Nasal Pathology Research Articles

Association of Adenoid Hypertrophy with Nasal and Middle Ear Pathologies in Adults.

A prospective comparative study was carried out in patients attending ENT Out Patient Department of a tertiary care Hospital with an aim to determine the association of adenoid hypertrophy with chronic nasal and middle ear pathologies in those aged 18years or above. Patients presenting between August 2020 and February 2022 with chronic nasal and middle ear pathologies who underwent diagnostic nasal endoscopy were seen for adenoid hypertrophy and its association was analysed statistically. Adenoid hypertrophy (AH) in 18-25, 26-35, 36-45 and 46-55years age group are 56.25, 28.12, 12.5, 3.125% respectively with a male:female ratio of 3:1. None of the patients were above 56years in the study. No statistically significant association could be derived between chronic nasal and middle ear pathologies with AH. AH is a vital cause of nasal obstruction in adult population with a rising frequency these days owing to allergy, chronic infection and increased pollution. The entire of the individuals presenting with nasal obstruction, snoring and other nasal symptoms and chronic middle ear pathologies; AH should at all times be kept in mind as a ground and the patients shall be appraised for adenoid hypertrophy.

Intranasal Schirmer Test in Allergic Rhinitis: Relationship to Symptom Scores and Role in Determining Response to Treatment.

The Intranasal Schirmer test (INS) is an easy to administer test that can yield objective measurement of the quantity of nasal secretion and has been studied in patients with various nasal and systemic pathologies; however, the role of INS in patients with allergic rhinitis remains unclear. Our aim was to determine the relationship between various allergic symptoms and the Intranasal Schirmer Test (INS) score and to evaluate the utility of INS in determining treatment effect in patients with allergic rhinitis. This prospective study included patients with allergic rhinitis who were randomly divided into 3 treatment groups (nasal steroid only, oral antihistamine only, nasal steroid and oral antihistamine). For all patients, Total Nasal Symptom Score (TNSS) was used to measure symptom severity and INS was administered before and after treatment. Pre-treatment and post treatment TNSS and INS scores were compared between different treatment groups and within each group. The study included 120 patients, with 40 patients in each group. There were significant differences both in pre-treatment and post-treatment symptom severity score with changes of INS scores between treatment groups (P < .001 and P = .002, respectively). There was a significant difference between pre-treatment and post-treatment symptom severity scores and the INS score in each treatment group (P < .001). There was also a significant positive correlation between INS score and TNSS (r = .591 and P < .001). The Intranasal Schirmer Test can be used as an objective tool for patients with allergic rhinitis as an adjunct to subjective patient symptom reports and can also be used to determine the response to treatment.

Bacteriological Profile of Chronic Rhinosinusitis and Adenotonsillitis: Evaluating the Role of Biofilm Production and Multidrug Resistance.

There is significant evidence that the etiology of chronic otorhinolaryngology infections such as chronic rhinosinusitis, adenotonsillitis, and otitis media depends on biofilms. As biofilm-forming bacteria can be resistant to the immune system, antibiotics, and other treatments, biofilm infections are often chronic. To identify the genus and species of the clinical isolates obtained from the swabs collected from the patients with chronic infections of the nasal and paranasal sinus, nasopharynx, and oropharynx and to evaluate phenotypic and genotypic methods for the detection of biofilms and antimicrobial resistance among the isolated organisms. A total of 100 patients with chronic rhinosinusitis and adenotonsillitis participated in this study. Various clinical samples from the nasal cavity, nasopharynx, and oropharynx were obtained and subjected to microbiological analysis and biofilm-forming capacity by three methods: tube methods, Congo red staining, and microtiter plate method. The various specific genes were amplified by polymerase chain reaction. The amplified gene products were separated by gel electrophoresis. This was a prospective cohort study conducted on a total of 100 patients with chronic rhinosinusitis and adenotonsillitis. The age of the study participants was between 7 and 53years with a mean age of 29.22 ± 15.03. This study included 54 (54%) nasal tissue samples and 46 (46%) adenotonsillar tissue. The frequently cultured organisms are coagulase-negative staphylococci (17%), E. coli (10%), Citrobacter (10%), and Klebsiella (7%). Staphylococcus aureus (4), and Methicillin-resistant Staphylococcus aureus (3) produced strong biofilm. Acenobacter (3), Citrobacter (4), and E. coli (4) showed moderate biofilm production. Coagulase-negative Staphylococcus aureus (11), E. coli (6), and Klebsiella (7) showed weak biofilm formation. Citrobacter (6), and Coagulase negative Staphylococcus aureus (6) were negative for biofilm production. Staphylococcus aureus expressed mecA gene (3) and Panton-Valentine Leukocidin gene (2), Pseudomonas expressed mucA gene (2), Citrobacter expressed blaCARB-2 (4) qnrA gene (2), E. coli expressed bla SHV (2) and bla TEM1 gene (2) and Klebsiella expressed Kfu (2) and uge (1). Acenobacter was negative for blaIMP1, blaVIM2 genes. This study adds to the information on the common pathogens-forming biofilms in various nasal pathologies and adenotonsillitis. The knowledge that a particular organism has a higher biofilm-forming capacity will help to sensitize the physician that factors such as biofilms may be at play and take appropriate measures.

Correlation between chronic suppurative otitis media and deviated nasal septum of the ipsilateral side

Background: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear with permanent defect in tympanic membrane with or without ear discharge, frequently have an underlying nasal pathology, which can worsen the middle ear disease secondary to Eustachian tube dysfunction, leading to negative middle ear pressure, tympanic membrane retraction, chronic otitis media with effusion and/or cholesteatoma. Present study was conducted to study the correlation of a etiopathogenesis, bacteriology of CSOM with the deviation of the nasal septum (DNS) of the ipsilateral side. Methods: Study was conducted in ENT department, AJ institute of medical science, Mangalore, Karnataka. Study group included 120 patients having CSOM, selected randomly from outpatient department (Time bound cross-sectional study). Predesigned proforma was used. Detailed history taken, followed by a thorough ENT examination. Relevant investigations were performed. Results: In this study, the prevalence of nasal disease (DNS) in patients with CSOM was 73.33%. Out of 120 CSOM patients, 88 patients had co-existent nasal disease (DNS). Among the 88 cases; 71 (59.2%) patients showed direct correlation with CSOM. Culture swabs showed similar bacterial isolates in aural and nasal swabs indicating, there may be retrograde spread of pathogens from nasopharynx to middle ear via Eustachian tube. Conclusions: A significant correlation was established between CSOM and DNS of the ipsilateral side. DNS played a key role in persistence of CSOM. A conscientious evaluation of nose and paranasal sinuses diseases is essential and we thus endorse management of nasal disease prior to the surgical treatment of ear disease, for meritful postoperative results.

Endotypes of Nasal Polyps in Children: A Multidisciplinary Approach.

Nasal polyps (NPs) are rarely reported in childhood and usually represent red flags for systemic diseases, such as cystic fibrosis (CF), primary ciliary dyskinesia (PCD) and immunodeficiencies. The European Position Paper released in 2020 (EPOS 2020) provided a detailed classification and defined the correct diagnostic and therapeutic approaches. We report a one-year experience of a multidisciplinary team, made up of otorhinolaryngologists, allergists, pediatricians, pneumologists and geneticists, with the aim of ensuring a personalized diagnostic and therapeutic management of the pathology. In 16 months of activity, 53 patients were admitted (25 children with chronic rhinosinusitis with polyposis and 28 with antro-choanal polyp). All patients underwent phenotypic and endo-typic assessment, using proper classification tools for nasal pathology (both endoscopic and radiological), as well as adequate cytological definition. An immuno-allergic evaluation was carried out. Pneumologists evaluated any lower airway respiratory disease. Genetic investigations concluded the diagnostic investigation. Our experience enhanced the complexity of children's NPs. A multidisciplinary assessment is mandatory for a targeted diagnostic and therapeutic pathway.

Effect of Nasal Septum Deviation on the Choroidal Thickness.

Nasal cavity blood circulation and ocular blood circulation have common pathways for both arterial blood supply and venous drainage. Therefore, nasal pathologies can affect ocular blood circulation. This study aimed to evaluate the relationship between nasal obstruction and choroidal thickness. A prospective study was planned by forming a group of 144 patients diagnosed with nasal septum deviation at the otorhinolaryngology clinic and 100 healthy voluntary individuals. Of the total, 69 patients with nasal right septum deviation were evaluated as Group 1, 75 patients with nasal left septum deviation as Group 2, and 100 healthy volunteers as the control group. Detailed ophthalmological examinations of all the participants were performed, and choroidal thickness was measured using spectral domain optical coherence tomography. The relationship between choroidal thickness and ocular parameters was evaluated and compared between the patient groups with nasal septum deviation and the control group. When the choroidal thickness measurements of the patients in Group 1 were examined, the choroidal thickness increased in all the regions in the eye contralateral to the deviation side (left), and intraocular pressure (IOP) was higher compared to the eye on the deviation side (right) and the control group at a statistically significant level. In Group 2, the choroidal thickness measurements increased in all the regions in the eye contralateral to the deviation side (right), and IOP was higher compared to the deviation side (left) and the control group. We found that the patients with nasal septum deviation hadhigher choroidal thickness and IOP values in the eye contralateral to deviation.

Effect of cannabis smoke condensate on human nasal epithelial cell adhesion, growth, and migration

ObjectiveWhen inhaled, cannabis smoke interacts with airway tissues, including the nasal mucosa, which may lead to nasal pathologies. We examined the effect of cannabis smoke condensate (CSC) on nasal epithelial cell and tissue behaviors. MethodsHuman nasal epithelial cells were exposed or not to CSC at different concentrations (1, 5, 10, and 20 %) and for different durations. Cell adhesion and viability were assessed, as well as post-wound cell migration and lactate dehydrogenase (LDH) release. ResultsThe nasal epithelial cells showed a larger cell size and a faint nucleus following exposure to CSC, compared to that observed in that control. This was supported by fewer adherent cells present after exposure for either 1 or 24 h to 5, 15, and 20 % CSC. CSC also had a significant toxic effect by reducing cell viability after both 1 and 24 h of exposure. This toxic effect was significant even at a low concentration (1 %) of CSC. The effects on nasal epithelial cell viability were confirmed by the decrease in cell migration. After the scratch and subsequent exposure to CSC for either 6 or 24 h, a complete inhibition of nasal epithelial cell migration was observed, compared to that found in the controls. CSC was toxic to the nasal epithelial cells, as the level of LDH significantly increased following cell exposure all CSC concentrations. ConclusionCannabis smoke condensate had a negative effect on several nasal epithelial cell behaviors. These findings indicate that cannabis smoke could be a threat to nasal tissues and ultimately lead to nasal and sinus disorders.

The effect of nasal surgeries on olfactory functional outcome

Abstract Background: Nasal pathologies can alter the olfactory function there by the quality of life. In this study, we did an olfactory assessment in patients undergoing nasal surgeries, and the preoperative values were compared with the postoperative values. Objective: The objective of the study is to assess the role of nasal surgeries on olfactory functions in patients with nasal pathologies. Materials and Methods: In total, 70 participants undergoing nasal surgeries were subjected to olfactory function assessment using the Modified I smell test, which comprises olfactory threshold testing and odor identification, and the Numerical Rating Scale. Olfactory assessment was done preoperatively, 4th week and 12th week after the surgery. Results: Among 70 cases, 18 were sinonasal polyposis (25.75%), 16 (22.85%) were chronic rhinosinusitis cases, 35 (50%) deviated nasal septum cases and only one (1.4%) bilateral inferior turbinate hypertrophy case. The overall mean preoperative combined olfactory score (COS) value was 16.03 ± 2.55, 18.06 ± 1.68 in the 4th week of the postoperative period, and in the 12th week, it was 17.99 ± 1.83. There was a significant improvement in olfactory function when preoperative COS was compared with postoperative COS in different nasal surgeries. The olfactory impairment in nasal polyposis and chronic rhinosinusitis was more when compared to other nasal pathologies like nasal obstructions due to deviated nasal septum and turbinate hypertrophy. Overall, 91.7% of participants who underwent functional endoscopic sinus surgery (FESS) and 90% of FESS + septoplasty cases showed improvement in olfactory function. Only 50% of septoplasty cases showed improvement. Conclusion: Nasal pathologies are more common among men of the age group 21–30 years. Olfactory impairment in nasal polyposis and chronic rhinosinusitis was more compared to other nasal pathologies like nasal obstructions due to deviated nasal septum. FESS significantly improves the olfactory function in chronic rhinosinusitis and sino-nasal polyposis patients.

Assessment of Olfactory Dysfunction Using ODOFIN Sniffin' Sticks: A Prospective Comparative Study.

Olfactory loss can impair the ability to detect harmful warning smells like smoke or gas leaks, significantly affect the quality of life and increase the morbidity. This study was done using Sniffin stick test kit with an objective to compare the effect of Steroid Nasal Spray with Normal Saline Nasal Spray in improving the olfactory dysfunction seen in cases of chronic nasal obstruction. This Prospective comparative study was conducted on patients presenting to the ENT OPD with olfactory dysfunction due to various nasal pathologies. The olfaction was assessed qualitatively using ODOFIN Sniffin' sticks before and 2weeks after the use of either a steroid [Group A] or Saline Nasal Spray [Group B] and the results documented and analysed. Total 162 eligible patients were selected. Majority of the study participants were males and the major symptom was Hyposmia. In group A, the initial Sniffin stick test showed Anosmia in 26 and Hyposmia in 55 patients and after 2weeks, only 2 and 26 patients had Anosmia and Hyposmia respectively. Wherein group B, there was no significant improvement in the olfaction even after 2weeks of treatment. The improvement in the olfaction was significant between the groups. (p = < 0.001). Our study using ODOFIN Sniffin' sticks for assessing olfactory dysfunction in various nasal pathologies showed that Steroid Nasal Spray is an effective and safe treatment option in managing olfactory dysfunction.

Primary Non-Hodgkin's Lymphoma of the Nose: A Rare Case Report.

Extranodal NK/T-cell lymphoma, nasal type (ENKL) is a rare nasal pathology, which in the past was grouped with list of granulomatous diseases. It is an aggressive non-Hodgkin's lymphoma characterized clinically by a non-relenting destruction of the midline structures of the palate and nasal cavity. Despite the malignant clinical nature, tissue diagnosis may be difficult due to extensive tissue necrosis mandating multiple biopsies and has an ominous prognosis, as the average survival rate lying between 6 and 25months as in large number of Asian studies. This is the case report of a 60-year-old female who presented with (L) nasal obstruction and recurrent episodes of rhinosinusitis for last 8months, which had been treated with antibiotics, anti-inflammatory drugs and intranasal corticosteroids without success. After performing battery of tests, diagnosed histologically and confirmed by immunohistochemical analysis that the patient had an ENKL, nasal type (AKA angiocentric T-cell lymphoma).

A novel task of canine olfaction for use in adult and senior pet dogs

While much work has been done in the field of canine olfaction, there has been little exploration of hyposmia or anosmia. This is partly due to difficulties in reducing confounds like training history and environmental distraction. The current study describes a novel olfaction test using spontaneous search behavior in dogs to find a hidden food treat in a three-choice task with both light-phase and dark-phase conditions. The study was performed in 18 adult control dogs, 18 senior/geriatric dogs enrolled in a longitudinal aging study, and a single dog with severe nasal pathology. In the senior/geriatric and control groups, dogs performed with higher accuracy (p < 0.0001) and were less likely to show biased selection strategy (p < 0.01) in the dark-phase than light-phase. While senior/geriatric dogs performed above chance, they had lower accuracy in the dark-phase compared to controls (p = 0.036). Dogs who scored higher on an owner questionnaire of cognitive decline showed a positive correlation with performance in the dark-phase; performance on additional cognitive tests did not correlate with performance in the dark-phase. This task can be used to quantify canine olfaction using clearly defined endpoints and spontaneous behaviors thus making it feasible to compare between and within groups of pet dogs.

Silicone nasolacrimal intubation: our experience in long term cases

Purpose: To evaluate the bicanalicular tube structural integrity and the anatomical and functional post operative results of cases of long and very long bicanalicular intubation (from 2 to 13 years). Methods: We studied all the patients of our Department with long-lasting intubation (greater than one year), from 2000 to 2021. We obtained an histocytological evaluation of the material of intubation and a nasal endoscopy. We investigated the causes of the long permanency and the patient tolerability. Results: In our study, 6 eyes from 5 patients (4 women and 1 man) underwent a nasolacrimal duct intubation. The mean intubation permanency time was 6.8 years and the median value was 7 years (minimum 2 years, maximum 13 years). The bicanalicular tube examinations found traces of mucus made of amorphous protein material, sporadic leukocytes and histiocytes. In all the patients the nasal endoscopy showed good conditions of the middle meatus mucosa. Conclusions: In complex cases, such as multiple re-operations, inflamed and small lacrimal sac, fibrotic sac, inflamed nasal mucosa for previous nasal pathologies, a permanent silicone tube could be a reasonable choice as it appears to be well tolerated and without major complication risks.

Oxidative Stress and Antioxidants in Chronic Rhinosinusitis with Nasal Polyps.

Oxidative stress results from an imbalance between the production of reactive oxygen species and the body's antioxidant defense system. It plays an important role in the regulation of the immune response and can be a pathogenic factor in various diseases. Chronic rhinosinusitis (CRS) is a complex and heterogeneous disease with various phenotypes and endotypes. Recently, an increasing number of studies have proposed that oxidative stress (caused by both environmental and intrinsic stimuli) plays an important role in the pathogenesis and persistence of CRS. This has attracted the attention of several researchers. The relationship between the presence of reactive oxygen species composed of free radicals and nasal polyp pathology is a key topic receiving attention. This article reviews the role of oxidative stress in respiratory diseases, particularly CRS, and introduces potential therapeutic antioxidants that may offer targeted treatment for CRS.

Association of Mastoid Pneumatization with Deviated Nasal Septum: A Clinicoradiological Study

Background: Deviated nasal septum (DNS) has been reported to jeopardizing the nasal aerodynamics. This in turn may affect the pressure dynamics in the nasopharynx and eventually affect the development and pneumatization of mastoid air cells. Few studies done previously have shown a positive correlation between nasal pathologies and mastoid pneumatization. Objectives: This study was undertaken to see for the possible association of mastoid cell pneumatization, with DNS. Materials and Methods: Limited high-resolution computed tomography temporal bone and computed tomography nose and paranasal sinuses were used to calculate the mastoid air cell volume and angle of septal deviation. The degree of septal deviation was graded into mild, moderate, and severe. The mastoid air cell system volume was calculated on the side of the convexity of the septal deviation and the other side. Results: It was found that there is a statistically significant difference in the mastoid volume on the affected side of the DNS vis a vis the unaffected side. Further, the degree of reduction of the volume was not a linear function of the degree of septal deviation. Conclusions: Septal deviation significantly reduces the mastoid air cell volume on the affected side Thus, early correction of pathological DNS in adults, irrespective of the etiology, is important, so as to avoid the chances of developing chronic ear pathologies in later life.

Adenoid ve Nazal Patolojilerin Pediatrik Epistaksisteki Etkileri

Aim: The aim of this study was to investigate the effects of adenoid and nasal pathologies in paediatric patients with recurrent epistaxis.Methods: A total of 100 (61 boys, 39 girls) individuals aged 2–17 years (mean age: 8.9 ± 3.6 years) were included in this study. Anterior rhinoscopy and flexible nasal endoscopy were used to examine all the patients. The epistaxis duration, treatment in active epistaxis by parents, medical history, medical treatment and interventions were recorded. The location of the epistaxis site, nasal mucosa type, the presence of nasal vestibulitis, nasal septum deviation location and type, adenoid size and the degree of inferior turbinate hypertrophy were recorded.Results: The deviation was present in 31 (62%) patients with recurrent epistaxis and in 14 (28%) patients without epistaxis. The presence of deviation was significantly higher in the epistaxis group than in the control group (p &amp;lt; 0.05). The nasal mucosa type was friable mucosa in 37 (74%) patients, vascularised mucosa in 11 (22%) patients and friable-vascularised mucosa in 2 (4%) patients in recurrent epistaxis group. A significant relationship was detected between nasal mucosa type and age, the presence of the deviation, deviation location, the Mladina type in epistaxis group (p &amp;lt; 0.05, p &amp;lt; 0.05, p &amp;lt; 0.05, p &amp;lt; 0.05).Conclusion: Nasal septum deviation, inferior turbinate hypertrophy and nasal mucosa type are associated with paediatric recurrent epistaxis.

Complex Approach to the Diagnosis of Children with Nasal and Nasopharyngeal Pathology. Key Results

Background. Nasal and nasopharyngeal pathology is one of the most important and widespread challenge in pediatrics and pediatric otorhinolaryngology. Prolonged nasal breathing difficulty can be caused by various diseases and their combinations. It requires multidisciplinary approach to diagnosis with the involvement of modern examination methods and pathogenetic treatment. Objective. The aim of the study is to develop complex technology for the management of children with nasal and nasopharyngeal pathologies. Methods. The study included 240 children aged from 6 to 18 years. All patients were divided into 3 groups, comparable by sex and age: Group 1 – 85 patients with confirmed ENT-organ disease, Group 2 — 104 patients with confirmed allergic disease, control group — 51 somatically healthy patients who did not have any ENT-organ or allergic diseases. Examination procedures: diagnostic nasopharyngeal endoscopy, rhinomanometry (RMM), rhinoresistometry (RRM), olfactometry. Results. The obtained results (RRM, RMM) have shown that air flow rate in nasal cavity increased due to nasal resistance decrease. Nasal resistance was higher and air flow rate was lower in all children with various ENT-organs or allergic diseases compared to the control group. Nasal resistance decreased in all study groups (significantly in children with aggravation of allergic diseases of airways and ENT-organs diseases) as well as air flow rate increased in all study groups (significantly in Group 1 and 2) after anemisation of nasal mucosa with decongestants. Apparently, it can be associated not only with anatomical features (nasal septum deviation), but also with inflammatory features of nasal cavity and nasopharynx (adenoid hypertrophy and inflammation, persistent swelling of nasal mucosa at allergic rhinitis). We would like to present the algorithm for diagnosis of children with nasal and nasopharyngeal pathologies according to the study results. The following practical guidelines have been proposed: 1) all patients with complaints on prolonged nasal breathing difficulties require not only otorhinolaryngologist examination, but also diagnostic endoscopy of nasal cavity and nasopharynx; 2) in case of nasal septum deviation and complaints on prolonged nasal breathing difficulties, it is necessary to perform functional methods for nasal breathing evaluating (RRM, RMM) to choose adequate treatment method; 3) the use of RRM, RMM would help to choose the optimal treatment approach in children with complaints on prolonged nasal breathing difficulties and confirmed diagnosis of allergic disease (allergic rhinitis, hay fever, etc.), also associated with adenoid hypertrophy and/or nasal cavity and nasopharynx inflammatory diseases; 4) all patients with confirmed chronic diseases of ENT-organs should be examined by allergist, and, if necessary, should undergo comprehensive allergological examination. Conclusion. The developed complex approach to the management of children with nasal cavity and nasopharynx pathology is innovative and represents the technology of personalized use of modern, objective methods for diagnosing the nasal cavity and nasopharynx state. The presented diagnostic algorithm and practical guidelines allow us to establish diagnosis and choose the treatment tactics within a short time. The use of these studies in clinical practice will allow to monitor the therapy efficacy (including various pharmacotherapeutic strategies) for nasal cavity and nasopharynx diseases in children. Timely examination and pathogenetic treatment will allow to prevent the chronization of pathological process in ENT-organs. This is especially crucial in childhood as it provides children with the best chance of healthy growth and development.

Role of Computed Tomography of Paranasal in Nasal and Sinus Pathology

Background: Pathological lesions of the paranasal sinuses include a wide spectrum of Conditions ranging frominflammation to neoplasms both benign and malignant. Most patient of common cold present with symptoms ofnasal discharge, nasal obstruction, headache and nasal allergy etc. The patient of paranasal mass usually presentwith facial deformity, swelling or repeated episodes of epistaxis.Aim: The aim of the study was to establish the role of CT in evaluation of pathologies and their proper earlydiagnosis.Materials and Methods: This is a prospective study, from may 2016 to september 2016, who attended the ENTdepartment of AIMSR.Statistical Analysis Used: SPSS.Results: Out of 50 cases 51 (51%) cases were males and rest 49 (49%) patients were females. The majority of thecases were of age group 16-30 which were 37case (37%) The most common symptoms were nasal obstruction(50%), followed by nasal discharge (49%), headache in 20% cases. Most common anatomical variations seen wasdeviated nasal septum (49%) more commonly on right side next common was agger nasi in 48% of cases. Maxillarysinuses are most commonly involved in the study, followed by the ethmoid sinuses and frontal sinuses. The mostcommon pathology seen was masses in 30% cases followed by DNS in 21% cases. The most common form ofmucosal thickening noted is circumferential type seen in 7% cases. The most common pathology involving thesinuses was sinusitis (30%) followed by polyp (25%).

Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques.

Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common causeof nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatmentis often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The studywas performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens.The study population comprised 205 patients that underwent surgery and were monitored in the hospital.Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery,postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operativelyand 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24),16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.

Atypical dyspnea presentation among adult population in Basrah, Iraq

Background: the presentation of shortness of breath is very common, and the differential diagnosis is so versatile that required great attention and out of box thinking to reach the final diagnosis which help to alleviate patients’ complains and improve their quality of life.Objective: evaluation of another differential diagnosis for patients with multiple, atypical dyspnea presentation at cardiology unit in Alsadar Teaching Hospital, Basrah, Iraq.Materials and Method: Fifty-eight patients have atypical dyspnea presentation enrolled in this study for the period from July 2020 tell August 2022. Cardiac and pulmonary causes were excluded by cardiologist prior to otorhinolaryngological evaluation for upper airway causes of dyspnea.Results: 58 adult patients enrolled in this study. The age range was 19 – 68 years with mean of 41.64 ± 12.67 years. The majority of the studied patients were in the 3rd and 4th decade of life (55.2%). Most of those patients had nasal pathology causing moderate to severe upper airway obstruction (63.8%). The majority of those patients report great improvement in their quality of life after intervention either medically, surgically or combination of both (88%).Conclusion: atypical dyspnea presentation in adults is challenging due to different pathology and systems involved. Upper airway causes of this presentation can be solved with great improvement in the patients’ quality of life.

Understanding Nasal Valve Compromise in Nasal Airway Obstruction: A New Classification System.

A key aspect of rhinoplasty is integrity of nasal valves area because of its fundamental role in patent nasal airway. furthermore, nasal obstruction is a dominant feature in patient with nasal valves dysfunction (NVD) which can be devastating outcome after rhinoplasty. Nonetheless, NVD has been widely investigated regarding their etiologies and management. However, it has been assumed that the anatomical complexity and interplay between its structures causing a confusion for a beginner surgeon to diagnose and treat NVD. This study was approved by the institutional review board of Chosun University Hospital, Gwangju, Korea (2022-11-005). To date, the lack of consensus on nasal valve pathologies and corrective procedures has led to its underestimations during analysis and management. As result, we proposed a classification system based on its affected anatomical part, location, and their management. Thus, implementing a classification system for NVD will help guide the practice of rhinoplasty and introduce a more structured approach. This approach will prove useful in expanding our understanding of how important to locate the pathology of NVD and apply the most relevant management options, particularly for a beginner surgeons. V.