Nasal Endoscopic Examination Research Articles

ROLE OF SYSTEMIC OMALIZUMAB IN MANAGEMENT OF ALLERGIC FUNGAL RHINOSINUSITIS

Background: Allergic fungal rhinosinusitis (AFRS) is due to the continuous exposure of fungal antigens to an atopic individual. It is caused by type I, IgE mediated (and possibly type III) hypersensitivity reaction to an extramucosal fungal antigen. Medical treatment following the surgery is the standard protocol of management. Steroids (systemic/topical) have been considered as the standard medical treatment for control of the disease despite high recurrence rate and their serious side effects. Instead, omalizumab, a humanized monoclonal anti-IgE antibody, can be tried as a new treatmentmodality with less side effects to control symptoms and decrease the recurrence rate in AFRS patients. It acts by aborting the immunological reaction to sinonasal fungi through preventing the release of inflammatory mediators that cause allergic signs and symptoms. Aim: To evaluate the role of omalizumab for postoperative management of AFRS patients in comparison to topical steroids as regarding symptom free interval and side effects. Patients and methods: A total of 20 patients with AFRS were included in the study. Patients were divided randomly into two equal groups: group A used local steroid and group B used single dose of subcutaneous omalizumab. Clinical parameters were compared at 4,8,12 and 24 weeks. Results: Although there was no statistical significant difference between both groups as regards endoscopic nasal examination posttreatment, patients of group B were statistically better as regards clinical and subjective parameters.Conclusion: We suggest that omalizumab has more superior effect than local steroids in controlling nasal symptoms in AFRS patients despite the same endoscopic scores post-treatment. More well-designed large prospective randomized controlled trials to determine the effects and optimal dosage and duration of omalizumab therapy in patients with AFRS will be necessary.

What the Radiologist Needs to Know About Sinonasal Masses

Although malignancies in the sinonasal cavity comprise only 3% of all head and neck cancers and 1% of all malignancies,1 they are important disease entities to consider because of their nonspecific clinical presentation. There is considerable overlap of symptoms of sinonasal tumors with symptoms of the much more common rhinosinusitis. CT for rhinosinusitis symptoms is common in clinical practice and often ordered by primary care physicians who do not have the instruments to perform thorough endoscopic nasal examinations. Thus, the first physician to suggest the presence of a sinonasal lesion often is the general radiologist, frequently one without neuroradiology subspecialty training. It is imperative that radiologists not only are aware of imaging findings of both benign and malignant sinonasal masses and mass-like lesions but also are able to recommend the next appropriate steps in patient management.

Atopy and Quality of Life in Pediatric Chronic Rhinosinusitis.

Background Atopy has been suggested in the development of chronic rhinosinusitis (CRS), as allergic rhinitis (AR) is common coexisting disease in pediatric and adult patients with CRS. The contribution of AR to CRS is less clear till date. Objectives The objectives of this study were to determine atopic profile of children with CRS and impact of atopic status on disease severity and quality of life. Methods One hundred ten patients, aged between 7 and 18 years of age, diagnosed with CRS based on history, detailed clinical examination including nasal endoscopic examination were included in this cross-sectional study. Scoring of CRS was done according to Lund Mackay Endoscopic Appearance Score. Patients underwent skin prick test against 65 common aeroallergens (1:10 w/v, 50% glycerinated) for evidence of atopy. SN-5 Sinus and Nasal Quality of Life Survey was used to assess the quality of life in the study subjects. Results Positive skin prick test to at least one of the common aeroallergens was present in 58 (52.7%) patients. Most common aeroallergen sensitivity was seen with insects in 48 (43.6%) patients. Patients of CRS with atopy had higher mean Lund Mackay endoscopic score and SN-5 score than nonatopic patients which was statistically significant. Conclusion In conclusion, we recommend that testing for aeroallergen sensitivity and assessment of quality of life should be included in the protocol for diagnosis and management of pediatric patients with CRS. Early diagnosis and treatment of allergy may halt the progression of CRS and also the development of asthma and other allergic multimorbid disorders.

The evaluation of nasal mucociliary clearance in patients with Helicobacter pylori infection.

This study aimed to examine nasal mucociliary clearance time in patients with Helicobacter pylori infection. Fifty patients who were newly diagnosed with H pylori infection using gastric biopsy in the gastroenterology out-patient clinic, and 50 age- and gender-matched healthy adults who were admitted to the otorhinolaryngology out-patient clinic, were included in this study. After an otorhinolaryngological examination (anterior rhinoscopy and nasal endoscopic examination), the nasal mucociliary clearance time of each subject was calculated using the saccharine test. The mean mucociliary clearance time was 06:29 ± 3:31 minutes (range, 00:55-15:19 minutes) in the control group and 10:12 ± 06:09 minutes (range, 01:28-32:00 minutes) in the study group. Comparisons of the two groups revealed a statistically significant difference (p = 0.002). Nasal mucociliary clearance time was significantly increased in patients with H pylori infection. The results suggest that H pylori infection may have an unfavourable effect on nasal mucociliary clearance.

Sinonasal Manifestations in Children with Cystic Fibrosis

Background: Involvement of the upper respiratory tract and pathological changes in the nose and paranasal sinuses are common in patients with cystic fibrosis. Objectives: We aimed to identify sinonasal manifestations in Iranian children with cystic fibrosis. Methods: Forthy seven children with cystic fibrosis were enrolled and symptoms related to the nose and paranasal sinuses were recorded using a questionnaire. The patients’ nasal and sinus CT scan were investigated in terms of findings related to cystic fibrosis. Results: The most common complaint was nasal congestion (61.7%). Ground glass opacity in the nasal cavity was found in 63.8% of the patients. Postnasal drip was observed in 36.2% of the patients. In nasal endoscopic examination, 15 (31.9%) patients had clear polyps in the nasal cavity. Conclusions: History, CT scans, and initial clinical examination (rhinorrhea in anterior rhinoscopy) does not allow accurate diagnosis of chronic rhino sinusitis or nasal polyps in children with cystic fibrosis.

Extramedullary Plasmacytoma of the Maxillary Sinus with Intra-Orbital Extension: A Case Report of a Rare Condition

Introduction: The most common site for extramedullary plasmacytomas (EMP) is the upper respiratory tract, including the oropharyngeal and nasal cavities, paranasal sinuses, and larynx. The EMPs of the head and neck area are uncommon malignancies comprising only 3% to 4% of all the plasmacytomas. Case Presentation: We presented a 78-year-old man with right facial swelling, right exophthalmos, diplopia, and decrease in visual acuity of the right eye for three weeks. A right nasal mass was identified on nasal endoscopic examination. Computed tomography scan of the paranasal sinuses revealed a mass in the right maxillary and ethmoid sinuses with orbital extension. Histopathologic examination showed plasmacytoma of paranasal sinuses. Patient received 56 Gy in 28 fractions of radiotherapy. He was well in the follow-up visits during the next one year. Conclusions: Although sinonasal EMP is rare, it is worth being considered in the differential diagnoses of paranasal malignancies. Radiotherapy is the treatment of choice for solitary EMPs of paranasal sinuses. Long-term follow-up is essential in EMPs.

Turbinate-septal suture for middle turbinate medialization during endoscopic sinus surgery

Background Lateralization of middle turbinate (MT) and synechia formation are common complications after endoscopic sinus surgery (ESS). These complications can be prevented with one of MT medialization techniques. Aim The aim of this study was to evaluate the effectiveness of MT-septal suturing technique in prevention of lateralization of MT and synechia formation after ESS. Patients and methods A total of 25 patients were selected for this prospective cohort study in the period between January 2017 and January 2018 at the Otorhinolaryngology Department, Tanta University Hospital, complaining of chronic rhinosinusitis refractory to medical treatment. The age of the patients ranged from 16 to 60 years. We selected patients who did not have a history of previous ESS, nasal tumors, or bleeding disorders. A total of 25 patients of the study had undergone MT medialization (suturing technique) after ESS. All the patients were assessed by endoscopic nasal examination (preoperative, 2 weeks, and 3 months postoperatively) and sinonasal outcome test (SNOT-22) questionnaire (preoperatively and 3 months postoperative). Results Two-week postoperative endoscopic nasal examination of 25 patients showed that there was mild adhesion and synechia to lateral nasal wall in two patients in one side (8%) owing to separated sutures. Synechia was divided in outpatient clinic. No synechia was detected on 3-month postoperative endoscopic examination. Conclusion Lateralization MT and synechia formation after ESS complications can be prevented with one of MT medialization techniques. The MT suturing technique is simple, reliable, and effective in prevention of lateralization of MT and synechia formation after ESS.

A comparative study of diagnostic nasal endoscopy and computed tomography in chronic rhinosinusitis

Background: Chronic rhinosinusitis (CRS) is a common condition in medical practice. It is defined as inflammation of the mucosa of nose and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least 12 weeks' duration. Objective: This study aimed to determine the correlation of nasal endoscopy examination and computed tomography (CT) in the early diagnosis of CRS. Materials and Methods: The study was carried out in outpatient Department of Otorhinolaryngology, in Rizgary Teaching Hospital in Erbil. A total of 60 patients with clinical evidence of sinonasal diseases were evaluated with nasal endoscopy and computed tomographic evaluation. Patients with previous variation of paranasal sinus anatomy due to facial trauma and former sinus surgery were rejected. Patients with history of having malignant neoplasms or congenital malformations were also excluded from the study. Results: Sixty patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.18 + 10.19 years, ranging from 20 to 63 years. The median was 37.5 years. The largest proportion (41.7%) of the sample aged 30–39 years old, and only 16.7% aged ≥50 years. The main symptoms of the patients were nasal obstruction (80%), ear pressure (80%), and nasal discharge (78.3%). No significant difference was detected between the two tests regarding their findings. Conclusion: Nasal endoscopy have sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures.

Correlation of anatomical variations in chronic sinusitis with diagnostic nasal endoscopy and CT scan of paranasal sinuses: an observational study

<p class="abstract"><strong>Background:</strong> Drainage and ventilation of paranasal sinuses are important for normal function which depends on effective mucociliary clearance. In present study we tried to emphasize variations in lateral wall of nose and clinical features leading to nose and paranasal sinus disease using diagnostic nasal endoscopy and variations in CT scan of paranasal sinuses. The objectives of the study are to observe various anatomical variations in nose and paranasal sinuses and their clinical presentation using diagnostic nasal endoscopy and CT scan of paranasal sinuses and to compare various anatomical variations in nose and paranasal sinuses.</p><p class="abstract"><strong>Methods: </strong>Present study included 54 patients presenting in Department of ENT, Head and Neck Surgery, during February 2015 to February 2017. </p><p class="abstract"><strong>Results:</strong> Diagnostic nasal endoscopy findings reveal that most common finding was polypoidal changes in nasal mucosa in 36 (66.67%) of patients, followed by mucopurulent discharge in 26 (48.14%), postnasal discharge in 20(37.03%) and 4 (7.40%) patients showed prominent agger nasi cell. CT scan of paranasal sinuses revealed multiple sinus involvement in 41 (75.92%) of patients with partial involvement of sinuses. Complete sinus opacification with pan sinusitis was observed in 9 (16.67%), blockade at osteomeatal complex was observed in 46 (85.18%), paradoxical middle turbinate was observed in 5 (9.25%), Concha bullosa was observed in 12 (22.23%) of patients.</p><p class="abstract"><strong>Conclusions:</strong> Each variation have an anatomic and surgical significance, hence each and every case should be individually studied in detail before undergoing functional endoscopic sinus surgery to maximize patient benefit and to prevent unnecessary complications. Diagnostic nasal endoscopic examination is clinical guide to evaluate disease.</p>

Alpha-tocopherol acetate nasal spray in the treatment of pollen-induced allergic rhinitis

This study compared the effectiveness and tolerability of alpha-tocopherol acetate nasal spray (ATANS) to those of beclomethasone nasal spray (BNS) and loratadine (LT) for the treatment of pollen-induced allergic rhinitis. This active-controlled, patient-preference, observational trial lasted 7 days. Tested variables were nasal symptoms, endoscopic examination, additional medications, general effectiveness, safety, and tolerability. Of 116 patients, 63 patients decided to use ATANS, 32 BNS and 21 LT. During the treatment, the mean daily rhinitis symptom score decreased significantly in all groups. The 7‑day mean score in the ATANS group (0.98) was comparable to that of the BNS group (0.92) and significantly higher than that of the LT group (0.70, P < 0.05). After treatment, the endoscopic score was significantly lower in all groups; the reductions were significantly greater in the BNS and LT groups than in the ATANS group (BNS vs. ATANS: P < 0.01; LT vs. ATANS: P < 0.05). Additional medications were not used by 60% (ATANS), 47% (BNS) and 95% (LT) of patients; the difference between ATANS and LT was significant (P < 0.01). Treatment was assessed as good or very good by 56% (ATANS), 69% (BNS) and 86% (LT) of patients; the differences between ATANS and BNS (P < 0.05) as well as between ATANS and LT (P < 0.01) were significant. Most patients (96%) did not experience any adverse events. Pollen intensity was comparable between groups and decreased marginally on day 7. ATANS can be considered an effective symptomatic treatment for patients with allergic rhinitis who wish to avoid side effects of antihistamines and corticosteroids. German “Register Klinischer Studien” (Reference number: DRK9338)

Endoscopic Evaluation of the Eustachian Tube: assessment of a novel tool for grading Eustachian tube inflammation.

Signs of inflammation are commonly encountered during endoscopic examination of the Eustachian tube (ET) region. The clinical applicability of these findings may be enhanced by use of a standardized assessment score. Digital video recordings were obtained of 50 nasal endoscopy examinations of the nasopharyngeal portion of the ET. Four fellowship-trained rhinologists independently reviewed the videos with regard to specific physical findings: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. Scoring of this Endoscopic Evaluation of the Eustachian Tube (3ET) was reported using both 2-point and 3-point scales. Each reviewer repeated the scoring at a 10-day interval. Interrater and intrarater agreement were calculated for each item and the total scores. Interrater and intrarater agreement were greater for the 3-point scale than the 2-point scale. Interrater agreement for overall instrument using the 3-point scale was in the "acceptable" range for Krippendorff's alpha on both the first trial (0.6922) and second trial (0.7238). Intrarater agreement was generally "excellent" for individual items as well as the overall instrument. The 3ET comprising these 4 physical findings has acceptable interrater and intrarater reliability, and may be applied to future clinical studies of ET function and disease.

The Effect Of Functional Endoscopic Sinus Surgery On Lung Function In Patients With Chronic Sinusitis And Nasal Polyps Without Asthma

Objectives: The aim of this study was to look into how functional endoscopic sinus surgery (FESS) for CRSwNP without asthma affects lung function. The investigators aimed to determine any correlation between Lund-Kennedy scores, Lund-Mackay scores and pulmonary function. Methods: All participants underwent nasal endoscopic examination and CT scanning paranasally. Lund-Kennedy endoscopy and Lund-Mackay CT scores were calculated and compared with postoperative findings. Statistical analysis was performed to compare preoperative and postoperative spirometry findings to assess efficacy of surgery on pulmonary function. Results: There were no statistically significant differences between the Lund-Mackay scores for primary FESS and revision. Nevertheless, Lund-Kennedy scores did show evidence of greater statistical significance when comparing revision FESS and primary FESS (p=0.04) With respect to both primary and revision FESS patients there was no statistical significance between the preoperative values of FEV1, FEV1/FVC, FVC, and FEF25-75 and the same parameters measured one month postoperatively (p>0.05). Conclusion: Our results reveal that FVC improves following FESS in cases of CRSwNP that are not also asthmatic. No relationship was demonstrable between how severe the disease is and how the lung functions. Further research that looks at FESS in asymptomatic cases of airway obstruction over more prolonged follow-up needs to be undertaken.

Chronic otitis media with effusion in chronic sinusitis with polyps.

The relationship between otitis media with effusion (OME) and chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. We conducted a cross-sectional study of 80 consecutively presenting patients-42 males and 38 females, aged 15 to 76 years (median: 48)-who were diagnosed with CRSwNP. Our aim was to ascertain the prevalence of OME in CRSwNP patients, to determine whether the severity of CRSwNP affected OME, and to identify risk factors for OME in CRSwNP patients. The severity of CRSwNP was assessed on the basis of nasal symptoms, endoscopic nasal examinations, and Lund-Mackay staging scores. In addition to demographic data, we obtained information on each patient's history of otitis, otoscopic findings, and the results of pure-tone audiometry and tympanometry. We then compared the data between CRSwNP patients with OME (n = 20) and those without (n = 60). In the OME group, a conductive hearing loss was present in 16 patients (80.0%); all patients in the control group had normal hearing. With regard to symptoms, only rhinorrhea appeared to be more common in patients with OME than in those without, although the difference was not statistically significant. We found no significant difference in nasal polyposis grades between the two groups. Also, we found no correlations between the risk of OME and previous surgical treatment, asthma, allergy, aspirin intolerance, aspirin and/or NSAID intolerance, aspirin and/or sulfite intolerance, and aspirin-exacerbated respiratory disease. Based on our findings, we conclude that OME occurs frequently during the evolution of CRSwNP, even when the nasal disease is well controlled. This finding suggests the possible presence, in OME and/or CRSwNP, of a global inflammatory process that involves the epithelium in both the middle ear and upper airway.

Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation.

Background Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient's own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation.

Evaluation of olfactory function in children with seasonal allergic rhinitis and its correlation with acoustic rhinometry

ObjectivesSeasonal allergic rhinitis (SAR) is common in children and hyposmia is a major symptom affecting the quality of life. The aim of the present study is to assess olfactory dysfunction in pediatric patients with SAR and correlate the results with acoustic rhinometry measurements. MethodsForty children, diagnosed as moderate and severe SAR based on clinical findings, ARIA (Allergic rhinitis and it's impact on asthma) classification and prick test results were enrolled in the study. Endoscopic nasal examination, acoustic rhinometry, total nasal symptom score (TNSS) and Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed 'in season' (May–August) and 'out season' (November–February). Three patients who did not show up in 'out season' examinations were excluded from the study. ResultsThe ages of the children ranged between 8 and 18 years with a hyposmia increased and odor identification decreased (p < 0.005, p = 0.003, respectively), whereas no differences were found between odor thresholds and the discrimination values (p > 0.05). Mean CCCRC value was obstruction score (r =−0.340, p = 0.04), subjective hyposmia (r = −0.44, p = 0.007) and TNSS (r = −0.494, p = 0.02). Although some of the acustic rhinometry parameters were lower during allergy season, there were no correlations between acoustic rhinometry parameters and CCCRS values. ConclusionNearly half of the children with AR reported a mild to moderate hyposmia during pollen season and there was a decrease in odor identification, which can be easily shown using a CCCRC test.

Factors to estimate swallowing function in patients with acute stroke

Evaluation of the swallowing ability by video nasal endoscopic examination of the swallow (VEES) and videofluorographic swallow study (VFSS) is recommended to safely resume oral intake after fasting patients with stroke. However, expert staff and special equipment are needed to perform these examinations. Furthermore, these are difficult to perform in patients who are not cooperative during examinations due to delirium or cognitive impairment. We sought to investigate the predictive factors of oral intake and create a model to estimate the swallowing function of patients with acute stroke. We included 93 patients with first ever stroke, who underwent VEES or VFSS at our hospital between October 1, 2015 and October 31, 2017. Patients’ functional oral intake scale (FOIS) was recorded at the time of the procedures. A multiple linear regression analysis was performed using FOIS as a dependent variable. Independent variables were age, FIM motor, FIM cognition, Onodera's prognostic nutritional index (O-PNI), speech intelligibility (SI), and Brunnstrom recovery stage for the arm (BRS-A), leg (BRS-L) and hand (BRS-H). The ethical committee of our hospital approved the study. An estimation model of FOIS using three factors (FIM motor, O-PNI, speech intelligibility) was derived by multiple linear regression analysis. The formula used for estimating FOIS (Y FOIS ) was Y FOIS = exp (0.098 + 0.308 × FIM motor + 0.304 × O-PNI − 0.575 × SI) − 1. The multiple correlation coefficient was 0.76, and the adjusted R-square was 0.56. The ability to perform activities of daily living, overall severity of speech function, and nutritional status before disease onset are effective ways to estimate swallowing function in patients with acute stroke.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal

IntroductionAfter post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. ObjectiveThe aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. MethodsThe study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. ResultsThe group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p<0.001) and by nasal endoscopic examination (p=0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. ConclusionThe use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Higher prevalence of nasal polyposis among textile workers: an endoscopic based and controlled study.

There is a deficit of reliable epidemiologic studies exploring the prevalence of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Recent data suggests that occupational dust exposure may be involved in its physiopathology. To compare the prevalence of nasal polyposis (NP) in a group of workers with occupational dust exposure (textile workers) and in a control group (retail store workers). Cross-sectional study with a random sample of textile and retail store employees. Clinical data was gathered through a systematic interview, which included RhinoQOL and CAT questionnaires. A systematic endoscopic nasal examination was performed using a 0 degree rigid endoscope. Lund-Kennedy endoscopic score was determined for each participant. Statistical analysis was performed with SPSS. 316 participants were included in the study, i.e. 215 textile workers and 101 retail store workers. NP was found in 19 subjects among textile workers and none in the control group. The prevalence of NP increased by age strata and by years of dust exposition. Polypoid degeneration of the middle turbinate was more prevalent in the exposed group with Lund-Kennedy scoring also higher. RhinoQOL and CAT questionnaires had both significantly higher scores among textile employees. Previous medical diagnosis of atopic diseases or chronic lower airway diseases did not differ between exposed and control groups or even between subjects with and without NP. These results point to an important correlation between occupational dust exposure and NP occurrence.

Rhinolithiasis: lesion specificities of the first case described in Togo

&lt;p class="abstract"&gt;Rhinolithiasis is a solid concretion by progressive deposition of calcareous salts around an endogenous or exogenous central body, resorbable or not, of variable shape and sizes. Its diagnosis is based on endoscopic nasal examination completed by a computed tomography (CT) of the naso-sinus cavities. We are reporting the first described case of rhinolithiasis in Togo, particularly remarkable for its association with septal perforation, nasal mycosis, and granulomatous reaction.&lt;/p&gt;

Assessment of posterior choanal obstruction caused by adenoidal hypertrophy: Intra-operative mirror versus rigid nasendoscopic examination

ObjectivesThe aim of the study is to compare the degree of posterior choanal obstruction caused by adenoidal hypertrophy intra-operatively, when assessed by mirror versus rigid nasendoscopic examination, in children undergoing adenoidectomy. MethodsThis is a prospective blinded study including all consecutive paediatric cases undergoing adenoidectomy under care of the senior author during the period from June 2015 to December 2016. All cases were performed under general anaesthesia. The degree of posterior choanal obstruction caused by adenoidal hypertrophy was assessed in each patient using both a rigid nasendoscope and a nasopharyngeal mirror. Photographs of the choanae and the adenoids were obtained for both methods. Two independent ENT specialists (a registrar and a consultant), who were blinded to the clinical history and identity of the patients, assessed these photographs. Assessors scored the degree of choanal obstruction on the right and left sides separately out of 100%. The scores were analysed using the Two-Sample equal variance T-test function. ResultsA total of 26 patients were included; all of them were children aged between 2 and 13 years. A total of 52 choanae were assessed and photographed, resulting in 52 photographs for the nasendoscopic views and 26 photographs for the mirror views.The trans-nasal nasendoscopic views consistently showed a significantly higher degree of posterior choanal obstruction compared to trans-oral mirror examination views (P-value < 0.001). There was no significant difference between the scores of both assessors (P-value > 0.05). In 8 of the 26 patients (30.7%), the registrar's decision would have changed from not proceeding with surgery had he only used the mirror view, to proceeding with surgery had he also used the nasoendoscopic view. This was the case for 6 of the 26 patients (23%) reviewed by the consultant. There were three patients in common in which both the registrar and the consultant would have similarly changed decisions. ConclusionIntra-operative nasendoscopy is more sensitive than mirror examination in assessing the degree of posterior choanal obstruction due to adenoidal hypertrophy. It is important to consider nasendoscopy in patients with symptoms of adenoidal hypertrophy where mirror examination of the posterior choanae is negative.