Nasal Obstruction Research Articles

Diagnostic Accuracy of X-Ray PNS for Paranasal Sinuses (X-Ray PNS) Sinus Pathologies with Computed Tomography Paranasal Sinuses (CT PNS) A The Gold Standard

OBJECTIVES To determine the diagnostic accuracy of X-ray PNS in different pathologies of paranasal sinuses, using CT PNS as the gold standard, and establishing X-ray PNS as a potential first-line screening tool. METHODOLOGY This cross-sectional study was conducted over two years in the Department of Radiology, Rehman Medical Institute Peshawar. 100 patients in the sample with suspected PNS pathologies were selected through the purposive sampling technique, aged 18-70. All patients underwent X-ray PNS initially, followed by CT scans. CT PNS was performed even in cases with normal X-ray findings to check for false negatives or positives. RESULTSOut of 100 patients, 56% were male. Most PNS pathologies (55%) were in the 15-35 age group (mean age 24 years, SD ±3.89). The most common symptoms were nasal obstruction (40%) and headache (39%). X-ray PNS showed 67% sensitivity, 60% specificity, 85% PPV, and 64% NPV. The overall diagnostic accuracy of X-ray PNS was 66% compared to CT PNS. CONCLUSION X-ray PNS demonstrates a diagnostic accuracy of 66% in diagnosing PNS pathologies. While not as comprehensive as CBCT, X-ray PNS shows potential as a first-line screening tool, particularly for larger sinuses, potentially reducing unnecessary radiation exposure from CT scans.

Effects of unilateral nasal obstruction on mandibular condyle in mice of different ages: An exploration based on H-type angiogenesis coupling osteogenesis.

Nasal obstruction leads to a hypoxia condition throughout the entire body. In this study, the unilateral nasal obstruction (UNO) mouse model was established by blocking the left nostril of mice. The aim of this study was to investigate the effects of UNO-induced hypoxia on mandibular condyle in juvenile (3-week-old), adolescent (6-week-old) and adult (12-week-old) male C57BL/6J mice from the perspective of H-type angiogenesis coupling osteogenesis. Firstly, UNO exerted a significant inhibitory effect on weight gain in mice of all ages. However, only in adolescent mice did UNO have an obvious detrimental effect on femoral bone mass accrual. Subsequently, micro-computed tomography (CT) analysis of mandibular condylar bone mass revealed that UNO significantly retarded condylar head volume gain but increased condylar head trabecular number (Tb.N) in juvenile and adolescent mice. Furthermore, UNO promoted the ratio of proliferative layer to cartilage layer in condylar cartilage and facilitated the chondrocyte-to-osteoblast transformation in juvenile and adolescent mice. Moreover, although UNO enhanced the positive expression of hypoxia-inducible factor (HIF)-1α in the condylar subchondral bone of mice in all ages, an increase in H-type vessels and Osterix+ cells was only detected in juvenile and adolescent mice. In summary, on the one hand, in terms of condylar morphology, UNO has a negative effect on condylar growth, hindering the increase in condylar head volume in juvenile and adolescent mice. However, on the other hand, in terms of condylar microstructure, UNO has a positive effect on condylar osteogenesis, promoting the increase of condylar Tb.N, chondrocyte-to-osteoblast transformation, HIF-1α expression, H-type angiogenesis and Osterix+ cells in juvenile and adolescent mice. Although the changes in condylar morphology and microstructure caused by UNO have not yet been fully elucidated, these findings improve our current understanding of the effects of UNO on condylar bone homeostasis.

Demographic and Clinical Features of Allergic Rhinitis Presenting at a Postgraduate Teaching Hospital

Allergic rhinitis is a common disorder that affects millions worldwide and it represents a global concern. Objective: To determine the frequency of clinical variables, and demographic pattern of the allergic rhinitis patients in the otorhinolaryngology outpatient department in a Teaching Hospital. Methods: This cross-sectional study was conducted at the Department of Ear, Nose, and Throat of Kulsumbai Valik Site Postgraduate Teaching Hospital Karachi from 1st July 2022 to 31st December 2023. The study comprised allergic rhinitis patients. A total of 750 patients were included in this study after diagnosing allergic Rhinitis mentioned on their prescription. Data were collected properly on a predesigned questionnaire. Variables included age, gender, socioeconomic status, residence, sneezing, itching in the eye and nose, rhinorrhea, nasal discharge, bluish pale nasal mucosa (Nasal Congestion), edematous turbinate, and headache. Data were entered in SPSS software version 23.0 and analyzed. Results: The mean age of patients were 39 ± 13 years. Male were reported 447 (59.6%) and female patients were 303 (40.4%). 390 (52%) patients have resided in Industrial areas while 360 (48%) patients were in city areas. The most common symptom was nasal itching 522 (69.6%) followed by rhinorrhea 492 (65%) and nasal discharge 465(62%). Conclusions: It was concluded that allergic rhinitis patients presenting at the ENT outpatient department showed that males were commonly affected with the productive age group 59% of males suffered from Allergic Rhinitis. The most frequent and common symptom was nasal itching (69.6%) followed by rhinorrhea (65%) and nasal discharge (62%).

Efficacy and Safety of Mometasone Furoate Nasal Spray in Treating Nasal Polyposis: A Systematic Review and Meta-Analysis.

Topical and systemic corticosteroids are the most effective medical treatment for nasal polyps, this study aims to systematically explore the efficacy and safety of mometasone furoate (MTF) for patients with nasal polyps (NP). The systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and was registered in The International Prospective Register of Systematic Reviews (PROSPERO.) Data were extracted from relevant and appropriate randomized controlled trials (RCTs) of synthetic corticosteroids for patients with nasal polyps from PubMed, Google Scholar, Web of Science, and Science Direct, encompassing studies published between January 1995 and July 2024. A total of 834 publications were found based on the search criteria. Around 1,710 patients were reviewed for this systematic review from full full-text articles. Primary outcomes include achange in polyp size(assessed by total polyp size scores), and nasal congestion (assessed by measuring changes from baseline in nasal congestion/obstruction scores). secondary outcomes consist of nasal symptoms, including loss of smell, anterior rhinorrhea, postnasal drip, quality of life outcomes, and adverse events. Mometasone furoate nasal spray (MFNS) significantly improves nasal symptoms and reduces nasal polyp size for patients with nasal polyps (NP).

Mild and symptom-free months in patients with chronic rhinosinusitis with nasal polyps treated with dupilumab

BackgroundFrequently reported outcomes of clinical trials in chronic rhinosinusitis with nasal polyps (CRSwNP) may have limited relatability for patients. ObjectiveTo enhance the patient relatability of outcomes in dupilumab clinical trials for CRSwNP, daily symptom scores were used to determine new patient‑centered end points: mild-to-no-symptom months (MSM) and symptom-free months (SFM). MethodsThis work is a post hoc analysis of patients receiving dupilumab 300 mg or placebo every 2 weeks for 24 weeks (SINUS-24 study; NCT02912468) or 52 weeks (SINUS‑52; NCT02898454). Patients recorded symptom severity scores daily for each of nasal congestion, loss of smell, and anterior and posterior rhinorrhea on a scale of 0 to 3 (0 = no symptoms; 1 = mild; 2 = moderate; 3 = severe). We assessed the proportions of patients reporting only MSM or SFM throughout the 28‑day period before randomization, week 24 (pooled studies), and week 52 (SINUS‑52). ResultsSignificantly more dupilumab‑treated than placebo-treated patients achieved MSM for all 4 symptoms (week 24: 31.0% vs 4.4%; odds ratio [OR] 12.9 [95% CI 6.4-25.8]; week 52: 38.3% vs 2.6%; OR 15.6 [5.9-41.0]; both P < .0001). In addition, significantly more dupilumab-treated than placebo‑treated patients achieved SFM for at least 1 of the 4 symptoms (week 24: 35.4% vs 10.8%; OR 4.9 [95% CI 3.1-7.8]; week 52: 50.0% vs 9.2%; OR 9.1 [95% CI 4.6-17.9]; both P < .0001). ConclusionOne-third of patients with severe CRSwNP treated with dupilumab achieved MSM for all 4 cardinal symptoms (nasal congestion, loss of smell, and anterior and posterior rhinorrhea). Moreover, half of the patients achieved SFM for at least 1 of the 4 symptoms. These results support the benefit of dupilumab in improving patient‑centered outcomes. Trial RegistrationClinicalTrials.gov Identifiers: NCT02912468 (SINUS-24) and NCT02898454 (SINUS-52).

Secondary Contouring for the Butterfly Graft: Improving Form and Preserving Function.

The butterfly graft (BFG) secondary contouring procedure addresses external nasal irregularities following the primary BFG surgery. We explore demographic factors associated with the desire for secondary contouring and assess patient-reported outcomes following the procedure. A retrospective analysis of 374 patients undergoing BFG between April 2020 and April 2023 identified 10 individuals electing for secondary contouring. Demographics, Nasal Obstruction Symptoms Evaluation (NOSE) scores, Rhinosinusitis Disability Index (RSDI), and decision regret scale (DRS) were collected and reported. Secondary contouring rate was 2.7% of total cases. The majority of patients desiring BFG secondary contouring were white females (90%). NOSE scores significantly improved post-primary surgery (mean change: 51.7, SD: 14.01, p-value: <0.05). Although overall NOSE scores remained improved after secondary contouring (mean change: 47.2, SD: 18.84, p-value: <0.05) compared with their preoperative NOSE scores, one patient (10%) reported worse score after secondary contouring. Four patients (40%) reported worsening after secondary contouring compared with after initial BFG surgery. DRS indicated minimal regret from patients. BFG secondary contouring is a valuable option for patients with external nasal complaints, providing improvements in nasal appearance and durable improvement in breathing outcomes. We emphasize the importance of patient counseling and appropriate patient selection. Our results suggest that patients should expect a slight worsening of NOSE scores following secondary contouring, but that significant worsening is a low risk. Level 4: Case series Laryngoscope, 2024.

A patient report scale research to access the symptom burden in patients with IgA nephropathy

Patients diagnosed with IgA nephropathy (IgAN) commonly experience a substantial burden of symptoms encompassing both physical and psychological aspects. Presently, there's a dearth of standardized assessment tools to effectively gauge the extent of symptom burden in IgAN patients. Therefore, this study aims to devise an IgAN Symptom Assessment Tool that enables a comprehensive evaluation of patient symptom burden and their self-perceived severity. Employing a prospective observational design, this study conducted a survey among patients diagnosed with IgAN at a hospital in China. The research team formulated an IgAN Symptom Burden Assessment Scale and administered a questionnaire to gauge patient symptom burden. Severity assessment was conducted on a 5-point Likert scale, with higher scores indicating a more pronounced burden of symptoms. The finalized scale comprised 14 distinct symptom items, and the questionnaire survey garnered responses from 200 patients, achieving a 100% response rate. Statistical analysis unveiled that nearly all patients regarded these symptoms as prevalent and significantly impactful on their daily lives, resulting in a considerable burden. Notably, mild oliguria, moderate nasal congestion, bitter taste , throat discomfort, alongside severe manifestations such as muscle weakness, fatigue, and foamy urine, were frequently reported by patients. The findings underscore that a substantial proportion of IgAN patients grapple with a significant burden of symptoms, emphasizing the imperative for healthcare providers to prioritize symptom management and implement proactive measures to alleviate these challenges. This study presents an innovative tool tailored for evaluating symptom burden specifically in IgAN patients. Subsequent research should center on validating this tool within larger patient cohorts to optimize the efficacy of symptom management in this demographic.

An Observational Study on the Treatment Outcomes of Adenotonsillar Hypertrophy in Children

Background: Adenotonsillar hypertrophy, marked by abnormal enlargement of the adenoids and tonsils, is common in children and can cause various health issues. For severe cases, surgical intervention, mainly adenotonsillectomy, is often recommended and has proven effective in improving airway obstruction, sleep quality, and overall health outcomes. This study aimed to assess the treatment Outcomes of adenotonsillar hypertrophy in children. Methods: This prospective observational study was conducted in the Department of Head &amp; Neck Surgery (ENT), Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from January 2023 to June 2023. A total of 57 children with primary symptoms of mouth breathing, snoring, and sleep disturbances were purposively enrolled as study subjects. For data analysis, MS Office tools were applied. Results: Most participants (61.4%) were aged 2-5 years and female (60%). All participants (100%) reported symptoms of nasal blockage, snoring, and mouth breathing. A majority (61.4%) had grade 2 tonsillar hypertrophy. After 3 months of medical treatment, 57.9% experienced complete relief of nasal symptoms, including sleep apnea, 24.6% showed moderate improvement, and 17.5% saw no improvement. Conclusion: Intranasal steroids, combined with oral amoxicillin e-clavulanic acid and montelukast, reduce adenotonsillar hypertrophy symptoms and lower surgical intervention rates. This approach targets inflammation and infection, potentially improving patients' quality of life. More studies are needed to establish guidelines and optimize treatment.

Expert perspectives on the prescription pattern of levocetirizine₊montelukast and fexofenadine₊montelukast for the management of allergic rhinitis in the Indian settings

Background: Studies have shown that oral antihistamines are considered as the gold-standard therapy for allergic rhinitis. However, there is dearth of studies among clinicians, so this study aimed to gather expert opinion on the prescribing pattern of levocetirizine₊montelukast and fexofenadine₊montelukast for managing AR in India. Methods: This cross-sectional study, conducted through a multi-response questionnaire comprising 24 questions, gathered insights from experts across diverse Indian settings. It explored perspectives on clinical observations, experiences, demographic profiles, treatment characteristics in AR, and the utilization of fexofenadine₊montelukast and levocetirizine₊montelukast for AR management in clinical practice. The data were analyzed through descriptive analysis. Results: Majority of clinicians (52%) preferred levocetirizine₊montelukast for AR, with half of them recommending a 2-week course. Additionally, 38% of clinicians noted its effectiveness in addressing all AR symptoms. Most clinicians agreed that levocetirizine and montelukast combination therapy was effective in improving nighttime nasal symptoms (74%) and nasal congestion (69%). Furthermore, majority of clinicians acknowledged that the combination offers both immediate (74%) and long-term (56%) relief from AR symptoms. Approximately 58% of the healthcare providers reported overall improvement across categories with fexofenadine₊montelukast, encompassing daytime nasal symptoms, nighttime nasal symptoms, and daytime eye symptoms. Conclusion: Clinicians recommended the combination of levocetirizine₊montelukast and fexofenadine₊montelukast to manage AR. Levocetirizine₊montelukast combination was preferred by clinicians for its efficacy in alleviating nighttime nasal symptoms and congestion. Fexofenadine₊montelukast combination was also endorsed for overall improvement across various symptoms.

Computed Tomography Analysis of the Nasal Septal Deviation and Related Paranasal Sinus Pathologies

Purpose: Nasal Septum Deviation (NSD), which is defined as a dislocated septum, is a prevalent condition that is mostly asymptomatic; however, it can cause difficulties such as nasal obstruction and rhinosinusitis symptoms. Other Paranasal Sinuses (PNS) disorders, e.g., Osteo Meatal Complex (OMC) obstruction, have been assumed to be correlated with NSD. This study investigates the possible correlation of specific radiological findings of PNS pathologies in patients with or without the existence and direction of NSD. We also discussed the different types of NSD and their incidence among different groups stored by age, gender, etc. Materials and Methods: This is a cross-sectional study conducted at multiple imaging centers in Iran between July 2019 and February 2020 to estimate the prevalence of deviated nasal septum and correlate between NSD and other findings using paranasal sinus scans. All the individuals who met the inclusion and exclusion criteria were included in the study. NSD types have been classified based on Mladina's method. Results: We prospectively reviewed PNS Computed Tomography (CT) scans obtained from 254 cases (82 men and 172 women), aged 18 to 81 years (mean: 35.53), evaluated over seven months. Out of 254 cases, 135 (53 %) patients had NSD, without any direction predominance (right-sided vs. left-sided), and equally distributed between genders. The most common NSD types were type V with a frequency of 42.22% and type III with a frequency of 24.44%. Other PNS CT findings were also investigated in our patients, like OMC obstruction, pansinusitis, mucocele, air-fluid level, mucosal thickening, and concha bullosa. There was no statistically significant correlation between any of these pathologies and NSD (P-value &gt; 0.05). Conclusion: Although NSD was observed in more than half of our cases' PNS CTs, there was no significant correlation between NSD and other findings in most subjects. This reveals that the effectiveness of septal repair surgeries in relieving patients' symptoms might not be as high as expected.

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.

A rare presentation of nasopharyngeal mass: a case report

A Thornwaldt's cyst develops in the nasopharynx, which is the region where the throat and nasal passageways converge, extending from the back of the nasal tube to above the soft palate. A painful throat, obstruction of the eustachian tube, and pus with an unpleasant taste and odour might result from an infection of the cyst. Here in our study, we report a case of a 27-year-old male presented with symptoms of nasal obstruction and voice change for the past 1 year. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the roof of the nasopharynx without bony erosion of skull base. Further based on his radiological investigations, heterogeneous hyperintense lesion in T1/T2 weighted images of size 5×5 mm noted in nasopharynx most likely to be the Thornwaldt’s cyst. Thus, the surgical removal of the nasopharyngeal mass has been performed through a transoral and trans nasal endoscopic technique with no remnants at the surgical site. The histopathological findings revealed respiratory-type epithelium with underlying lymphoid tissue confirming Thornwald’s cyst as diagnosis. The patient was discharged with no complications and have been periodically advised for a follow-up. The differential diagnosis should include a meningocele or meningo-encephalocele. Various therapeutic approaches, including endoscopic, transoral, or trans palatal surgical interventions, can be used for treatment of symptomatic cysts.

The value of objective methods for assessing nasal breathing function in the diagnostic algorithm for allergic rhinitis

The visual analogue score (VAS) is recommended to assess the severity of symptoms of allergic rhinitis (AR), but despite its advantages, it is a tool for subjective assessment of symptoms and often does not correlate with the true state of nasal patency. Anterior active rhinomanometry (AAR) is the method to objectify obstructive changes in the nasal cavity in patients with AR and is the most accurate method to assess nasal breathing function from a physiological and aerodynamic point of view. In addition, AAR with a decongestant test allows a differential diagnosis of the causes of nasal obstruction. Our study showed that there was no correlation between VAS and AAR scores. In addition, we found the importance of performing AAR with a decongestant test and subsequent assessment of unilateral flow and resistance parameters, which allowed us to suspect the presence of structural changes in the nasal cavity in patients with AR, as recorded as a result of anterior rhinoscopy and/or endoscopic examination. Thus, in addition to the use of VAS, it is necessary to include AAR in the diagnostic algorithm for AR, which allows not only to confirm the presence or absence of nasal breathing impairment, but also to differentiate the causes of its occurrence for the subsequent selection of the optimal management of patients with AR.

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.

Clinical Outcomes After Innovative Multipoint Impedance-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve for Treatment of Chronic Rhinitis.

Objective: Chronic rhinitis substantially impacts a person's quality of life. We evaluated a novel, multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Methods: This was a prospective, multicenter, single-arm clinical study of posterior nasal nerve ablation in adults with chronic rhinitis. The primary efficacy endpoint was the change in reflective Total Nasal Symptom Score (rTNSS) at 6-month follow-up. Additional assessments included the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), Nasal Obstruction Symptom Evaluation (NOSE), and mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ). The primary safety endpoint was the incidence of related serious adverse events. Results: Seventy-nine of 80 enrolled participants completed 6-month follow-up. Statistically significant improvements were observed for mean change in rTNSS (-4.2), ETDQ-7 (-1.2), NOSE (-33.5), and mini-RQLQ (-1.8; P < .0001 for all). Allergic and nonallergic rhinitis subgroups demonstrated significant improvement in all assessments (P < .0001) with no significant differences between subgroups. Higher baseline rTNSS was associated with greater improvements at follow-up. One serious adverse event of epistaxis was reported. Conclusions: The results of this study demonstrate the efficacy and safety of a multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Significant improvements were observed in rTNSS, ETDQ-7, NOSE, and mini-RQLQ assessments.Study registration: www.clinicaltrials.gov. Unique identifier NCT05591989.

Sinonasal Outcomes Obtained after 2 Years of Treatment with Benralizumab in Patients with Severe Eosinophilic Asthma and CRSwNP: A "Real-Life" Observational Study.

Benralizumab is a monoclonal antibody that targets the interleukin-5 receptor (IL-5Rα), leading to the rapid depletion of blood eosinophils. RCTs have demonstrated efficacy in patients with severe eosinophilic asthma (SEA). The aim of this study was to assess the efficacy of benralizumab on sinonasal outcomes in a real-life setting in patients with SEA and concomitant chronic rhinosinusitis with nasal polyps (CRSwNP). We included 25 patients (mean age: 57.47 years, range: 35-77, F/M = 12:13) who were prescribed 30 mg benralizumab every month for the first three administrations and then every 2 months. The primary endpoint was to evaluate changes in the SinoNasal Outcome Test-22 (SNOT-22) and nasal polyp score (NPS) over a 24-month treatment period. Secondary endpoints included measuring the effects on nasal obstruction and impaired sense of smell. The mean NPS score decreased significantly from 5.11 ± 1.84 at baseline to 2.37 ± 1.96 at 24 months. The mean SNOT-22 decreased from 57 ± 15.30 at baseline to 26 ± 16.73 at 24 months. The SSIT-16 mean score improved with an increase in olfactory performance from 5.23 ± 2.58 at baseline to 7 ± 3.65 at 24 months. Moreover, 8/25 patients (32%) required rescue treatment with systemic steroids and 2 patients required endoscopic sinus surgery. While the improvement may not seem optimal at 12 months, a progressive enhancement was noted during the second year of treatment. Despite our data showing an improvement in quality of life and a reduction in the size of nasal polyps, no significant improvement in olfactory sensitivity was observed. In addition, in several patients, rescue treatments were required to maintain control of nasal and sinus symptoms. A careful risk-benefit assessment is therefore needed when deciding to continue treatment, weighing the potential for further improvement against the risks of complications. Such decisions should always be made in the context of a multidisciplinary team.

Sewing: A New Quilting Suture Method for Nasal Septum Repair

A deviated nasal septum leads to congestion and headaches. Surgery is the primary treatment, requiring careful postoperative septum positioning to prevent bleeding and hematoma. The study compared this method with nasal packing and traditional nasal septum suturing regarding surgical time, patient pain, nasal obstruction, and bleeding after septoplasty. The surgical time for nasal packing was significantly shorter than that for the other 2 suturing methods (P &lt; 0.0001), but there was no statistically significant difference between the two suture methods (P = 0.1358). The Visual Analog Scale scores showed that the pain in the packing group was significantly higher than that in the other 2 groups within 2 days after surgery (P &lt; 0.0001). The pain during suture removal was significantly higher in the packing group than in the “sewing group” (P &lt; 0.0001). The number of injuries to the outer wall of the nasal cavity by continuous suturing was significantly higher than that by sewing (P &lt; 0.0001). Tearing within 2 days after surgery was significantly higher in the packing group than in the other 2 groups (P &lt; 0.0001). Compared with nasal packing, nasal septum suturing can significantly reduce postoperative pain and tearing, improve comfort, and do not increase bleeding. The newly described nasal septum sewing method in this study has no difference in surgical time compared with the traditional suturing method and can reduce injuries to the outer wall of the nasal cavity. In addition, it is painless and easy to remove during suture removal.

Sinonasal intestinal-type adenocarcinoma in northern Portugal: a woodworker’s occupational hazard

Abstract Background Sinonasal carcinomas (SNC) constitute about 3% of all head and neck carcinomas, squamous cell carcinoma being the most common histologic subtype. Some geographical patterns in incidence are observed, as occupational exposure to wood dust is associated with intestinal-type adenocarcinoma (ITAC). Aims This study aims to describe the prevalence and characteristics of sinonasal ITAC cases in a region of northern Portugal with a robust wood industry. Methods A retrospective study of all sinonasal malignancies diagnosed over 5 years, in a tertiary hospital, primarily focused on ITAC subtypes. Data on sociodemographic and clinical variables were collected through electronic medical records and telephonic assessments. Results Of all 33 cases, 85% were ITAC. ITAC predominantly affected males (96%) with a mean age of 66.2 years. Most patients diagnosed with sinonasal ITAC had occupational wood dust exposure (96%), particularly to hardwoods. Initial symptoms included unilateral nasal obstruction (75%) and epistaxis (71%). Despite a median time of 3 months from symptoms to consultation, 50% presented at an advanced stage, with a 29% mortality rate. Conclusions Sinonasal ITAC is an occupational hazard of woodworkers and represents the vast majority of SNC in the region. This study advocates for targeted community interventions, emphasizing occupational safety measures and healthcare awareness to reduce morbimortality associated with this occupational cancer.

Clinical analysis of influenza in the neonatal intensive care unit

BackgroundThe aim was to investigate the clinical characteristics, treatment and prognosis of neonatal influenza.MethodsThe clinical data of 21 neonates who were diagnosed with influenza and admitted to the neonatal intensive care unit of Henan Provincial Children’s Hospital, China, between January 2023 and January 2024 were retrospectively analyzed.ResultsA total of 21 patients were admitted, including 14 with influenza A and 7 with influenza B. Eighteen of these patients were reported to have been exposed to family members with respiratory symptoms before hospitalization. Among all the patients’ mothers, only 1 received the influenza vaccine during pregnancy. Fifteen newborns had fever, 13 appetite loss, 10 cough, 9 shortness of breath, 9 nasal obstruction, 3 runny nose, 3 vomiting, 2 severe wheezing, 2 choking, 2 diarrhea, 1 bloating, and 1 sputum in the throat. The pulmonary auscultation sounds were coarse in 19 neonates, weak in 2, moist rales were appreciated in 5 and wheezing in 4 of them. The peripheral total white blood cell count was normal in 18 patients and elevated in 3. The C-reactive protein level was normal in all subjects, and the procalcitonin level was elevated in 1. Nineteen patients had pneumonia on chest imaging. All patients were treated with oseltamivir and finally recovered.ConclusionInfluenza A is the most common type of neonatal influenza. The clinical symptoms are atypical, and fever is the main symptom. Treatment with oseltamivir is safe and effective, and the prognosis is mostly favorable.

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.