Nasal Endoscopic Examination Research Articles

Role of Adenoid-Nasopharyngeal Ratio in Assessing Adenoid Hypertrophy.

Most of the time, pediatrician is the first to see children with adenotonsillar hypertrophy (AH) and they mostly rely on clinical assessment with or without some investigation to refer these children to otorhinolaryngologist. Numerous methods have been described for evaluation of AH, but many of these methods are not possible to follow in busy pediatric outpatient unit either because of lack of cooperation from child or due to limited availability of test or due to cost constraints. This study has been conducted to determine the diagnostic accuracy of lateral neck X-ray (LNX) for assessing AH and to assess the correlation between adenoid size in LNX and clinical symptoms in a pediatric unit. Prospective study conducted in Department of ENT, Pathmavathy Medical Foundation, Kollam, Kerala, India from January 2015 to March 2016. 60 consecutive children of both genders, between the age group of 5 to 14years, attending Department of Pediatrics with a provisional diagnosis of AH were included in the study. The symptom scores, radiographic ratio of adenoid to nasopharynx and endoscopic scorings were calculated. Lateral neck X-ray with calculation of adenoid-to-nasopharynx ratio is found to have significant correlation with patient reported symptoms and findings in nasal endoscopic examination (NE). LNX can be considered as a useful objective tool in evaluation of children with adenoid hypertrophy. Primary care physicians or pediatricians can confidently use lateral neck X-ray for making clinical decisions and can consider nasopharyngoscopy when clinical picture remains unclear or more evaluation is needed.

Epistaxis at Patan Hospital: A Retrospective Review and an Audit

Objective: The objective of this study was to review the cases of epistaxis and audit its management at Patan Hospital. Materials and Methods: This was a retrospective study and an audit carried out in patients admitted for epistaxis in Patan Hospital from August 2012 to August 2014. All the patients with primary epistaxis were included. The data were analyzed in terms of the specific defined parameters and were compared with that of Guy’s Hospital, United Kingdom, of year 2011.Results: Out of 146 patients, 111 had primary epistaxis. Ninety-three patients (83.78%) with primary epistaxis had anterior bleeding and 18 patients (16.21%) had posterior bleeding. The majority of the patients (31.53%) were treated with chemical cautery, followed by anterior nasal packing (27.02%). Eleven patients (10%) underwent sphenopalatine artery cauterization. The data of our hospital were optimal or near optimal in some aspects like documented initial nasal examination, and initial cautery attempt whereas, parameters like re-bleeding rate, surgical intervention and endoscopic nasal examination after cessation of bleeding were found to be sub-optimal.Conclusion: The improvements are required in some aspects of management of epistaxis like decreasing the re-bleeding rate, increasing the timely surgical intervention and compulsory endoscopic evaluation of nasal cavity after cessation of bleeding. This can be attained with adherence to the protocol as proposed. A multi-center audit would be required to develop a common consensus regarding its management.Nepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, Page: 26-30

Results of radiofrequency ablation of inferior turbinate hypertrophy in allergic and non-allergic rhinitis patients

Objectives:For the treatment of the inferior turbinate hypertrophy that is unresponsive to medical treatment, turbinate surgery with radiofrequency is a widely used method. This study aims to evaluate the efficacy of turbinate surgery with radiofrequency ablation for the treatment of turbinate hypertrophy, and compare the results of patients with allergic rhinitis and non-allergic rhinitis.Methods:A total of 59 consecutive patients aged 18–67 years (mean 37±13) who underwent radiofrequency ablation to the inferior turbinate at our tertiary care hospital from September 2017 to January 2018 were enrolled in this prospective nonrandomized clinical study. The patients with allergic rhinitis (n=23) were classed as group 1, and the patients with non-allergic rhinitis (n=36) were classed as group 2. Endoscopic nasal examination and an acoustic rhinometer were applied, and a standard 0–10 visual analog scale (VAS) was used to assess nasal symptoms preoperatively and postoperatively at the third and sixth months.Results:The study found a significant reduction in nasal obstruction for both groups postoperatively. This reduction was higher in group 1. The decrease in nasal VAS scores for itching, rhinorrhea, and sneezing were statistically significant in group 1, whereas the decrease in nasal VAS scores for sneezing was significant in group 2.Conclusion:This study demonstrates that radiofrequency appears to be an effective and safe treatment option for inferior turbinate hypertrophy of patients with allergic rhinitis or non-allergic rhinitis. It also provides a better perception of all nasal symptoms in patients with allergic rhinitis, and a better perception of nasal obstruction and sneezing in patients with non-allergic rhinitis.

Saline Nasal Douching Versus Decongestant Nasal Drops: A Comparative Study of Relative Efficacy in Post-Septal Surgery

Background and Objective: This study aimed to compare the relative efficacy of saline nasal douches versus topical nasal decongestant in post-operative septal surgery and to assess the feasibility and likely utility in post-operative septal surgery. Material and Methods: The study was a hospital-based prospective double-blind randomized controlled study. Over a period of 18 months, 120 patients following septal surgery were assigned to one of two groups-Group I: Saline nasal douching and Group II: Decongestant nasal drops (xylometazoline 0.1 %). The outcome measures recorded on the 5th and 10th postoperative days are nasal congestion, anosmia, facial pain, itching, crusts, edema, scarring and nasal discharge. On the 14th postoperative day, the patients underwent diagnostic nasal endoscopic examination by the operating surgeon and the findings were recorded on the proforma. Results: On the 5th postoperative day, group I patients were found to be symptomatically better than group II and this trend continued upto the 10th postoperative day, with group I patients reporting better symptomatic outcomes. Examination of the nasal cavities showed statistically significant differences between the two groups in terms of crusts, edema and scarring. Conclusion: Saline nasal douching appears to provide better alleviation of post-septal surgery symptoms (anosmia, facial pain and itching) than nasal decongestants as experienced by the patient in terms of VAS scores. There was no difference in alleviating nasal decongestion between the 2 groups.

An atypical case of Kartagener’s syndrome

<p class="abstract"><span lang="EN-IN">Kartagener’s syndrome is an autosomal recessive disease characterized by the tetrad of situs inversus, bronchiectasis, sinusitis and infertility. It is a subset of a larger group of disease known as primary ciliary dyskinesia. A 23 year old male patient presented to our hospital with complaints of Right sided headache for the past 3 weeks. General Physical examination was normal except that the heart sounds were heard over the right side. Dextrocardia was suspected. Routine ENT and Diagnostic nasal endoscopy examination revealed deviated septum towards the left along with pale greyish polyp like mass in the right nasal cavity. CT PNS was ordered. It showed bilateral frontal, ethmoidal and maxillary sinusitis with Right nasal polyp. Routine Blood investigations were normal but Chest X-ray showed dextrocardia with fundal shadow over the right side and normal ECG was obtained only when the chest leads were reversed. USG abdomen confirmed the suspicion of situs inversus totalis. To rule out Kartageners syndrome HRCT Chest was done which revealed normal lungs with no findings. Sperm analysis was also done which was normal except for the count (<15 million/ml). Saccharin test was performed and it was delayed (>20 min). Anesthetic fitness was obtained and he was taken up for surgery - Septoplasty with fess.<em> </em>The diagnosis of kartageners syndrome was done based on clinical and radiological findings, with variation in form of no bronchiectasis and oligospermia. This type of atypical presentation of Kartagener’s syndrome might be a rare sub type of the disease which is infrequently reported.</span></p>

MR Imaging-Based Evaluations of Olfactory Bulb Atrophy in Patients with Olfactory Dysfunction.

Although the olfactory bulb volume as assessed with MR imaging is known to reflect olfactory function, it is not always measured during olfactory pathway assessments in clinical settings. We aimed to evaluate the utility of visual olfactory bulb atrophy and neuropathy analyses using MR imaging in patients with olfactory dysfunction. Thirty-four patients who presented with subjective olfactory loss between March 2016 and February 2017 were included. Patients underwent a nasal endoscopic examination, olfactory testing with the Korean Version of the Sniffin' Sticks test, and MR imaging. All patients completed the Sino-Nasal Outcome Test and Questionnaire of Olfactory Disorders. Olfactory bulb atrophy and neuropathy were evaluated on MR images by 2 head and neck radiologists. The etiology of olfactory loss was chronic rhinosinusitis with/without nasal polyps in 15 (44.1%) patients, respiratory viral infection in 7 (20.6%), trauma in 2 (5.9%), and idiopathic in 10 (29.4%) patients. Although 10 (29.4%) of the 34 patients were normosmic according to the Sniffin' Sticks test, their scores on the other tests were like those of patients who were hyposmic/anosmic according to the Sniffin' Sticks test. However, the detection rate of olfactory bulb atrophy was significantly higher in patients with hyposmia/anosmia than it was in patients with normosmia (P = .002). No difference in olfactory bulb neuropathy was identified among patients with normosmia and hyposmia/anosmia (P = .395). MR imaging evaluations of olfactory bulb atrophy can be used to objectively diagnose olfactory dysfunction in patients with subjective olfactory loss.

Identification of Nasal Irrigation Bottle Contamination in Post Sinonasal Surgery.

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, fluid from the bottle and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs will be taken from the nasal irrigation bottle and patient's middle meatus before the surgery and at each post surgery visits (2 and 4weeks). Patients will be advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient's nasal cavity at 2 and 4weeks, any evidence of infection will be noted and documented. Additionally, a swab of fluid irrigated from the nasal cavity collected during the clinic follow-ups will also be taken. The specimens will be sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n=15) and control (n=12) groups. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (P=0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp. group. Other groups of bacteria that were cultured were Enterobacter sp., Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.

Pre- and post-operative application of acoustic rhinometry in children with otitis media with effusion and with or without adenoid hypertrophy-a retrospective analysis

BackgroundThere is no standardized scheme for preoperative evaluation of adenoid hypertrophy or a consensus on surgical indications for adenoidectomy in children with otitis media with effusion (OME), especially for young children intolerant to nasal endoscopic assessment. The aim of this study was to evaluate the efficacy and reliability of acoustic rhinometry (AR) in evaluating benefits from adenoidectomy in children with OME. MethodChildren with OME who were scheduled for surgical intervention were reviewed and AR tests performed preoperatively and postoperatively. The patients were divided into two groups based on the surgical strategy (Group I: tympanostomy tube placement alone; Group II: tympanostomy tube placement plus adenoidectomy). Correlation and regression analyses were performed to assess the relationship between findings of AR and nasal endoscopy. AR parameters including minimal nasal cross-sectional area (MCA), and nasopharyngeal volume (NPV), as well as scores of subjective symptoms were obtained to evaluate the utility of AR pre- and post-surgery. ResultsSixty-five children aged 4–10 years who met the inclusion criteria were included. No significant differences in gender or age distribution were observed between Group I and Group II. MCA, as well as NPV significantly decreased in Group II when compared with Group I (p = 0.000). A significant inverse correlation was observed between NPV and choanal obstruction ratio in both groups I (r = -0.625, p < 0.001) and II (r = −0.570, p < 0.001). A significant difference between preoperative and postoperative NPV and subjective symptom scores was observed in group II after adenoidectomy (p = 0.000). ConclusionAR parameters showed a good clinical correlation with findings of nasal endoscopy and thus may be useful for evaluating candidacy for surgical adenoidectomy among children with OME, especially in whom preoperative nasal endoscopic examination is not feasible. Additionally, AR can reveal the changes occurring within the nasopharyngeal passage before and after adenoidectomy.

The imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid rhinorrhea in patients with pituitary tumor

Objective To investigate the imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid (CSF) rhinorrhea in patients with pituitary tumor. Methods From June 2009 to November 2014 there were 23 cases with delayed CSF rhinorrhea in our hospital, which occurred one year to 5 years after the operation for pituitary tumor. Pituitary hormone assay, head MRI, cisternal CT and nasal endoscopic examination were performed in all patients. After definite diagnosis the patients underwent nasal endoscopic repair surgery of CSF rhinorrhea. During the operation, large leakage orifices were packed with muscle, and then patched with xenogenic acellular dermal matrix, while the small ones were directly patched with xenogenic acellular dermal matrix after tumor resection, and the sphenoid sinus was packed with gelatin sponge and iodoform gauze. Results Patients were hospitalized for 3 to 5 weeks. Among them, 20 patients were successfully recured after one nasal endoscopic repair surgery, 2 underwent the second surgery, and one underwent the third surgery. Patients were followed up for 3 months to 5 years with no CSF rhinorrhea reoccurred. Conclusions Delayed postoperative CSF rhinorrhea in patients with pituitary tumor were likely due to residual tumor growth and postoperative radiotherapy. Pituitary tumor often occur in sella, thus nasal endoscopic resection and repair surgery is feasible in treatment. The surgery is safe and the success rate is high. DOI: 10.3969/j.issn.1672-6731.2017.09.012

The effect of closed septorhinoplasty on nasal functions and on external and internal nasal valves: A prospective study.

Because nasal function and shape are so closely intertwined, quantitative assessments can better define their relationship and how they are affected by septorhinoplasty. The aim of this prospective study was to perform an analysis of the nasal airflow resistances and a three-dimensional (3D) evaluation of the soft-tissue changes after closed septorhinoplasty. Before surgery (T0) and 6 months after closed septorhinoplasty (T1), 30 patients underwent symptoms evaluation by means of the Italian version of the Nasal Obstruction Symptom Evaluation scale, endoscopic fiberoptic nasal examination, and visual analog scale for subjective assessment of nasal obstruction. Nasal airflow resistances were investigated with active anterior active rhinomanometry. A 3D laser scanner was used to evaluate facial soft-tissues, with specific nasal points and angles. Subjective nasal obstruction decreased. Anterior active rhinomanometry demonstrated a reduction in total inspiratory and expiratory resistances between T0 and T1 but without statistical significance. The significance was still absent after decongestion, excluding turbinate hypertrophy as a cause of failed objective amelioration of nasal resistance. Facial laser scanning showed statistically significant reduction of the superior nasal width and superior alar angle, and a weak negative correlation between the superior alar angle and nasal resistances. The absence of objective reduction of nasal airflow resistances could be the result of concurrent surgery on nasal septum and nasal valve. In particular, the ameliorating effect on nasal airflow resistances is counterbalanced by the worsening effect of the narrowing of nasal valve.

Analysis of Plasma Epstein–Barr Virus DNA to Screen for Nasopharyngeal Cancer

BackgroundCirculating cell-free Epstein–Barr virus (EBV) DNA is a biomarker for nasopharyngeal carcinoma. We conducted a prospective study to investigate whether EBV DNA in plasma samples would be useful to screen for early nasopharyngeal carcinoma in asymptomatic persons.MethodsWe analyzed EBV DNA in plasma specimens to screen participants who did not have symptoms of nasopharyngeal carcinoma. Participants with initially positive results were retested approximately 4 weeks later, and those with persistently positive EBV DNA in plasma underwent nasal endoscopic examination and magnetic resonance imaging (MRI).ResultsA total of 20,174 participants underwent screening. EBV DNA was detectable in plasma samples obtained from 1112 participants (5.5%), and 309 (1.5% of all participants and 27.8% of those who initially tested positive) had persistently positive results on the repeated sample. Among these 309 participants, 300 underwent endoscopic examination, and 275 underwent both endoscopic examination and MRI; of these participants, 34 had nasopharyngeal carcinoma. A significantly higher proportion of participants with nasopharyngeal carcinoma that was identified by screening had stage I or II disease than in a historical cohort (71% vs. 20%, P<0.001 by the chi-square test) and had superior 3-year progression-free survival (97% vs. 70%; hazard ratio, 0.10; 95% confidence interval, 0.05 to 0.18). Nine participants declined to undergo further testing, and 1 of them presented with advanced nasopharyngeal carcinoma 32 months after enrollment. Nasopharyngeal carcinoma developed in only 1 participant with negative EBV DNA in plasma samples within 1 year after testing. The sensitivity and specificity of EBV DNA in plasma samples in screening for nasopharyngeal carcinoma were 97.1% and 98.6%, respectively.ConclusionsAnalysis of EBV DNA in plasma samples was useful in screening for early asymptomatic nasopharyngeal carcinoma. Nasopharyngeal carcinoma was detected significantly earlier and outcomes were better in participants who were identified by screening than in those in a historical cohort. (Funded by the Kadoorie Charitable Foundation and the Research Grants Council of the Hong Kong government; ClinicalTrials.gov number, NCT02063399.)

Endoscopic intranasal findings in unilateral primary acquired nasolacrimal duct obstruction

PurposeTo evaluate intranasal endoscopic findings in patients with unilateral primary acquired nasolacrimal duct obstruction and compare them with the normal cohort. MethodsA prospective case-control study with 50 unilateral primary acquired nasolacrimal duct obstruction (PANDO) and 50 healthy controls. All patients were evaluated by endoscopic nasal examination for the presence of deviated nasal septum (DNS), type of deviation (bony or cartilaginous), side of deviation, septal spurs, caudal dislocation, any turbinate hypertrophy and endoscopic features suggestive of sinusitis. ResultsA significant increase in the incidence of nasal septal deviation was found in PANDO cases (60%, 30/50) compared to controls (36%; 18/50; P=0.03). The laterality of septal deviation corresponded to the side of NLD obstruction in 90% (27/30) cases. Higher location of DNS (73% vs 22%; P=0.0009) and bony deviation (77% vs 44%; P=0.02) were observed among study group as compared to controls. The odds of having NLD obstruction are 2.7 times more among individuals having septal deviation versus no deviation (95% CI, 1.19–5.99). ConclusionUnilateral PANDO has a higher incidence of ipsilaterally deviated nasal septum. This association is significant. Routine nasal endoscopic examination should be performed in cases undergoing dacryocystorhinostomy to better plan a concomitant septoplasty if needed.

Smell and Taste Impairment After Total Laryngectomy.

Aim of this observational study is the evaluation of olfactory and gustatory impairments in laryngectomized long-term survivors compared to control subjects. Correlation between smell and taste alterations, age, and previous adjuvant treatments in laryngectomees was investigated. Fifty control subjects and 50 patients who underwent total laryngectomy for advanced laryngeal carcinoma were evaluated. All subjects underwent symptoms evaluation, oropharyngeal exam, endoscopic fiberoptic nasal examination, and Taste Strips and Sniffin' Sticks tests. Hyposmia was reported by all laryngectomees and hypogeusia by 54% of patients. Sniffin' Sticks and Taste Strips tests demonstrated a statistically significant difference between controls and laryngectomees regarding olfactory threshold, odor discrimination and identification, Threshold Discrimination Identification (TDI) score, and sour, salty, and gustatory Total Taste score ( P < .05). Multivariate analysis for Total Taste score in laryngectomees showed a statistically significant correlation with aging, having an odds ratio of 0.127 for age ≥65 years, but not with TDI score, radiotherapy, and follow-up time, whereas multivariate analysis for TDI score demonstrated no correlation with radiotherapy, age, and follow-up time. Total laryngectomy determines olfactory and gustatory impairments that should be taken into account in clinical practice. Relationships between sensorial alterations, aging, follow-up period, and adjuvant treatments should be further evaluated in prospective studies.

Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method.

Congenital choanal atresia (CCA) is a very rare abnormality of the nose, but in the case of bilateral presence, it becomes a life-threatening malformation. Various surgical treatment options, such as transpalatal, transseptal, and open rhinoplasty techniques, as well as the transnasal approach, have been defined for the repair of CCA. In this study, the authors intended to evaluate the outcomes of transnasal endoscopic surgery for CCA, and stent implementation's impact on surgical success. Patients who were admitted to the Otorhinolaryngology Department of Gaziantep University and patients who had not undergone CCA surgery before were included in the study. Patients who underwent transnasal endoscopic choanal atresia surgery (TECAS) were advised to have regular nasal endoscopic examinations performed at check-ups; after a 6-month follow-up period, surgical results were evaluated concerning whether stenosis had occurred or not. Of the 48 patients who underwent TECAS after a minimum 6-month follow-up period, 34 of patients revealed no stenosis, so the overall surgical success rate was 70.8%. Fourteen (29.2%) patients who underwent TECAS developed stenosis and required revision surgery. Transnasal endoscopic choanal atresia surgery is the most preferred approach for CCA repair and has many advantages, such as excellent vision, shorter operative time, minimal bleeding, and minimum complication. Despite advances in endovision systems and surgical instruments, stenosis is the most challenging problem after TECAS, so new treatment strategies should be developed to prevent stenosis.

Sinonasal tumours: a clinical study and management

Background: Sinonasal tumours are rare. Malignant lesions are more common than benign ones and prognosis is grave. This study was undertaken to understand clinical and histological features in addition to diagnostic workup, treatment outcomes, survival and prognostic factors of sinonasal tumours.Methods: Time bound descriptive study at Department of ENT, KIMS, HUBLI, of 31 patients presenting with features suggestive of sinonasal tumours from October 2014 to September 2016. All patients were subjected to diagnostic nasal endoscopy, biopsy and radiological assessment of nose and paranasal Sinuses.Results: 31 patients with sinonasal tumours were included in study group. Male patients outnumbered the female patients (2.4:1). Cigarette smoking was found to be important risk factor and was statistically significant(p&lt;0.05). Patients mainly presented with complaints like nasal obstruction, nasal discharge, headache, hyposmia/ anosmia, facial swelling, facial pain, etc. Malignant tumours were more than benign tumours. JNA and IP were most common among benign and SCC was most common among malignant tumours.Conclusions: Sinonasal tumours are rare. Early diagnosis is important. Nasal endoscopic examination and CT scan can diagnose sinonasal tumours at an early stage. With many etiological factors analysed, cigarette smoking was found to be an important risk factor even for sinonasal tumours.

The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty.

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4days). However, 1week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

Long-term Results of Combined Rhinoplasty and Septal Perforation Repair.

Combined rhinoplasty and septal perforation repair is a technically challenging procedure, and few studies have reported the outcomes. To present the long-term surgical results of rhinoplasty with concurrent septal perforation repair. This retrospective study included 17 patients who underwent rhinoplasty with concurrent septal perforation repair at a tertiary academic medical center from March 2005, through March 2015. Patients had a mean postoperative follow-up duration of 50.9 months. The etiology of the deformity, presenting symptoms, perforation size, intraoperative surgical techniques, and complications were analyzed. Final follow-up was completed on March 31, 2015. Postoperative subjective (telephone survey of patient satisfaction) and objective (Objective Rhinoplasty Outcome Score) patient satisfaction and endoscopic nasal cavity examination at the last follow-up. Among the 17 patients (14 men; 3 women; mean [SD] age, 40 [16] years), 12 (71%) had previously undergone septoplasty and/or septorhinoplasty, 4 (24%) had nasal trauma, and 1 (6%) had an unknown cause. The main aesthetic reasons for rhinoplasty were a saddle nose deformity (10 patients [59%]) and deviated nose related to a previous surgery or trauma (5 patients [29%]). The functional reasons for surgery included nasal obstruction (14 patients [82%]) crusting (2 patients [12%]), epistaxis (1 patient [6%]), and whistling (1 patient [6%]). The perforation size varied from 2 to 30 mm, with a mean of 14.3 mm. Surgery was performed through the open rhinoplasty approach. Perforations were first closed with an advancement flap in 6 patients, rotation flap in 6 patients, a combination of both in 4 patients, and a combination of advancement flap and free mucosal graft in 1 patient, with or without interposition grafts. Rhinoplasty was performed with various grafts, maneuvers, and septal reconstruction. Complete closure with symptom relief was achieved in 15 patients (88%). The mean objective score evaluating the rhinoplasty results was 3.4 (on a scale of 0-4, where 3.4 is good to excellent). No serious complications occurred after surgery. Concurrent rhinoplasty and nasal septal perforation repair is a safe and effective option when necessary. The open rhinoplasty approach facilitated septal perforation closure, whereas septal perforation repair did not affect the surgical result of rhinoplasty. 4.

Chronic Rhinosinusitis Patient with Nasal Polyp Characteristics at Otorhinolaryngology-Head and Neck Surgery Outpatient Clinic, Dr. Hasan Sadikin General Hospital, Bandung

Objective: To evaluate chronic rhinosinusitis (CRS) with nasal polyp (NP) characteristics in patients with routine visits to the Otolaryngology-Head and Neck Surgery outpatient clinic of Dr. Hasan Sadikin General Hospital, Bandung. Methods: This descriptive retrospective cross-sectional study was conducted at the Rhinology-Allergy Outpatient Clinic, Departement of Otolaryngology-Head and Neck Surgery, Dr. Hasan Sadikin General Hospital, Bandung, in the period of January 2014 to December 2014. Data were obtained from medical records and the sampling method used was total sampling. A total of 100 CRS with NP patients were evaluated. Nasal endoscopy examinations were performed. Patients were classified based on age into 10–20 years, 21–31 years, 32–42 years, 43–53 years, and >54 years groups. Results: Chronic rhinosinusitis with NP incidences were mostly found in male patients compared to females. There were several CRS cases with NP risk factors, including smoking and allergy. Conclusions: In the study, CRS with NP patients may possibly have one or more risk factors. Smoking is the major risk factor from CRS with NP after allergy. Keywords: Nasal polyp, nasal endoscopy, rhinosinusitis, risk factor DOI: 10.15850/ijihs.v4n2.834

Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy.

To examine the surgical outcome of three-flap external dacryocystorhinostomy (3-flap ex-DCR) based on the most common site of granulation occurrence in no-flap endonasal DCR (no-flap en-DCR). This was a retrospective observational study. We first examined the location of granulation occurrence in the osteotomy site using nasal endoscopy after no-flap en-DCR on 53 sides of 37 patients (5 male, 32 female) with nasolacrimal duct obstruction. Based on the results of this surgery, we performed 3-flap ex-DCR on 70 sides of 61 patients (18 male, 43 female) with nasolacrimal duct obstruction. Anatomical success was defined as no reflux under lacrimal irrigation and a patent osteotomy site under nasal endoscopic examination at postoperative 12months. Functional success was defined as no symptoms of watery eyes over the same period. In the no-flap en-DCR patients, the granulation was formed in 42 sides (79.2%): 18 sides (34.0%) on the superior portion, 9 sides (17.0%) on the inferior portion, 35 sides (66.0%) on the anterior portion, and only 1 side (1.9%) on the posterior portion, which was very small. Based on these results, we performed the 3-flap ex-DCR with the anterior, superior, and inferior flaps. Anatomical success with this technique was achieved in all sides (100%), and functional success was obtained in 66 of 70 sides (94.3%). The 3-flap ex-DCR did not cause recurrent nasolacrimal duct obstruction, rendering it a very useful technique in terms of quality of life and medical economics.

Retropharyngeal liposarcoma: A rare cause of dysphagia

IntroductionLiposarcoma is a rare malignant mesenchymal tumour. Very few cases of retropharyngeal liposarcoma have been reported in the literature. SummaryA 30-year-old woman with no notable history reported swallowing disorders for the past year associated with dysphonia. Nasal endoscopic examination demonstrated a tumour arising from the left lateral pharyngeal wall, ascending as far as the junction of the free margin of the epiglottis, aryepiglottic fold, and pharyngoepiglottic fold and obliterating the ipsilateral pyriform sinus with preservation of cord mobility. The rest of the physical examination was normal. The preoperative assessment was completed by gadolinium-enhanced MRI of the neck. Open surgery was performed. Definitive histological examination concluded on dedifferentiated liposarcoma with negative resection margins. Following staging chest computed tomography that did not reveal any metastases, the multidisciplinary consultation meeting decided to deliver adjuvant volumetric modulated arc therapy. No recurrence was observed nine months post-treatment. DiscussionRetropharyngeal liposarcoma is a rare tumour. The authors report the first case of a dedifferentiated histological subtype in this site. A review of the literature completes this case report by providing a description of prognostic factors and the various treatments.