Nasal Endoscopy Research Articles

Compare nasal endoscopy with Computed Tomography scans for chronic rhinosinusitis detection in adult Iraqi patients

Background: Chronic rhinosinusitis (CRS) is often diagnosed based on clinical features. Assurance in this context is based on the finding of inflammatory features during nasal endoscopy and computed tomography (CT) scans of the paranasal sinuses. While a CT scan is considered the most reliable method, research has shown that nasal endoscopy is also valuable and can sometimes provide additional information to supplement the CT scan in diagnosing CRS. Objective: The study goal was to demonstrate the comparative reliability of nasal endoscopy and computed tomography scans in diagnosing chronic rhinosinusitis in adult patients treated at Baqubah Teaching Hospital. Patients and Methods: The study sample consisted of consecutive adult participants clinically diagnosed with chronic rhinosinusitis. Patients who had a computed tomography scan of the paranasal sinuses and a nasal endoscopy during three months were the subjects of this investigation; the outcomes were linked. Results: Study results exhibit that the most prevalent symptoms seen in the study participants were nasal discharge and nasal obstruction, reported by 95% and 90%, respectively; the most prevailing observation during nasal endoscopy was middle meatus purulent discharge, noticed in 58% of the patients. Maxillary sinus was most often affected, seen in 65% of the patients on a CT scan, and 40% had obstruction of the osteomeatal complex on CT imaging. The nasal endoscopy had a sensitivity of 73.3%, specificity of 85.3%, positive predictive value of 92.7%, and negative predictive value of 55.8%. The research also found no significant differences in positive predictive value (PPV) between nasal endoscopy and CT scan. In contrast, the sensitivity of nasal endoscopy was significantly greater than that of CT scan. Conclusion: The study found that nasal endoscopic findings for patients with positive clinical features were purulent (cream-colored) discharge and middle meatus polyps, which is sufficient for diagnosing chronic rhinosinusitis; the study showed that Nasal endoscopy is almost as accurate as CT scans and CT scan findings are well correlates with sinus endoscopy, due to its precision, cheap cost, and radiation dosage.

Isolated fungal sphenoid sinusitis with unilateral lateral rectus palsy six years post lung transplant

Rhino-orbital-cerebral mucormycosis (ROCM) infections are rare and usually occur in patients with diabetes, malignancy, or organ transplantation. The most common presenting symptoms include facial pain and swelling, fever, and rhinorrhea. Mortality rates reach nearly 50%. Those with previous organ transplants typically present with sinus symptoms a few weeks to months after transplantation. A 75-year-old man presented with headache. His history was significant for bilateral lung transplantation in 2017. On his fourth presentation, he was admitted to the hospital for work up. Imaging showed small fluid levels within the right maxillary and sphenoid sinuses. Infectious work-up revealed no meningitis. On day three, the patient complained of diplopia on the right. His examination was significant for right lateral rectus palsy. Repeat imaging was performed and showed increasing fluid levels of the right maxillary and sphenoid sinuses, and the otolaryngology consultation service was consulted. Nasal endoscopy was significant for pink, vascularised mucosa with no obvious regions of pallor or necrosis. Endoscopic sinus surgery was performed. There were no findings suggestive of fungus but purulence of the right sphenoid grew Rhizopus. The patient’s nerve palsy did not resolve and progressed to the contralateral orbit. Repeat nasal endoscopy continued to show healthy mucosa while MRI showed enhancement worrisome for meningitis. To our knowledge, this is the only reported case of fungal sphenoid sinusitis resulting in meningitis and death six years after transplant. Current literature documents fungal infection in post-transplant patients up to four years after surgery, with most occurring within the first year. Suspicion for fungal infection should remain high in this patient population. Keywords: mucormycosis, lung transplant, sinusitis, lateral rectus palsy

Endoscopic dacrocystorhinostomy: Reasons for failure and possible solutions.

Endoscopic dacryocystorhinostomy is a well-established procedure with high success rate. There are multiple causes of failure of this procedure which affect surgical success. To analyze causes of failure in endoscopic dacryocystorhinostomy and ascertain methods to overcome causes of failure. After approval from the Institutional Review Board a retrospective review of 119 patients was undertaken over an 11-year period from 2008 to 2018. A tertiary care hospital in North India. Patients presenting to the Otorhinolaryngology out-patient department and diagnosed as failed endoscopic dacryocystorhinostomy cases. After thorough preoperative workup consisting of history, examination and diagnostic nasal endoscopy, patients underwent revision endoscopic dacryocystorhinostomy. After exclusion of 2 cases, 117 patients were included in the study. The mean age at presentation was 31.4 years. Number of previous surgeries: 92 patients had had one surgery, 20 patients had had two surgeries, 5 patients had had three surgeries and 9 patients had had multiple surgeries before presentation. All patients (100%) had epiphora, 75 (64.1%) patients had associated discharge and 4 (3.4%) had persistent medial canthal swelling. Duration of symptoms following previous surgery was 1-6 weeks. Commonest cause of failure was incomplete sac exposure in 117/117 cases (100%). Other causes were cicatricial closure of ostium in 47 (40.1%), synechiae in 20 (17%), canalicular obstruction in 4(3.4%), lacrimal sac diverticulum in 3 (2.5%), nasal polyps in 2 (1.7%), concha with adhesion in 2 (1.7%), septal deviation in 2 (1.7%) cases. Meticulous and thorough sac exposure is the most important factor affecting surgical success. Comprehensive preoperative assessment of cases, meticulous surgical technique, and postoperative follow up are needed for successful outcomes.

Extent of Endoscopic Sinus Surgery for Odontogenic Sinusitis of Endodontic Origin with Ethmoid and Frontal Sinus Involvement.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

A Rare Case of Sinonasal Large Cell Neuroendocrine Carcinoma with Lymph Node Metastasis

Abstract Introduction/Objective Sinonasal carcinomas comprise less than 1% of cancers, and the most common types are squamous cell carcinoma at 51.6% and adenocarcinoma at 12.6%. There are only limited published reports of sinonasal large-cell neuroendocrine carcinoma (LCNEC). This entity has distinguishing immunohistochemical and histomorphologic features; it stains positively for neuroendocrine markers (i.e., synaptophysin and CD56) and histologically has abundant amphophilic cytoplasm with prominent nucleoli. Methods/Case Report We present a 60-year-old female patient who was evaluated for a submandibular neck lump. Computed tomography identified a 3.2 x 1.8 x 1.6 cm enhancing lesion with central necrosis in the right submandibular space, representing either an enlarged necrotic right submandibular lymph node or a neoplasm arising from the right submandibular gland. The pathology of the lymph node biopsy was consistent with metastatic high- grade neuroendocrine carcinoma. The neoplastic cells stained positively for INSM1, CK8/18, CK AE1/3 (subset), TTF- 1, and Ki-67 (50%). Dotatate positron emission tomography showed evidence of focal activity in the right anterior nasal cavity supporting evidence with primary nasal cavity origin. Nasal endoscopy was performed, visualizing an area of necrotic friable tissue. Pathology confirmed the presence of large cell neuroendocrine carcinoma in the right nasal biopsies with metastatic LCNEC in right neck levels 1, 2A, 2B, 3, and 4. The malignant cells on hematoxylin and eosin stain had similar morphology to those in the initial lymph node biopsy, supporting a diagnosis of LCNEC. Results (if a Case Study enter NA) NA Conclusion Sinonasal large-cell neuroendocrine carcinomas are extremely rare. Upon literature search, there have been fewer than ten case reports published of this entity. Furthermore, large-cell neuroendocrine carcinoma behaves aggressively, and diagnosing this entity could result in earlier intervention and better patient outcomes. Highlighting the possibility of this diagnosis could broaden differentials in neoplasms that arise from the nose.

The Effect of Platelet-Rich Plasma and Hyaluronic Acid Nasal Injections in the Treatment of Traumatic Olfactory Dysfunction.

Objective: Platelet-rich plasma (PRP) has been injected into the olfactory cleft to treat olfactory dysfunction related to coronavirus disease 2019. In this study, we aimed to evaluate the effect of PRP combined with hyaluronic acid (HA) nasal injection in the treatment of traumatic olfactory dysfunction. Methods: Patients who had lost olfactory function after experiencing head trauma and were willing to receive PRP and HA nasal injections for treatment were enrolled. Before nasal injection, 10 cc of blood was drawn from the patients. The drawn blood was injected into a centrifuge tube for processing, and finally, 5 cc of the PRP mixed with HA was drawn out using an empty syringe. The PRP mixed with HA was injected into the upper part of the middle nasal septum and the medial side of the middle turbinate of the patient's nasal cavity under a nasal endoscope. The olfactory function of each patient was evaluated by the phenyl ethyl alcohol (PEA) odor detection threshold test before and at both 1 and 3 months after nasal injection and the traditional Chinese version of the University of Pennsylvania Smell Identification Test at 3 months after nasal injection. Results: A total of 28 patients received PRP and HA nasal injections between August and December of 2023 and came back for evaluation of the effect. In all, 20 (71.4%) patients felt their olfactory function improved 1 month after injection, and 24 of 28 (85.7%) patients reported their olfactory function improved at 3 months after injection. The bilateral or unilateral PEA threshold decreased in 22 (78.6%) patients 1 month after injection, and decreased in 15 (53.6%) patients 3 months after injection. Conclusions: Our results show that PRP and HA nasal injections were associated with favored patient-reported outcomes and improved the olfactory threshold in the treatment of traumatic olfactory dysfunction.

Comparative analysis of nasal endoscopic and radiological findings in chronic rhinosinusitis patients

Background: Chronic rhinosinusitis (CRS) is a complex inflammatory disorder causing significant reduction in quality of life and interfere in day to day activity. Accurate diagnosis is crucial for effective management, typically involving nasal endoscopy and CT imaging to assess the extent of sinus involvement. Methods: This prospective observational study was conducted at Jaipur national university institute of medical sciences and research centre from July 2022 to May 2024. It included 75 patients diagnosed with CRS. Subjective quantification of disease was done using SNOT-22 scoring system. Diagnostic evaluations were performed using nasal endoscopy and CT scans, with findings scored according to the Lund-Kennedy and Lund-MacKay systems. Results: The study highlighted a strong correlation between endoscopic and CT findings, with Pearson correlation coefficients of 0.892 and 0.909 for endoscopic vs. SNOT-22 scores and CT vs. SNOT-22 scores, respectively. Discrepancies between the two diagnostic tools were also noted, emphasizing their complementary roles in CRS management. Conclusions: Integrating nasal endoscopy and CT imaging provides a robust framework for diagnosing and managing CRS, allowing for a detailed assessment of both mucosal and anatomical changes. The combined use of these tools enhances the ability to tailor treatment plans effectively.

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Sustained co-release of ciprofloxacin and dexamethasone in rabbit maxillary sinus using polyvinyl alcohol-based hydrogel microparticle

Topical delivery to paranasal sinuses through sustained-release stents is one of the new horizons in treating chronic rhinosinusitis (CRS). This study aims to introduce and evaluate sustained co-release of encapsulated ciprofloxacin (CIP) and dexamethasone (DEX) in polyvinyl alcohol-based carriers within the maxillary sinus of rabbit animals. DEX and CIP were loaded in a tyramine-substituted polyvinyl alcohol microparticle (PVATyr MP). The mechanical stability, degradability, and sustained-release patterns of both drugs as well as cellular cytocompatibility were assessed in vitro. The PVATyr MPs were then injected into the maxillary sinus of rabbits and they were monitored weekly for 21 days. Nasal endoscopy, MRI imaging, and tissue microscopy were used to follow the changes and compared them with the control condition. Also, the concentrations of drugs were evaluated in the maxillary sinus and blood samples over the study period. Produced PVA-based MPs possessed a relatively narrow particle size distribution (CV 7.7%) with proper physical stability until 30 days of incubation. The uniform-sized PVATyr MPs and their surrounding hydrogel showed sustained-release profiles for DEX and CIP for up to 32 days in vitro. The injected drugs-loaded hydrogel showed complete clearance from the maxillary sinus of rabbits within 28 days. The concentrations of DEX and CIP in mucosal remained within the therapeutic window when measured on days 7, 14, and 21, which were well above the plasma concentrations without any pathological changes in endoscopy, MRI imaging, and histological examinations. DEX/CIP loaded PVATyr MPs provided an effective, controlled, and safe sustained-drug delivery in both in vitro and in vivo analyses at therapeutic concentrations with minimal systemic absorption, suggesting a promising treatment approach for CRS.Graphical

Ayurveda Management of Allergic Rhinitis: Protocol for a Randomized Controlled Trial.

Allergic rhinitis (AR) is the inflammation of the membranes lining the nose due to allergen exposure and is characterized by sneezing, nasal congestion, itching of the nose, or postnasal discharge. The prevalence varies worldwide, perhaps due to the geographic and aeroallergen differences, with 10% to 30% of the world's population experiencing AR. In this study, Anu Taila Nasya, Naradiya Laxmivilas Rasa, and Shirishadi Kwath will be compared to a fluticasone nasal spray. The primary aim is to assess the efficacy of Ayurvedic management for AR (or vataja pratishyaya) by comparing it to a conventional control group. The secondary aims are to determine the mean change in the nasal endoscopy index and the mean change in the laboratory tests. This ongoing study is an open-label randomized controlled interventional trial, with a sample size of 90 both in the trial and standard control group (including dropouts, 20%), and will be carried out for 24 months. Participants in the trial group will receive Ayurvedic treatment, that is, Anu Taila Nasya (6 drops in each nostril for 7 days for 3 consecutive weeks), Naradiya Laxmivilas Rasa (250 mg twice per day), and Shirishadi Kwath (40 ml twice per day for 45 days). The participants in the control group will receive a fluticasone propionate nasal spray (2 sprays once per day for 45 days). The primary outcome will include the mean change in the Control of Allergic Rhinitis and Asthma Test score, and the secondary outcomes will include the mean change in the nasal endoscopy index (assessment of nasal membrane color, pale or hyperemia; rhinorrhea, watery or yellow; and inferior turbinate swelling, hypertrophy) and the mean change in the laboratory tests. As of May 2024, 72 patients have been enrolled in both groups. Data analysis should be completed by February 2025. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publication in a relevant journal. The Ayurvedic approach could be an evidence-based therapeutic tactic for the management of AR. Clinical Trials Registry India CTRI/2023/06/053395; https://tinyurl.com/564d2zz8. DERR1-10.2196/56063.

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.

Real-time augmentation of diagnostic nasal endoscopy video using AI-enabled edge computing.

AI-enabled augmentation of nasal endoscopy video images is feasible in the clinical setting. Edge computing hardware can interface with existing nasal endoscopy equipment. Real-time AI performance can achieve an acceptable balance of accuracy and efficiency.

The Diagnosis and Treatment of Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by local chronic inflammation of the mucous membranes of the nose and paranasal sinuses. It affects approximately 5% of the population. This review is based on relevant publications retrieved by a selective search of the literature, with particular attention to current national and international guidelines. CRS is defined by, and diagnosed on the basis of, a combination of symptoms and objective findings of nasal endoscopy and imaging studies. It markedly impairs quality of life and gives rise to both direct and indirect health care costs. In 20-45% of cases, CRS is associated with comorbid bronchial asthma and a significantly elevated risk of further diseases (e.g., COPD, OR 1.73; depression, HR 1.50; obstructive sleep apnea, OR 1.91; carcinoma, OR 1.14-5.30). CRS is primarily treated medically with topical steroids (standardized mean difference of nasal symptoms, -0.63 (95% confidence interval [-0.89; -0.37]; standardized mean difference of quality of life as measured by SNOT -22, -5.46 [-8.08; -2.84]), as well as with nasal lavage and, as an option, systemic steroids (and antibiotics where appropriate). If appropriate medical treatment fails to bring about adequate and sustained improvement, endoscopic surgery on the paranasal sinuses is indicated. This improves the individual symptoms, the overall symptom score, and patients' quality of life. Severe refractory CRS with nasal polyposis can be treated with biological agents. CRS calls for individually adapted medical and/or surgical treatment.

Inferior Turbinate/Nasal Cavity Ratio: A Novel Objective Tool with Potential Clinical Implications

Background: The nasal cavity is the upper part of the respiratory tract which communicates with the external environment through the anterior apertures. It also communicates with the nares, and the nasopharynx via the posterior apertures. The nasal cavity is divided into two by a septum, each cavity consisting of a roof, floor, medial wall, and lateral wall. The nasal cavity is formed laterally by the inferior, middle and superior nasal conchae (turbinates). Aim: The aim of the study was to investigate the dimensions of the inferior turbinate as seen in selected Nigeria subjects and develop novel anatomical parameters and indices with potential clinical implications. Methods: This retrospective study was done in the Radiology department of the Rivers State University Teaching Hospital following ethical approval, 339 CT films of adults (males and females) were analysed in this study. Sex and side differences were analysed using t-test, while relationship between anatomical structures were analysed using the Chi square test. The confidence interval was set at 95% and p &lt; 0.05 was considered significant. The volume of the inferior turbinate and nasal cavity were measure and the inferior turbinate/nasal cavity ratio was calculated. Results: The mean volume of the inferior turbinate for males was 2.01±0.12, female was 2.22±0.14 and for the entire population it was 2.12±0.13. The mean volume of the nasal cavity for male and female were 15.98±0.40 cm3 and 14.73±0.34 cm3, respectively, whereas the average for the population was 15.35±0.37 cm3. Conclusion: To the best of our knowledge, this is the first research that used well defined anatomical landmarks in estimating the volume of the nasal cavity and inferior turbinate. This study also provided a clinically objective tool in assessing the degree of nasal cavity obstruction by providing a grading system for the inferior turbinate/nasal cavity. This tool will particularly be very useful in resource poor settings like ours where nasal endoscopy and rhinometry may not be readily available and affordable. Therefore radiologist can use this grading system to grade the degree of inferior turbinate hypertrophy and predict the degree of nasal obstruction and severity of symptoms.

The Anaesthetic Efficacy of Tetracaine and Oxymetazoline Compared With Co-Phenylcaine in Healthy Individuals.

Nasal anaesthetic-decongestant sprays are commonly used prior to nasal instrumentation, such as flexible and rigid nasal endoscopy. Co-phenylcaine (lignocaine 5%, phenylephrine 0.5%, ENT Technologies Pty Ltd., Melbourne, VIC, Australia) is a combination spray commonly used for this purpose. However, lignocaine is less potent than other local anaesthetics, and both active constituents of Co-phenylcaine have a bitter taste. It was hypothesised that a combination spray containing tetracaine and oxymetazoline would both offer more potent topical anaesthesia and have a better taste. Four anaesthetic-decongestant nasal sprays were tested in 10 healthy participants (Co-phenylcaine, and tetracaine 0.5%, 1% and 2% with oxymetazoline 0.05%). Sensory thresholds were sequentially measured at the head of the inferior turbinate using Semmes-Weinstein monofilaments over the following hour. Participants also rated taste on a Likert-style scale, and reported whether they experienced subjective numbness of the maxillary teeth. A median peak sensory threshold of 60 g (the maximum tested) was observed with Co-phenylcaine, but this threshold was exceeded by all the tetracaine-based sprays. Tetracaine 2% with oxymetazoline 0.05% had a significantly more rapid onset than Co-phenylcaine (4 min vs. 6 min, p < 0.05) and a longer duration of action. Eight participants reported dental numbness after administration of tetracaine 2% with oxymetazoline 0.05%, but only one participant after Co-phenylcaine. Tetracaine-based sprays were generally perceived to taste less unpleasant than Co-phenylcaine. Tetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic-decongestant spray than Co-phenylcaine, with a longer duration of action.

Patient perspectives on international multidisciplinary consensus criteria for chronic rhinosinusitis disease control.

Recently, a set of consensus criteria and near-consensus criteria for the evaluation of chronic rhinosinusitis (CRS) disease control was identified by an international multidisciplinary panel of key stakeholders. The objective of this study is to evaluate patient perspectives on these disease control criteria. This is a qualitative phenomenological study using constant comparative methodology. Twenty-one one-on-one interviews, ranging from 6 to 15 min and based on a standardized semi-structured script, with CRS patients from diverse backgrounds were performed. The authors analyzed transcripts of the interviews to identify recurrent themes in patient responses. Conclusions were drawn based on these themes. All participants agreed with the consensus criteria (overall symptom severity, nasal obstruction severity, patients' self-assessed CRS control, and need for CRS-related oral corticosteroids), and most participants agreed with near-consensus criteria (nasal endoscopy, smell loss and nasal drainage severities, impairment of day-to-day activities, and overall quality of life) identified by the international multidisciplinary panel. Some patients disagreed with inclusion of smell loss due to common etiologies-such as post-viral or iatrogenic causes-that would not necessarily be an indicator of active sinonasal inflammation. One theme that emerged was the need for a facial pain/pressure criterion to be added. CRS patients overwhelmingly affirmed recently described consensus and near-consensus criteria for CRS disease control with the caveat that a question asking about facial pain/pressure should be included as well. Recently, identified consensus criteria for CRS disease control should be interpreted within the context of patient perspectives.

In office sampling of eosinophil peroxidase to diagnose eosinophilic chronic rhinosinusitis.

Practical biomarkers for endotypic characterization of chronic rhinosinusitis (CRS) remain elusive, hindering clinical utility. Eosinophil peroxidase (EPX) is an enzyme released by activated eosinophils. The objective of this study was to evaluate a clinic EPX assay as a marker of eosinophilic CRS. Subjects with and without CRS presenting to a tertiary care rhinology clinic were prospectively enrolled, and nasal cytology brushings were collected from the middle meatus during in-clinic nasal endoscopy. ELISA assay was used to quantify EPX levels, and a customized multiplex immunoassay was used to quantify inflammatory cytokine mediators. Findings were correlated with clinical data. Forty-two subjects were enrolled, including 31 CRS subjects and 11 controls. Median EPX levels were 125.0ng/mL (standard deviation [SD] 1745.8) and 6.5ng/mL (SD 99.0) for CRS group and controls, respectively (p=0.003). EPX levels were associated with history of asthma (p=0.015), allergies (p=0.028), polyps (p=0.0006), smell loss (p=0.006), and systemic eosinophilia or elevated immunoglobulin E (p≤0.0001). Twenty-eight subjects from both the CRS and control groups had prior pathology for comparison, with histologic confirmation of local tissue eosinophilia (>10 eosinophils/hpf) in 11 subjects. This subgroup had a median EPX level of 967.5ng/mL compared to 10.6ng/mL in 17 subjects without local tissue eosinophilia (p=0.0008). EPX levels were positively correlated to interleukin-5 levels (p=0.0005). EPX levels can be measured via well-tolerated in-clinic collection of nasal mucus. EPX levels are associated with clinical markers of type 2 inflammation and tissue eosinophilia and may provide a valuable diagnostic tool to delineate eosinophilic CRS.

Clinical analysis of 21 cases of children with ectopic bronchogenic cyst

Objective: To analyze the clinical characteristics, treatment, and prognosis of ectopic bronchogenic cysts in children. Methods: A retrospective analysis was conducted on the data including the clinical characteristics, auxiliary examination and treatment of 21 children with ectopic bronchogenic cysts diagnosed pathologically at Children's Hospital Affiliated to Zhengzhou University from July 2015 to December 2023. There were 16 males and 5 females, with a male-female ratio of 3.2∶1, and the age ranged from 4 days to 8 years old (median age 2 years and 8 months). Results: Among the 21 cases of ectopic bronchogenic cysts, 11 cases were found in the pharynx, with symptoms including dyspnea (4 cases), snoring during sleep (3 cases), and choking on milk(4 cases).Ten cases were found in the head, neck or anterior chest, 5 of these cases had infection history, and 5 showed progressive mass growth.Imaging and endoscopy showed 9 patients underwent preoperative color ultrasonography revealed cystic masses with well-defined boundaries. CT examination was performed on 13 patients, which showed round or nearly round masses with homogeneous density, smooth margins, and regular cyst walls. CT attenuation values ranged from 2 to 52 Hounsfield Units (HU). Four cystic lesions were assessed via MRI, 3 cases demonstrated long T1 and long T2 signals, while 1 case had a slight short T1 and long T2 signal, with high signal intensity on fat-suppressed images. Eleven cases of pharyngopharyngeal cysts were examined by electronic nasopharyngoscopy. The cysts appeared as spherical or ovoid masses with smooth surfaces, close to or slightly light in color with the surrounding tissue, with one cyst presenting with a bluish blue in the oropharynx. All 11 pharyngeal cysts were excised using low-temperature plasma under general anesthesia and intubation assisted by a nasal endoscope. The cysts were pulled and excised as completely as possible.Ten cases of neck and anterior chest cysts were completely excised. Postoperative histopathology confirmed bronchogenic cyst. Twenty-one children were followed up postoperatively for 4 months to 7 years without recurrence, except for 1 patient who was lost to follow-up. Conclusions: Ectopic bronchogenic cysts are uncommon and lack of typical imaging and clinical features.Combination of ultrasonography, CT and MRI is recommended for cases occuered in neck and anterior chest, while electronic nasopharyngoscopy complements pharyngeal evaluations. Surgical intervention is the preferred treatment choice for this disease.

“Mucosal infection with tsukamurella species following nasal septum procedure: a rare case report”

Introduction and Importance: Tsukamurella species are rare, aerobic, Gram-positive bacteria known to cause infections, primarily in immunocompromised individuals. This case report presents a rare instance of a mucosal infection caused by Tsukamurella species following a nasal septum procedure in an immunocompetent patient. Case Presentation: A 51-year-old man with a history of multiple hereditary exostosis, allergic rhinitis, and recent nasal fracture repair presented with persistent fevers and low back pain. Postoperatively, he developed sinus pain and small oral lesions, initially treated with antibiotics for presumed sinusitis. Despite treatment, his fever persisted, leading to an emergency department visit. Laboratory tests indicated sepsis, but a CT scan of the sinuses showed no sinusitis. Despite broad-spectrum antibiotics, the patient’s fever continued. On admission day 9, nasal endoscopy and culture identified Tsukamurella species. The patient was treated with Augmentin, fluconazole, and levofloxacin, leading to resolution of symptoms and discharge with ongoing treatment. Clinical Discussion: Tsukamurella species are uncommon pathogens that are often associated with bacteremia in immunocompromised individuals. This case highlights the diagnostic challenges and importance of considering unusual pathogens in post-procedural infections, even in immunocompetent patients. Accurate identification and appropriate management are critical in improving outcomes for patients with Tsukamurella infections. Conclusion: This case underscores the need for vigilance in diagnosing rare infections like Tsukamurella, even in immunocompetent individuals. The successful resolution with combination therapy highlights the importance of appropriate antibiotic selection in managing such infections.

Epidermoid Cyst at the Root of the Sphenoidal Pterygoid Process: A Rare Case Report.

Epidermoid cysts of the skull base are rare. We present the case of a woman with an epidermoid cyst at the root of the sphenoidal pterygoid process. She experienced tightness of the forehead skin without headache. Computed tomography (CT) scan revealed a hypodense lesion at the base of the skull in the right middle cranial fossa, which had partly eroded the pterygoid root. Magnetic resonance imaging (MRI) scan revealed a soft cystic mass that eroded the pterygoid root with hypo-/iso-intense on T1-weighted images, hyperintense on T2-weighted images, inhomogeneous hyperintense on diffusion-weighted images, a slightly low apparent diffusion coefficient, and no enhancement, suggesting a diagnosis of an epidermoid cyst. Surgical excision was performed using a nasal endoscope via the pterygoid process-root approach. A histopathological examination confirmed the diagnosis of an epidermoid cyst. At the 6-month follow-up, no recurrence was found on MRI or nasal endoscopy, and the symptoms of forehead tightness disappeared. In conclusion, epidermoid cysts at the root of the sphenoidal pterygoid process are exceptionally rare. Preoperative MRI and CT scans are necessary for the correct diagnosis and differentiation of other low-growing lesions. Nasal endoscopy is crucial for surgical excision and postoperative follow-up for potential recurrence.