Inferior Turbinate Research Articles

Deviated Nasal Septum and Inferior Turbinate Hypertrophy: Are They the Independent Cause of Sleep-Related Breathing Disorders?

Background and Objectives Nasal obstruction has been assumed to be correlated with sleep-related breathing disorder (SRBD). However, a definite correlation between nasal obstruction and SRBD is still controversial. This study aimed to define whether symptoms and severity of the deviated septum of nose (DSN) and inferior turbinate hypertrophy (ITH) are correlated with the severity of SRBD.Subjects and Method This is a retrospective study of 60 patients’ preoperative polysomnography who have undergone septoplasty and turbinoplasty. Patients with obesity, tonsillar hypertrophy, high Mallampati class, mandibular problem, and nasal polyp or concha bullosa were excluded from the analysis. Subjective nasal obstruction scores, and DSN/ITH grades were collected, and correlations between apnea-hypopnea index (AHI), lowest oxygen saturation, and snoring time were analyzed.Results The average of AHI, lowest saturation and relative snoring time were 3.72±5.79, 89.78%±6.81%, and 8.45%±10.43%, respectively. The number of patients who were normal, obstructive sleep apnea (OSA) syndrome mild, moderate, and severe were 49 (82%), 6 (10%), 4 (7%) and 1 (1%), respectively. The degrees of DSN and ITH, and subjective nasal congestion scores showed no significant correlation with polysomnographic results. Age and AHI had a correlation coefficient of 0.54 (<i>p</i><0.001) and AHI increased with increasing age. Multiple linear regression demonstrated that age (regression coefficient 0.229, 95% confidence interval 0.135 to 0.322, <i>p</i><0.001) was significantly associated with AHI, while other variables showed no statistically significant association with AHI (<i>p</i>>0.05).Conclusion Septal deviation and turbinate hypertrophy are unlikely to cause OSA/snoring independently without other causes of SRBD.

Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study.

Background This study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. Methodology The paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent. Results In our study, the SDCA values of the ≥35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the ≥35-year age group were significantly lower than those ofthe <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the ≥35-year age group.Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the ≥35-year age group. Conclusions SD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.

High-Intensity Focused Ultrasound Therapy Versus Coblation for the Treatment of Inferior Turbinate Hypertrophy: A Clinical Trial.

To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) therapy with coblation for the treatment of inferior turbinate hypertrophy (ITH). In this randomized controlled clinical trial, 20 patients underwent inferior turbinate surgery, which consisted of either HIFU or coblation therapy. Efficacy, safety, and tolerability were evaluated by subjective symptom scores, acoustic rhinometry, and nasal endoscopy. The modified nasal obstruction symptom evaluation (NOSE) score and nasal obstruction visual analog scale (NO-VAS) significantly decreased in both groups 12 weeks postoperatively. The between-group differences in the evaluation scores were not statistically significant. On nasal endoscopy, the HIFU patients showed improvements in mucosal swelling sooner than the patients undergoing coblation therapy. Nasal crusting significantly increased in the patients undergoing coblation compared to the patients undergoing HIFU therapy until postoperative week 4. Mucosal preservation was superior in the HIFU patients. Although HIFU was less painful than coblation therapy during the procedure, the difference was not significant (4.9 vs. 6.3, P=0.143). The difference in global satisfaction between the two groups was not statistically significant, although satisfaction was slightly higher among the HIFU patients than among the coblation patients (4.6 vs. 4.1, P=0.393). HIFU provided results similar to those of coblation therapy for patients with nasal obstruction due to ITH, but HIFU therapy caused less discomfort during the procedure. HIFU therapy appears to be a good noninvasive alternative to the current surgical modalities for ITH.

Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery.

To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .

A Study of Complications, Sinonasal Predispositions and Microbiological Profile of Chronic Otitis Media.

Keeping in view the changing flora of chronic otitis media (COM), geographical variability of its complications and differential prevalence of sinonasal predisposing diseases in these patients, we studied the microbiological profile along with the complications and sino-nasal diseases in patients with COM. It was a Cross-sectional study conducted during Nov 2017 to Dec 2019 in department of Otorhinolaryngology, Jawaharlal Nehru Medical College, AMU, Aligarh. The study included 200 cases of chronic suppurative otitis media, both Mucosal (safe) and Squamous (unsafe) type, out of which 111 (55.5%) were males and 89 (44.5%) were females. The overall prevalence of complications in patients with COM in our study was high at 6.5% with 61.54% complications being extracranial and 38.46% were intracranial. DNS was the most common sino-nasal disease found in 22.5% of patients followed by Inferior turbinate hypertrophy, Adenoid hypertrophy and polyp in 6.5%, 5.5% and 4% of participants respectively. A culture positive result was found in 84.5% of the samples with 55.5% samples being monomicrobial and 29.0% being polymicrobial. COM like the other chronic diseases impacts quality of life. As long as health-care delivery fails to target high-risk groups in developing countries such as ours infections like CSOM will persist with its adverse consequences. With the development and widespread use of antibiotics, the types of pathogenic micro-organisms and their sensitivity to antibiotics have changed. Continuous evaluation of pattern and antibiotic sensitivity of isolates is necessary to decrease the potential risk of complications by early institution of appropriate treatment.

Short-term Postoperative Outcomes of Platelet-rich Plasma after Inferior Turbinate Radiofrequency

Short-term Postoperative Outcomes of Platelet-rich Plasma after Inferior Turbinate Radiofrequency

Endoscopic Management of Rhinolithiasis: A Systematic Review.

This study reviews the presentation, management, and outcomes of patients with rhinolithiasis. An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews. Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow-up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp). Fifty-five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4-80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow-up of 8.5 months (range, 0.25-36 months). Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long-standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively.

Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease.

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study.

The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated. This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods. For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05). Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV. Step Le Fort I advancement surgery technique usually affects nasal structures positively regarding the nasal airway.

A novel and alternative therapy for persistent allergic rhinitis via intranasal acupuncture: a randomized controlled trial

BackgroundAcupuncture is used to treat allergic rhinitis (AR) in traditional Chinese medicine, and the ST2 and ST36 acupoints are generally selected in clinical practice. We report a new intranasal acupuncture method at the Neiyingxiang (EX-HN9) and Biqiu points for the treatment of persistent AR (PAR). Here, the efficacy and safety of this method were evaluated.MethodsA total of 120 patients diagnosed with PAR were randomly allocated (2:1 ratio) to intranasal acupuncture or Western medicine groups, the basic principle of random grouping is SAS random grouping method. The applicator held a nasal endoscope and a 0.30 × 75 mm filiform needle in their left and right hands, respectively. When aiming at the Neiyingxiang or Biqiu point, the applicator quickly inserted the needle to a 20-mm depth as parallel as possible to the inferior turbinate or middle turbinate, without special reinforcing and reducing techniques (the needle remained for 20 min). The intranasal acupuncture groups received acupuncture treatment three times per week for 2 weeks. The Western medicine group was treated with budesonide nasal spray (two sprays/nostril, twice/day) and loratadine (one tablet/night) for 2 weeks. Visual analog scale (VAS) scores were the primary outcome. Quality of life, medication dosages and adverse events were secondary outcomes measured using the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ). Confidence assessments were performed to evaluate data from the treatment and follow-up periods.ResultsThe results were as follows: (1) VAS and RQLQ scores were significantly lower in the intranasal acupuncture group than in the Western medicine group on day 1 (i.e., first treatment) (P < 0.05; 95% CI − 13.1 to − 9.6 VAS points) (P < 0.05; 95% CI − 20.27 to − 12.28 RQLQ points). Overall symptoms (95% CI − 2.86 to − 1.86 points), nasal obstruction (95% CI − 6.33 to − 5.36 points), olfactory function (95% CI − 2.91 to − 1.75 points), sleep (95% CI − 5.05 to − 3.57 points), actual problems (95% CI − 2.03 to − 0.06 points), nasal symptoms (95% CI − 6.62 to − 4.5 points), and emotional problems (95% CI − 5.05 to − 3.5 points) were significantly improved. (2) VAS and RQLQ scores in the two groups were significantly improved at week 2; however, there were no significant group differences in the VAS (P > 0.05; 95% CI − 1.21 to − 1.38 points) and RQLQ (P > 0.05; 95% CI − 0.33 to − 3.46 points) scores. Olfactory function symptoms were significantly improved (95% CI − 1.58 to − 0.21 points). (3) During the follow-up period, there was a significant difference between the two groups (P < 0.05) with higher RQLQ and VAS scores in the intranasal acupuncture group than in the Western medicine group. VAS scores on rhinobyon symptoms, nasal itch, rhinorrhea and olfactory function and RQLQ scores for activities, non-nasal/eye symptoms, actual problems, nasal symptoms, and eye symptoms were significantly improved. (4) No adverse events were observed in either group during treatment.ConclusionsIntranasal acupuncture has good efficacy and safety in the treatment of PAR. Moreover, VAS and RQLQ scores were much lower in the intranasal acupuncture group than in the Western medicine group, and acupuncture had an immediate impact, especially for improving nasal congestion, olfactory function and sleep.

Nasal residence time and rheological properties of a new bentonite-based thixotropic gel emulsion nasal spray – AM-301

Objective The present work provides characterization of rheological properties of a new bentonite-based thixotropic gel emulsion nasal spray (AM-301), its nasal residence time, distribution, safety and tolerability. Significance The nasal epithelium is a portal of entry for allergens and primary infection by airborne pathogens. Non-pharmacological interventions, which enhance physical and biological barriers, protect against allergens and pathogens without drug-related side effects. AM-301 has shown promising efficacy and safety in the nasal epithelium against viruses (in vitro) and pollen (clinical). Methods Technical part (i) spray characterization was performed with a validated droplet size distribution method; evaluation of the rheological properties of the formulation was performed by a validated amplitude sweep method and a validated oscillation, rotation, oscillation; Clinical part (ii) nasal and oropharyngeal endoscopy were used to provide a semi-quantitative evaluation of distribution and residence time of fluorescein-labelled AM-301 in the nose and oropharynx of healthy volunteers; (iii) tolerability and safety. Results (i) The non-Newtonian rheological properties of the formulation allow AM-301 to be sprayed and then to revert to a gel to prevent run-off from the nasal cavity; (ii) the formulation remains on the inferior turbinate, septum and oropharynx of volunteers for up to 210 min and on the middle turbinate for up to 60 min; two nasal sprays provide no substantial benefit over a single application with regards to coverage or retention; (iii) the spray is well tolerated Conclusions Single dose spray delivery of AM-301 provides extended coverage of the nasal mucosa up to the inferior turbinates.

Bleeding Post Radiofrequency Ablation of Inferior Turbinate

Nasal obstruction is a troublesome condition and negatively impacts the quality of life. One of the most important causes is inferior turbinate hypertrophy. Radiofrequency submucosal tissue ablation is an effective technique used to reduce inferior turbinate volume. It is considered a safe, minimally invasive procedure with a low risk of complications. Most of the complications reported were minor such as pain, edema, sneezing, crustation, and bleeding. This study demonstrates a case of major bleeding as a complication of radiofrequency ablation of inferior turbinate aiming to reduce the incidence of such complication. The patient had major bleeding resulting in a drop in hemoglobin level, however, no surgical intervention was required, and he was managed conservatively.

Nasal and Skull Base Reconstruction with Turbinate Flaps

Introduction: The reconstruction of the skull base and nasal mucosa can be performed using different local flaps. The use of the nasoseptal flap is the most common method to reconstruct these areas, but sometimes, due to septal perforations, a history of previous surgeries that may have damaged its pedicle, or because its rotational arc is not ideal, other nasal flaps such as those from the inferior or middle turbinate with their various pedicles may need to be employed. Objectives: The aim of this study was to ascertain the success rate of reconstructions involving the nasal cavity and skull base utilizing inferior and middle turbinate flaps. Methods: Data collected prospectively were analyzed using an Excel spreadsheet for patients who underwent skull base and nasal cavity defect repairs employing turbinate flaps between May 2014 and August 2021. Results: Nine patients were treated and a total of ten reconstructions were performed. Five middle turbinate flaps were executed, two involving medial rotation to address defects situated on the ethmoid roof and three involving lateral rotation to repair a defect within the ethmoid fovea, with two of these flaps closing the frontal ostium. Furthermore, an inferior turbinate flap with a posterior pedicle was utilized to repair the defect resulting from the resection of a meningocele, which was located on the ethmoid roof. Four lateral wall flaps with an anterior pedicle were employed to reconstruct the mucosa of the nasal cavity and to address a defect in the anterior skull base. Conclusion: The reconstruction of anterior skull base defects using turbinate flaps was highly satisfactory, achieving a 100% success rate. The use of lateral wall flaps to repair defects produced by rhinectomies that included resection of the nasal mucosa was also successful and we did not have partial or total necrosis of the flaps. The excellent blood supply to the lateral nasal walls and the ability to dissect these flaps with different arterial pedicles and extend their surface, including the nasal floor, allows for various flap rotations and the reconstruction of defects of different sizes.

Management of hypertrophic rhinitis by application of Kadali kshara

Nasal obstruction is a predominant symptom in hypertrophied inferior turbinate. It can be understood as Nasanaha (~nasal obstruction) in Ayurveda. Even though there are many conditions of the nose causing nasal blockage; inferior turbinate hypertrophy which is a cardinal feature in hypertrophic rhinitis is one of the most common causes of anatomical nasal obstruction, the others being internal nasal valve stenosis and septal deviation. The turbinate hypertrophy in this condition can be managed medically using nasal decongestants and corticosteroids and it can be also managed surgically. Continuous use of nasal decongestants can cause rebound congestion. Surgical management also has limitations such as synechiae formation and postoperative bleeding. Kshara pratisarana (~external application of alkali), which is one among the types of parasurgical procedures explained in Ayurveda, can be used effectively in this condition. Moreover, nasal obstruction is one of the most common symptoms presented to an otorhinolaryngologist and it badly affects the quality of life of the patient. The present case report is a case of a 24-year-old female who was unable to sleep properly due to severe nasal obstruction and chronic rhinitis along with hypertrophy of both inferior turbinates. This also affected her studies badly. She also complains of thick nasal discharge along with obstruction. The patient had the complaints for two years but the symptoms became more severe during the past six months. On anterior rhinoscopic examination using Thudicum's nasal speculum, the presence of bilateral inferior turbinate hypertrophy was observed. The patient was treated with Pratisarana of Kadali kshara (~alkali of Musa paradisiaca Linn.) along with Sigrusimhyadi taila nasya. The treatment was effective in the present case with no recurrence during a follow-up period of 30 days. This case report revealed that nasal obstruction, which is a common problem seen nowadays can be managed effectively using Ayurvedic intervention.

Shorter Cilia Length and Aberrant Ciliated Marker DNAI1 in Allergic Rhinitis.

This study aimed to investigate whether the impaired ciliary length and aberrant ciliary ultrastructure marker, dynein axonemal intermediate chain 1 (DNAI1), are important pathological characteristics in nasal mucosa from patients with allergic rhinitis (AR). Biopsies were taken from the inferior turbinate (IT) of controls (n = 20) and patients with AR (n = 20). The ciliary length and the DNAI1 location patterns were assessed by using immunofluorescent staining. Three patterns of DNAI1 localization were defined using a semi-quantitative scoring system: normal (N), partial (P) and absence (A). Every individual section was assigned a score between 0 and 2 in each high-power field (5 fields per sample). The score of 0 = pattern N >70%; 1 = patterns N + P >70%; and 2 = pattern A ≥30%. The receiver operating characteristic (ROC) curve was used to evaluate the predicted value of DNAI1 score for AR. The ciliary length was reduced by 33.3% in patients with AR compared with controls (P < 0.0001). The higher DNAI1 score was found in the AR group, with a median (first and third quartile) of 0.9 (0.4 and 1.08), which was 0.1 (0 and 0.76) in the control group (P = 0.0071). The ROC of DNAI1 was calculated based on the area under the curve of 0.74 (P = 0.0094). The cutoff value of ROC was 0.5833, with a sensitivity and specificity of 70%. These results suggested that the shorter ciliary length and aberrant localization of DNAI1 are potentially important pathological characteristics of the allergic nasal mucosa. The aberrant localization of DNAI1 may provide a novel candidate target for clinical management of AR.

Computed Tomography Morphology of Affected versus Unaffected Sides in Patients with Unilateral Primary Acquired Nasolacrimal Duct Obstruction

This study aimed to describe the anatomical details of the bony nasolacrimal duct (BNLD) and adjacent nasal structures by analyzing computed tomography (CT) images, and to investigate their effects on the development of primary acquired nasolacrimal duct obstruction (PANDO). A total of 50 patients with unilateral PANDO who underwent dacryocystorhinostomy, with a mean age of 57.96 years, were included. The preoperative CT images were reviewed to measure the anteroposterior and transverse diameters of the BNLD at the entrance and exit levels, as well as the minimum transverse diameter along the tract. The sagittal CT images were analyzed to classify the shape of the bony canals into columnar, funnel, flare, and hourglass. The associated paranasal abnormalities, including nasal septum deviation (NSD), sinusitis, angle between the bony inferior turbinate and medial wall of the maxillary sinus, and mucosal thickness of the inferior turbinate, were investigated. Fifty CT images were analyzed, and all parameters measured on both sides of the BNLD were not significantly different between the PANDO and non-PANDO sides, except for the minimum transverse diameter, which was significantly smaller on the PANDO side (p = 0.002). Columnar-shaped BNLD was the most common on both sides. No significant difference was observed in the incidence of paranasal abnormalities between sides; however, deviation of the septum toward the non-PANDO side was more common (67.9%). A small minimum transverse diameter of the BNLD may be a risk factor for PANDO. The association between nasal abnormalities and PANDO was not remarkable.

Characteristics of Extranodal NK/T-Cell Lymphoma, Nasal Type, Compared with Nasal Diffuse Large B-cell Lymphoma.

Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration.

OUTCOMES OF SEPTOPLASTY IN CHILDREN.

Aim: The aim of the study was to present the experience of a local hospital surgical department where septoplasty is performed on children suffering from its degeneration. Materials and methods: A retrospective cohort study with 100 patients aged between 3 and 18 years were taken. Both males and females out of 100 patients were followed up for 7 years. The patients were treated with using septoplasty as well as the related clinical procedures such as cauterization of the inferior turbinate. We performed clinical evaluation and nasal endoscopy of the cases in the postoperative period. The longest observation period was 7 years. Results: The male and female child enrolled in the study were 60 (60%) and 40 (40%), respectively. Out of this number of patients, 92 (92%) had inferior turbinate cauterization. In all the 100 cases, we did not notice any intraoperative complication. Also, all the cases were evaluated in 15th, 30th, and 60th days of observation. Conclusions: When performed correctly, septoplasty in children is a good clinical intervention as it allows the right growth and development of the crani-ofacial region and prevents abnormalities in psychic and somatic components in young patients. Moreover, this study confirms the previous studies that have demystified the point of view, that the setoplasty should only be recommended when the patients reach the ages of 17 and 18.

Lobomycosis in a Post-Covid 19 Patient: A Case Report and Review of Literature.

To document a case of lobomycosis and to discuss its epidemiology & diagnosis. A 53-year-old male presented with a history of nasal congestion, nasal discharge, and epistaxis following Covid 19 infection. On physical examination, there was necrotic slough in the nasal vestibule near the inferior turbinate. Scrapings and punch biopsy were taken from the lesion. Hematoxylin-eosin-stained sections showed necrotic and mucoid areas with mixed inflammatory cell infiltration and numerous budding yeasts 3- 7μm diameter in singles, and small clusters with single narrow based budding as well as multiple budding including sequential budding forming "chains of yeasts". A diagnosis of Lobomycosis was made. Yeasts of lobomycosis are often confused with other yeasts such as P. brasiliensis, Candida spp., B. dermatitidis, and Cryptococci, but characteristic 'sequential budding' with a 'chain of yeasts" aid in the final diagnosis. Demonstration of yeasts with characteristic chains either in tissue sections or in potassium hydroxide (KOH) preparation of scraped material, exudate, or exfoliative cytology is the mainstay in the diagnosis as the organisms are uncultivable in vitro in culture medium.

A STUDY OF CONVENTIONAL SEPTOPLASTY VERSUS ENDOSCOPIC SEPTOPLASTY

Introduction:Adeviated septum can be asymptomatic or can cause functional and cosmetic abnormalities. Different studies have been proposed for the correction of deviated septum, but septoplasty has been the treatment of choice. Septoplasty is a more conservative surgery and endoscopic septoplasty has become increasingly popular over the past few decades. Materials and Methods: The study was carried out to compare the postoperative results among patients of conventional and endoscopic septoplasty and to assess the efcacy of endoscopic septoplasty with other surgeries. The present study was conducted among 40 patients of deviated nasal septum admitted in the Department of Otolaryngology of Patna Medical College &amp; Hospital , Patna for 12 months. Patients were selected by simple random sampling and were divided into Groups Aand B, with 20 patients in each group. Group A underwent conventional septoplasty and Group B underwent endoscopic septoplasty. Results: The male-tofemale ratio in the present study was 3:1. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (44%) and concha bullosa (28%). Postoperatively, a signicant relief from the symptoms of nasal obstruction (80%), nasal discharge (30%), headache (30%), and postnasal drip (55%) was observed in endoscopic septoplasty. Complication rate was higher in conventional septoplasty. The endoscopic approach facilitates proper alignment by limited and precise resection of pathological areas. Conclusion: Endoscopic septoplasty provides precise resection of the pathological areas and better illumination with limited ap dissection and exposure.