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM. MethodsA retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM. ResultsA total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy. ConclusionThis study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures.

Cystic fibrosis pathogens persist in the upper respiratory tract following initiation of elexacaftor/tezacaftor/ivacaftor therapy.

Elexacaftor/tezacaftor/ivacaftor (ETI) therapy has revolutionized the treatment of cystic fibrosis (CF) for most affected individuals but the effects of treatment on sinus microbiota are still unknown. Changes to the airway microbiota in CF are associated with disease state and alterations to the bacterial community after ETI initiation may require changes to clinical management regimens. We collected sinus swab samples from the middle meatus in an observational study of 38 adults with CF and chronic rhinosinusitis (CRS) from 2017 to 2021 and captured the initiation of ETI therapy. We performed 16S and custom amplicon sequencing to characterize the sinus microbiota pre- and post-ETI. Real-time quantitative PCR (RT-qPCR) was performed to estimate total bacterial abundance. Sinus samples from people with CF (pwCF) clustered into three community types, dependent on the dominant bacterial organism: a Pseudomonas-dominant, Staphylococcus-dominant, and mixed dominance cluster. Shannon's diversity index was low and not significantly altered post-ETI. Total bacterial load was not significantly lowered post-ETI. Pseudomonas spp. abundance was significantly reduced post-ETI, but eradication was not observed. Staphylococcus spp. became the dominant organism in most individuals post-ETI and we showed the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the sinus both pre- and post-ETI. We also demonstrated that the sinus microbiome is predictive of the presence of Pseudomonas spp., Staphylococcus spp., and Serratia spp. in the sputum. Pseudomonas spp. and Staphylococcus spp., including MRSA, persist in the sinuses of pwCF after ETI therapy, indicating that these pathogens will continue to be important in CF airway disease management in the era of highly effective modulator therapies (HEMT).IMPORTANCEHighly effective modulator therapies (HEMT), such as elexacaftor/tezacaftor/ivacaftor (ETI), for cystic fibrosis (CF) have revolutionized patient care and quality of life for most affected individuals. The effects of these therapies on the microbiota of the airways are still unclear, though work has already been published on changes to microbiota in the sputum. Our study presents evidence for reduced relative abundance of Pseudomonas spp. in the sinuses following ETI therapy. We also show that Staphylococcus spp. becomes the dominant organism in the sinus communities of most individuals in this cohort after ETI therapy. We identified methicillin-resistant Staphylococcus aureus (MRSA) in the sinus microbiota both pre- and post-therapy. These findings demonstrate that pathogen monitoring and treatment will remain a vital part of airway disease management for people with cystic fibrosis (pwCF) in the era of HEMT.

Efficacy and Safety of Xylitol Nasal Irrigation after Functional Endoscopic Sinus Surgery: A Randomized Controlled Study

Xylitol is considered a naturally occurring antibacterial agent. It is generally believed to enhance the body’s own innate bactericidal mechanisms. It also provides anti-adhesive effects against both Streptococcus pneumoniae and Haemophilus influenza. This study was performed to evaluate the efficacy and safety of xylitol nasal irrigation in the postoperative care of functional endoscopic sinus surgery (FESS). Patients with chronic rhinosinusitis who received FESS were recruited and randomly assigned to two groups at one month post-surgery. Thirty-five patients in the xylitol group received 400 mL of 5% xylitol nasal irrigation daily for 2 months, while another 35 in the normal saline (NS) group received 400 mL of NS nasal irrigation daily for 2 months. Prior to FESS, as well as before and after nasal irrigation, sinonasal symptoms were assessed through the 22-item Sino-Nasal Outcome Test Questionnaire. The patients also underwent an endoscopic examination while undergoing nasal function tests, and a cytokine measurement of the nasal lavage and a bacterial culture from the middle meatus were performed. The safety of the nasal irrigation was assessed through any self-reported adverse events, the Eustachian Tube Dysfunction Patient Questionnaire and the eustachian tube function test. The endoscopic scores and olfactory threshold significantly decreased after xylitol irrigation when compared with those before irrigation. The prevalence of Staphylococcus aureus in the nasal secretions also decreased significantly after xylitol irrigation. The amounts of Interleukin-5 and Interleukin-17A were significantly increased in the nasal lavage after xylitol irrigation. No side effects, including those related to eustachian tube function, were seen after nasal irrigation in both groups. Our results showed that xylitol nasal irrigation was both beneficial and safe during the postoperative care of FESS.

Characterization of nasal aerodynamics and air conditioning ability using CFD and its application to improve the empty nose syndrome (ENS) submucosal floor implant surgery–Part II virtual surgery

BackgroundInformative virtual surgeries provide useful insights for surgical options to patients. In the case of evaluating surgical treatments for the empty nose syndrome (ENS), reliable CFD virtual surgery is a predictive tool for symptom improvement. MethodsFive submucosal implant surgeries with two different implant volumes and three different implant sites were performed on the diseased side of an ENS patient. In each case, a post-surgery nasal cavity was created based on ENS patient's computed tomography images. The airflow and air-conditioning abilities of these nasal surgery models were computed to examine the effects of implant size and site on the surgical outcomes. Significant findingsThe largest improvements were achieved with the larger submucosal implant size at the lateral site. Airflow was redistributed into the inferior and superior meatuses, enhancing air interactions with the nasal mucus. The increased wall shear stress enhanced mucus secretion and sensation of airflow. The reduced vortex size alleviated the paradoxical nasal obstruction feeling. The results suggested that larger implant sizes and the lateral implant site would be advisable for submucosal implant surgeries on ENS patients. Inferior implant with a smaller size being a second advisable approach in terms of heating and humidification efficiencies.

Adenoidectomy in a child with Crouzon syndrome complicated with severe obstructive sleep apnea: Case report and review of literature.

Crouzon syndrome is an extremely rare craniofacial dysplasia, which is mainly caused by the early ossification and closure of the coronal suture of the skull. Craniofacial deformities can cause stenosis of the nasal cavity and posterior nasal meatus, resulting in sleep apnea. A 9-year-old boy with sleep snoring for 6 years, progressive aggravation in the past 1 month and accompanied by apnea during sleep. This case was diagnosed with Crouzon syndrome complicated with severe obstructive sleep apnea and severe hypoxemia. After adenoidectomy, he was admitted to the pediatric intensive care unit with ventilator-assisted respiration. During this period, the blood oxygen saturation fluctuated greatly. After trying to extubate, the blood oxygen was difficult to maintain and had to be intubated again. After active treatment, extubation was successful. The wound of nasopharynx recovered well and the sleep state was significantly improved 3 months postoperation. It is suggested that the time of ventilator-assisted breathing should be prolonged and the perioperative airway management should be strengthened in order to reduce the risk of postoperative complications.

Sinonasal seromucinous hamartoma: a single institution case series combined with a narrative review of the literature.

This study aimed to investigate the clinical and histopathological characteristics of sinonasal seromucinous hamartomas (SHs). Eight patients with sinonasal SH and treated at a tertiary hospital between November 2005 and September 2023 were included. Additionally, a systematic review of published articles was conducted, analyzing 48 cases of SH described in the literature. Among the eight patients treated at our institution, tumors originated from the posterior nasal cavity in four patients and middle turbinate and middle meatus were the primary origin in two patients each. Coexistence of inflammatory nasal polyps (NPs) was observed in four cases. Histopathologically, four patients exhibited focal respiratory epithelial adenomatoid hamartoma (REAH) features, and low-grade dysplasia was found in one patient. A combined analysis with previous literature revealed that 46.3% of all cases originated in the anterior nasal cavity. The proportions of cases accompanied by NPs and those with focal REAH features were 20.5% and 39.1%, respectively. Additionally, the frequencies of cases exhibiting dysplastic features (5.4%) and recurrence (2.1%) were low. Remarkably, tumors originating from the anterior region tended to have a higher frequency of dysplasia than those originating from the posterior region, although this difference was not statistically significant (p = 0.0996). Patients with sinonasal SH showed favorable treatment outcomes following surgical resection. Focal REAH features and accompanying NPs were frequently observed. A substantial proportion of cases originate in the anterior nasal cavity, and these tumors may exhibit a high tendency for dysplasia.

A Large Asymptomatic Polyp Originating From the Nasal Septum: A Case Report.

A neoplasm was found in the left nasal cavity of a 45-year-old woman during electronic laryngoscopy for reflux pharyngitis. She reported experiencing an occasional slight headache in the left parietal region for 1 to 2 years, which she considered a migraine. Electronic laryngoscopy showed a gray, soft, smooth neoplasm in the left nasal meatus, located near the olfactory region blocking the olfactory clef and compressing the left middle turbinate. The neoplasm was resected at endonasal endoscopic surgery. Histological assessments indicated chronic mucus inflammation and cyst formation. This is a rare case because the polyp was large but asymptomatic and originated from nasal septum.

Maxitrol as an antibiofilm agent with potential applications in Otolaryngology‐Head and Neck Surgery

AbstractObjectivesMaxitrol (Novartis) is a topical ophthalmic medication that contains polymyxin B, neomycin, and dexamethasone. If it possesses antibiofilm activity, it may be useful for treating diseases of the head and neck in which biofilms are implicated, including chronic rhinosinusitis, chronic suppurative otitis media and osteoradionecrosis. We investigated the in vitro efficacy of Maxitrol against Staphylococcus aureus and Pseudomonas aeruginosa biofilms.MethodsMinimum biofilm eradication concentration (MBEC) assays were performed using biofilms of P. aeruginosa ATCC 27853 and S. aureus ATCC 6538 type strains, grown on 96‐pin lids and treated in Maxitrol for 30 min, 1 h, or 6 h. Isolates of both species were collected from the middle meatuses of patients with cystic fibrosis. Biofilms of clinical isolates were grown and treated in vitro for 6 h with Maxitrol, both undiluted at full concentration and at the identified MBEC, then cultured to identify bacterial survival.ResultsNeither type strain was eradicated at 30 min nor S. aureus at 1 h at any tested concentration. P. aeruginosa was eradicated by a median of 90% and 5.6% Maxitrol at 1 and 6 h, respectively, and S. aureus with 90% Maxitrol at 6 h. Undiluted Maxitrol reliably eradicated all clinical isolates of P. aeruginosa but only one of five S. aureus isolates.ConclusionsMaxitrol reliably eradicates P. aeruginosa biofilm but not S. aureus biofilm in vitro. It may have a therapeutic role against biofilms in which P. aeruginosa is the dominant pathogen.Level of EvidenceN/A.

The Ethmomaxillary Sinus-A False Duplicate Maxillary Sinus.

Functional endoscopic sinus surgery consistently benefits from good anatomical knowledge and modern imaging techniques. Ethmoid air cells migrate in specific topographical sites near the ethmoid. Posterior ethmoid air cells that descend into the maxillary sinus (MS) are ethmomaxillary sinuses (EMSs) that into the superior nasal meatus. Few previous studies found EMSs in 0.68% to 16.48% of cases. An EMS differs from a Haller's infraorbital cell nearing the ethmoidal infundibulum. A posterior ethmoid air cell intercalated between the ethmoid, MS and sphenoidal sinus is a Sieur's cell, but it could also be regarded as an EMS. An EMS should be discriminated from a maxillary recess of the sphenoidal sinus. An EMS could determine Onodi's maxillary bulla into the MS. The false duplicate MS described by Zuckerkandl consists of a MS draining into the middle nasal meatus adjoined by an EMS draining into the superior nasal meatus. These are separated by the ethmomaxillary septum. The latter may be confused with an intrasinus septum of the MS if the drainage pathways are not adequately documented. Therefore, a case-by-case anatomic identification of the pneumatic spaces nearing the MS should be performed before surgical endoscopic approaches of the nose and sinuses.

The role of using the submucosal conchoplasty technique for the management of concha bullosa in decreasing post-operative middle meatus synechia formation after functional endoscopic sinus surgery: a randomised controlled trial.

The study aimed to compare the applicability of classic lateral lamellectomy versus submucosal conchoplasty techniques in managing concha bullosa during and after functional endoscopic sinus surgery. The study randomly divided 56 patients with bilateral concha bullosa into two groups. One group of patients underwent the submucosal conchoplasty technique and the other group underwent the lateral lamellectomy technique. The study compared the intra-operative findings, including the time required for each technique, the amount of intra-operative bleeding and the post-operative endoscopic outcome of the middle meatus and middle turbinate stability. Submucosal conchoplasty was significantly more time-consuming than the lateral lamellectomy technique (p = 0.001*). The difference in the intra-operative amount of bleeding was (p = 0.086*). The lateral lamellectomy group showed a higher rate of synechia formation in the middle meatus (p = 0.012*). Submucosal conchoplasty is a valid technique for managing concha bullosa with better post-operative endoscopic outcomes.

Accessory Ostium of the Maxillary Sinus and Its Impact on Sinusitis

Background: One of the anatomical variations in the maxillary sinus is the accessory ostium (AO). In the nasal cavity, the lateral wall’s vertical plane is parallel to the form of the AO, which is round or oval in appearance. During a nasal endoscopic examination, AO may be seen in contrast to the normal ostium of the maxillary sinus, which is hidden behind the uncinate process. Methods: The search for recent research articles on AO of the maxillary sinus was done with databases Scopus, PubMed, Medline, and Google Scholar. This review article discusses the prevalence, development, endoscopic examination, clinical significance, surgical importance, relationship with chronic sinusitis, and its management. Results: AO may interfere with ventilation and drainage of the maxillary sinus. Hence, it is important to evaluate the anatomical features of the AO for its relationship with sinus pathology. The development of maxillary sinusitis may be significantly impacted by the anatomical variance known as AO of the maxillary sinus. The middle meatus’s posterior nasal fontanelle is where AO is most frequently observed. The possible mechanism for the formation of AO is obstruction of the natural ostium of the maxillary sinus by sinusitis or due to anatomical and pathological factors in the middle meatus leading to rupture of membranous regions such as fontanelle. Conclusion: Clinicians must have adequate knowledge regarding the anatomical variations of the AO. It frequently appears in the fontanelle, the membranous portion of the middle meatus’ lateral nasal wall that is between the uncinate process and inferior meatus.

Comparative study of nasal cavity drug delivery efficiency with different nozzles in a 3D printed model.

Nasal sprays are widely used in treating nasal and sinus diseases; however, there are very few studies on the drug delivery efficiency of nasal sprays. In this study, the drug delivery efficiency of three different nasal spray devices was evaluated in vitro using a 3D printed cast model of nasal cavity. Three nasal spray devices with different nozzles and angles of administration were used in the 3D model of the nasal cavity and paranasal sinuses. The spraying area (SA), maximal spraying distance (MSD), and spraying distribution scores on the nasal septum and lateral nasal wall were recorded. Different nasal spray devices have their own characteristics, including volume of each spray, SA, and plume angle. The SA of the three nozzles on the nasal septum increased with an increasing angle of administration. When the angle of administration was 50°, each nozzle reached the maximal SA. There was no statistically significant difference in MSD among the three nozzles at the three angles. The total scores for each nozzle using the three different spraying angles were as follows: nozzle A, 40°>30°>50°; nozzle B, 30°>40°>50°; and nozzle C, 30°>40°>50°. The total scores for different nozzles using the same angle were statistically significantly different and the scores for nozzle C were the highest. Nozzle C had the minimum plume angle. None of the three nozzles could effectively delivered drugs into the middle meatus at any angle in this model. The design of the nozzle affects drug delivery efficiency of nasal spray devices. The ideal angle of administration is 50°. The nozzle with smaller plume angle has higher drug delivery efficiency. Current nasal spray devices can easily deliver drugs to most areas of the nasal cavity, such as the turbinate, nasal septum, olfactory fissure, and nasopharynx, but not the middle meatus. These findings are meaningful for nozzle selection and device improvements.

Bystander-application of a novel nasal swab optimized for drug delivery is safe and non-traumatic for the general population

ObjectiveThe PN Naloxone Nasal Swab (Pocket Naloxone Corp., Bethesda, MD) is a swab optimized for drug delivery and intended for use by non-medical personnel for the emergency treatment of opioid overdose. The aim of this study (PNC-20–003) is to determine the safety of this nasal swab in a real-world environment. MethodsThis was a single-institution, quantitative-qualitative prospective trial performed at an outpatient clinic. Patients with normal or abnormal nasal structure were recruited. A non-medically trained individual placed the nasal (soaked in fluorescein dye) on each side of the patient’s nose. Endoscopy with recording was performed before and after swab placement. An independent reviewer rated degree of staining, mucosal bleeding, and trauma at nasal subsites. ResultsVideos from 32 nasal cavities (16 participants) were reviewed. All cavities had high intensity staining at the septum and the inferior turbinate. No patients had staining within the middle meatus, agger nasi, or olfactory regions. In patients with normal anatomy, obstructive nasal anatomy or prior nasal surgery, all cavities had staining near the nasal septum. Only 7 cavities (22 %) had minor bleeding defined as ooze that stopped in 1–2min, and 3 (9 %) had minor trauma defined as mucosal disruption less than 5mm. There were no significant differences in comparing pre- and post-swab nasal cavity, trauma, or bleeding exams. ConclusionsThese study results showed that this swab is atraumatic to the nasal mucosal membranes when administered by non-medical personnel. Analysis suggests contact with targeted sites for drug absorption regardless of anatomy.

Topography of the Nasal Conchae of Sahel Goat ‎ ‎(Capra hircus)‎

A total of five heads of adult Sahel goat obtained from slaughterhouse was examined to elucidate the topography of the nasal conchae. The heads were fixed in 10% formalin and mid-sagittal and cross-sections were performed to examine the shape, form, and explore the internal configuration of the conchae. The cylindrical shaped nasal cavity was divided into two equal halves by a median nasal septum and further reduces into sequence of clefts and meatus by the nasal conchae. The dorsal nasal concha was spindle shaped with tapered rostral ends that blends into the straight fold. The cone shaped middle nasal concha was situated caudo-ventral to both the dorsal and ventral nasal conchae and was bounded by the caudal ethmoidal labyrinth. The ventral nasal concha was the largest and extends rostral into dorsal alar fold and ventral basal fold. These conchae are formed by delicate lamellae that presented distinct structural pattern, depending on the levels of cross-sectional planes. The dorsal, middle, and ventral nasal meatuses which defined the nasal conchae, connects with the common meatus that lie parallel to the median nasal septum.

Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome.

Adhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone. In this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively. A significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p < 0.05) in all three treatment groups compared with the control. There was no significant difference noted between patients who received Chitogel alone and those who received Chitogel with 1 or 5 mM deferiprone. Chitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel.

Efficacy of endoscopic sinus surgery in management of odontogenic maxillary sinusitis after control of dental pathology

BackgroundOdontogenic sinusitis (ODS) has clinical features like rhinogenic sinusitis. Although it is usually unilateral, diagnostic overlap could happen. However, ODS necessitates different management which includes dental intervention to eliminate the dental infection source. In some patients, ODS may persist even after management of dental pathology. The aim of this study was to assess the clinical features, and diagnostic criteria of ODS that is persistent after management of dental pathology, and to evaluate the efficacy of endoscopic sinus surgery (ESS) as a therapeutic option of the disease.MethodsTwenty patients were included in this study. All patients were presented with ODS refractory to medical treatment after management of their dental problems. Clinical features of the patients were analyzed. Also, endoscopic nasal examination and computed tomography of paranasal sinuses (CT) were performed for all patients. ESS were used, with widening of the maxillary ostium for drainage. Follow-up was carried out for at least 6 months.ResultsAll patients had unilateral disease, with 3 main complaints: malodourous nasal discharge (90%), facial pain (75%), and nasal obstruction (45%). Endoscopic nasal examination showed either middle meatal purulence (70%) or polypoid mucosa (30%). CT showed either thickened maxillary sinus mucosa (50%), or complete maxillary opacity (50%) with retained foreign body in 2 patients (10%). After ESS, all patients reported relieve of their sinonasal symptoms, and nasal endoscopy showed patent middle meatus, with one patient demonstrated adhesions between the middle turbinate and lateral nasal wall which was asymptomatic.ConclusionPrior dental intervention is a suspicious diagnostic landmark for ODS, and unilateral foul nasal discharge is the main prevalent complaint. Nasal endoscopy usually shows purulence or polypoid mucosa in the middle meatus, and CT is a good diagnostic tool for ODS. ESS with good widening of the maxillary ostium is an effective therapeutic option for those patients.

Efficacy of nonmedicated middle meatal packing after endoscopic sinus surgery: A systematic review

AbstractObjectivesThis review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).MethodsWe conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation.ResultsOur search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow‐up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48–1.25). Similarly, no difference was seen at either 8–12 weeks of follow‐up, with an RR of 0.68 (95% CI: 0.42–1.20). Nasal congestion was reported to be less on the packed side on the follow‐up in one of the trials.ConclusionsOur systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long‐term sequelae.

Relationship between bleeding sites and clinical data: experience of 646 epistaxis cases in 8years.

This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. We retrospectively reviewed the data of 646 hospitalized epistaxis patients. The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. The bleeding sites can be identified in most epistaxis patients. Age > 50years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans.

Role of Sinonasal Anatomic Variants in Recurrent Acute Rhinosinusitis.

Prior studies evaluating the role of sinonasal anatomic variants with recurrent acute rhinosinusitis (RARS) are limited by inconsistent results. The goal of this study is to evaluate the association between sinonasal anatomic variants and RARS. A 1:2 retrospective case-control study was conducted using patients presenting to the rhinology clinic from August 2020 to January 2023. A total of 60 patients with RARS were compared to 120 control patients. RARS was diagnosed based on the International Consensus Statement on Allergy and Rhinology criteria of four or more independent episodes of acute rhinosinusitis per year with at least one episode documented by objective findings, with complete resolution of the infection in-between episodes. Sinonasal anatomic variants included nasal septal deviation (NSD), concha bullosa (CB), infraorbital (Haller) cells, nasal septal spur in the middle meatus, and frontal sinus cells (supra-agger, supra-agger frontal, and suprabullar frontal cells). Age was similar in RARS and control patients (47.4 ± 16.5 vs. 49.3 ± 14.5, p = 0.432). Both the RARS group and control group were more likely to be female (78.3% vs. 77.5%, p = 0.899). There was no significant association between NSD and RARS compared to the control group (OR = 0.97, p = 0.916), and no significant association between any of the anatomic variants and RARS [infraorbital cells (OR = 0.64, p = 0.167), CB (OR = 0.84, p = 0.596), spur in the middle meatus (OR = 1.28, p = 0.514), supra-agger (OR = 0.88, p = 0.708), supra-agger frontal cells (OR = 0.97, p = 0.939), or suprabullar frontal cells (OR = 1.13, p = 0.766)]. Our findings suggest no association between nasal septal deviation or any of the anatomic variants studied and RARS. 3 Laryngoscope, 134:3489-3492, 2024.