Nasal Pathology Research Articles

Temporal Fascia Versus Tragal Perichondrial Graft in Myringoplasty and Tympanoplasty

The objective of this study is to compare the results of tympanoplastywith underlay technique with respect to graft uptake, hearing improvement and complications. Thestudy was conducted between January 2006 & January 2018 at Haider clinic, Kulsum international Hospital Islamabad, MaroofInternational Hospital, Social security Hospital Islamabad and PAF hospital Islamabad. Sampling was done by non-probability convenient sampling type by random selection. Total of 1677 patients were selected had Tympanoplasty type 1. All had dry central perforations of different sizes for more than 3 months and conductive hearing loss of less than 40dB with patent Eustachian tube. Informed consent was taken from patients andethical committee. Patients with sensorineural hearing loss and with severe nasal pathology were excluded. Patients were divided into 2 groups, A and B, were subjected totympanoplasty by underlay technique by the same group of surgeons. In group A, temporalis fascia graft and in group B tragalperichondrial graft was used. Postoperative audiometry was done after 3 months in each case to calculate air bone gap. In our study there were 62% males and 38% females, mean age was 32.5. In Group A, 689 patients hadtympanoplasty with temporalis fascia and in group B 988 patients with chondro-perichondrial graft. Medialization was seen in 30(4.3%) patients in Group A and in 10(1%) in group B. Persistent Perforations happened in 32(4.6%) patients in group A and in 8(0.8%) patients group B. Graft uptake success rate using temporalis fascia was 85.9% and was 97.4% with Chondro-perichondrial graft. Hearing improvement was seen in 627(91%) patients in group A and 970(98%) patients in group B. Statistical analysis of the data was done using SPSS 16. Temporalis fascia and tragal perichondrium both are excellent material to repair tympanic membrane. Graft uptake rate and hearing improvement are better in perichondrial graft.

PREVALENCE OF PATHOLOGY OF A PERIODONTIUM AT PERSONS WITH THE COMPLICATED NASAL BREATH

Purpose of researches. To study prevalence of diseases of a periodont depending on concrete pathology of a nose, violation of nasal breathMaterials and methods. 73 persons with a nasal pathology par-ticipated in researches. At them studied the PMA, CPITN index-es and also separate symptoms of inflammation of a periodontis.Results of researches. The PMA index was higher than 25 %, a periodontal pocket of 2-3 mm, bleeding of gums 1-2 points. Re-cession of a gum was observed in more, than 50 % of cases; wedge-shaped defects - from 17 to 51 % , the CPITN Index came to 2.Conclusion. The complicated nasal breath contributes to the development of inflammatory diseases of a periodontis. The dis-ease period is longer, the processes of destruction in a periodontis are expressed more. The greatest changes in a periodontis are revealed at patients with a curvature of a nasal partition.

Rhinolith: Examining the clinical, radiological and surgical features of 23 cases

ObjectiveRhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases. MethodsThe medical records and radiological findings of 23 cases, who were operated for rhinolith between January 2010 and June 2018 in Tokat State Hospital, were analyzed retrospectively. The age, gender, the side where rhinolith exists, nidus presence, type of surgery and sinonasal pathologies that accompany rhinolith, and accompanying secondary sinonasal surgeries were examined. ResultsA total of 17 (73.2%) of the 23 cases were female, and 6 (26.8%) were male. The mean age was 24.9 years. The symptoms that were seen in the patients were nasal obstruction (100%), rhinorrhea (82.6%), nasal malodor (78.2%), oral malodor (26%), headache (26%), epistaxis (17.3%), face pain (4,3%), respectively. Nidus could be detected in 6 patients. The most frequent localization of rhinolith was between the inferior concha and the nasal septum (n=21). The most common concomitant sinonasal pathology in rhinolith was septum deviation (43.4%); and the second most common pathology was mucosal thickening (30.4%) in the maxillary sinus. The surgery type that accompanied rhinolith at the highest frequency was septoplasty (n=5). Other surgeries were septorhinoplasty (n=1), antrochoanal polyp excision (n=1), adenoidectomy (n=1). ConclusionThe most common symptoms of rhinolith, which is a rare nasal pathology, are nasal obstruction and rhinorrhea. Radiological imaging together with a rigid endoscopy is important especially to evaluate the placement of rhinolith. In addition to this, radiological imaging, evaluation of the sinuses that are not sufficiently evaluated with rigid endoscope are important for planning the type of the operation and secondary surgical procedures which may accompany.

Bilateral inferior conchae and turbinate hypertrophy causing choanal pseudoatresia

Respiratory distress in neonates is an emergency which requires a thorough investigation to determine the cause, whether it is due to the upper respiratory or lower respiratory entity. Nasal cavity pathologies rarely compromise the neonatal airway. Newborns are obligatory nasal breathers; thus, upper respiratory tract problems could potentially become life-threatening. We report a case of a newborn boy with inferior turbinate hypertrophy (ITH) causing respiratory distress treated successfully by nasal dilatation and posterior septoplasty. Congenital bilateral ITH is rarely seen and can mimic choanal atresia. Congenital ITH would be missed at initial presentation without radiographic imaging and physical evaluation. It should be considered as one of the differential diagnosis in cases suspected for choanal atresia.

Association of upper and lower airway eosinophilic inflammation with response to omalizumab in patients with severe asthma

Background: The anti-immunoglobulin E monoclonal antibody, omalizumab, is used to treat severe asthma and has the potential to ameliorate airway inflammation. However, the effect of omalizumab in ameliorating upper airway inflammation has not been fully elucidated. Objective: We investigated the association of upper and lower airway inflammation with the response to omalizumab treatment. Methods: We used the Global Evaluation of Treatment Effectiveness to assess the efficacy of omalizumab in treating 16 patients with severe asthma. We also investigated the symptom score, short-acting β-agonist inhaler use, pulmonary function, biomarkers, computed tomography scans, and nasal mucosa pathology at omalizumab initiation and after four months of treatment. Results: When the fraction of exhaled nitric oxide (FeNO) and the percentage of sputum eosinophil were used as indicators of lower airway inflammation, positive correlations were found between CD20 B-cell, mast cell, and eosinophil counts in the nasal mucosa. Improved asthma symptoms were observed in 12 of the 16 severe asthma cases. The FeNO and eosinophil levels in the nasal tissue, prior to the administration of omalizumab were predictors of the response to asthma treatment. Conclusions: These findings suggest heterogeneity among people with severe asthma. In addition, the phenotype associated with response to omalizumab, leading to improvement in asthma symptoms, comprises upper airway eosinophilia and high FeNO levels.

Chronic conjunctivitis as a prognosis factor of dacryocystorhinostomy: a retrospective case-controlled study

ObjectiveTo determine whether the history of chronic conjunctivitis increases the likelihood of epiphora after an external dacryocystorhinostomy (Ex-DCR) and to elucidate other factors that may affect the prognosis of this surgery. MethodsThis is a retrospective case-controlled study. Patients who had epiphora after an Ex-DCR were compared with patients who did not present epiphora. Medical history of conjunctivitis, use of antiglaucomatous drops, rhinitis, and nasal pathology were evaluated. ResultsA total of 129 adult patients undergoing external DCR were evaluated, of which 73% had decreased tearing. Forty-five percent of the patients who continued with epiphora had a history of conjunctivitis, compared to the 20% of those who did not (p = 0.003). At the same time, the 20% of those who continued with epiphora had a history of rhinitis compared to the 8% of those who did not (p = 0.043). ConclusionPatients with a history of chronic conjunctivitis are less likely to improve the epiphora after performing an Ex-DCR. We consider that it is important to evaluate this antecedent before surgery.

Assessment of nasal functions and their relationship with cholesteatoma formation in patients with unilateral chronic otitis media.

To evaluate the nasal functions of patients with unilateral chronic otitis media using rhinomanometry, comparing chronic otitis media sides with healthy sides, chronic otitis media patients with cholesteatoma and without cholesteatoma, and patients with healthy individuals. This prospective study included 102 patients with unilateral chronic otitis media (48 with and 54 without cholesteatoma). The control group comprised 40 individuals without any ear or nasal pathologies. All patients underwent active anterior rhinomanometry to measure nasal airway resistance and a saccharin test to measure mucociliary transport times. There were no significant differences in nasal airway resistance and mucociliary transport time between the chronic otitis media sides and unaffected sides in the 102 patients (p = 0.72 and p = 0.28, respectively), between the non-suppurative chronic otitis media patients (without cholesteatoma) and chronic otitis media with cholesteatoma patients (p > 0.05), or between the study and control groups (p > 0.05). The present study, with a larger sample size compared to previously published literature, supports the conclusion that unilateral nasal obstruction is unlikely to lead to chronic otitis media on the same side. The results also suggest that nasal functions do not contribute to the development of cholesteatoma.

Assessment of endoscopic sinus surgery in management of sinonasal diseases

Background: functional endoscopic sinus surgery (FESS) has revolutionized surgical care, opening new horizons in the management of chronic rhinosinusitis and other paranasal sinus disorders Messerklinger established and reinterated the importance of the sinus ventilation and pattern of mucociliary clearance. FESS was first described independently by both Messerklinger in German literature and Wigand. Aim of the work: this study aimed to assess the efficacy, safety and benefits of FESS in cases of chronic recurrent rhinosinusitis with or without nasal polyposis, fungal sinusitis,septal and turbinate pathology and CSF rhinorhea in terms of morbidity, mortality and recurrent of disease. Patients and Methods: This study was conducted in Bab Elshaerea University Hospital and Hearing and Speech Institute from July 2017 to August 2018. A total of 50 patients with clinical evidence of sinonasal diseases were categorized into 4 groups (Chronic recurrent rhinosinusitis with or without nasal polyposis (20 patients) ,fungal sinusitis (10 patients),septal and turbinate pathology(10 patients) and CSF rhinorhea(10 patients)). Patients were evaluated with nasal endoscopy and computed tomographic (CT) evaluation prior to FESS. Results: out of 50 patients, 26 were male and 24 were female in the present study. Male: female ratio was 52:48. Depending on symptoms, endoscopic examination and CT scanning, three patients only had a recurrence (Two patients from group of chronic recurrent rhinosinusitis with or without nasal polyposis and one patient from fungal sinusitis group). Conclusion: FESS provided an excellent and safe method for treating sinonasal disease. The success rates were encouraging, but because of the nature and chronicity of the disease, longer follow-up was necessary to truly assess the surgical effectiveness of the procedure.

Assessment of endoscopic sinus surgery in management of sinonasal diseases

Background: functional endoscopic sinus surgery (FESS) has revolutionized surgical care, opening new horizons in the management of chronic rhinosinusitis and other paranasal sinus disorders Messerklinger established and reinterated the importance of the sinus ventilation and pattern of mucociliary clearance. FESS was first described independently by both Messerklinger in German literature and Wigand. Aim of the work: this study aimed to assess the efficacy, safety and benefits of FESS in cases of chronic recurrent rhinosinusitis with or without nasal polyposis, fungal sinusitis,septal and turbinate pathology and CSF rhinorhea in terms of morbidity, mortality and recurrent of disease. Patients and Methods: This study was conducted in Bab Elshaerea University Hospital and Hearing and Speech Institute from July 2017 to August 2018. A total of 50 patients with clinical evidence of sinonasal diseases were categorized into 4 groups (Chronic recurrent rhinosinusitis with or without nasal polyposis (20 patients) ,fungal sinusitis (10 patients),septal and turbinate pathology(10 patients) and CSF rhinorhea(10 patients)). Patients were evaluated with nasal endoscopy and computed tomographic (CT) evaluation prior to FESS. Results: out of 50 patients, 26 were male and 24 were female in the present study. Male: female ratio was 52:48. Depending on symptoms, endoscopic examination and CT scanning, three patients only had a recurrence (Two patients from group of chronic recurrent rhinosinusitis with or without nasal polyposis and one patient from fungal sinusitis group). Conclusion: FESS provided an excellent and safe method for treating sinonasal disease. The success rates were encouraging, but because of the nature and chronicity of the disease, longer follow-up was necessary to truly assess the surgical effectiveness of the procedure.

Research of distribution pattern of allelic genes and genotypes of C/A polymorphism of COL1A1_1 collagen gene (RS1107946) in children with nasal obstruction of allergic genesis and orthodontic pathology

Purpose. Determination of the genotypes of C/A polymorphism of COL1A1_1 collagen gene (rs1107946) and patterns of distribution of allelic genes in children with nasal obstruction and orthodontic pathology. Materials and methods. A molecular-genetic study for determination of C/A polymorphism of COL1A1_1 collagen gene (rs1107946) was performed in 99 children at the age of 6 to 17 years, for 11 months and 30 days inclusive; 30 children of which had nasal obstruction due to allergic rhinitis without abnormal distal occlusion (the first group); 23 children had just the distal occlusion (the second group); 26 children had allergic rhinitis and distal occlusion (the third group); 20 almost healthy children (the fourth group). Genotyping was performed by the polymerase chain reaction method (Applied Biosystems, USA) using the total DNA samples isolated from whole venous blood using a set of reagents SNP-Screen (Syntol manufacturer) on the CFX96TM Real-Time PCR Detection Systems amplifier (Bio-Rad Laboratories, Inc., USA). Non-parametric statistic methods of the licensed software package Statistica for Windows 6.1.RU, serial number AXXR712D833214SAN5 was used for processing the research results. Results. Molecular-genetic study of the distribution patterns of allelic genes and genotypes of the C/A polymorphism of the COL1A1_1 (rs1107946) collagen gene in the examined children showed that the frequency of occurrence of the C allele was significantly higher than the A allele (71.72 % and 28.28 %, respectively). In this case, the homozygous C/C genotype was registered most often (68.69 %), homozygous genotype A/A (25.25 %) was rarely registered and heterozygous C/A (6.06 %) was very rarely registered. In the observation groups, in children with allergic rhinitis, distal occlusion and a combination of allergic and orthodontic pathology, the genotypes had the following distribution: the C/C genotype – 76.67 %; 34.78 %; 73.00 %; A/A genotype – 20.00 %; 56.52 %; 17.39 %; A/C genotype – 3.33 %; 8.70 %; 11.54 %. The occurrence frequency of alleles of the C/A polymorphism of the COL1A1_1 collagen gene (rs1107946) in the examined children showed that the children with distal occlusion were significantly frequent carriers of A allele (60.87 %), whereas the carriers of C allele were predominantly children with allergic rhinitis (78.33 %), with combined allergic and orthodontic pathology (78.85 %) and healthy (90.00 %), P < 0.05. The correlation between the results of the study conducted in groups of children with the distal occlusion and practically healthy showed that the sensitivity of the presence of A allelic gene was equal to 60.87 %, specificity – 90.00 %, accuracy – 61.54 %. Since the sensitivity and specificity of the diagnostic test exceeded 50.00 %, the prognostic value for the positive result was equal to 87.50 % and for the negative result – 66.67 % and confirm this prognostic significance for the development of the orthodontic pathology in children. This will allow improving the preventive measures in children with orthodontic pathology. Conclusions. The molecular-genetic studies for determining the A allele (rs1107946) of the COL1A1_1 collagen gene in children could be recommended to determine the risk of development and the need for early prevention of the distal occlusion in children.

A prospective study of sinonasal and nasopharyngeal pathology in chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) implies a permanent abnormality in the tympanic membrane characterized by irreversible changes in the mucosa of middle ear and mastoid cavity. Diseases of the nose and para nasal sinuses have been implicated in the development of the disease. Hence the present study aims at identifying the risk factors involved and the importance of its management in treating the disease. The objective was to study the correlation between COM and Sino nasal and nasopharyngeal pathology.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 100 patients with chronic otitis media were included in the study. A Detailed history and clinical examination was done using a pre-prepared questionnaire. Diagnostic nasal endoscopy was done in all cases to assess the nasal cavity and nasopharynx along with bacteriological study of ear and corresponding side of nasopharynx. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Symptomatic, clinical and diagnostic profile proved the evidence of sinonasal pathology in 82% of patients with COM. The comparative study of the microbiological flora of both ear and corresponding side of nasopharynx showed 77 % of ear swabs and 91% of nasopharyngeal swabs to be sterile. The results were statistically significant with a p value of 0.003.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study emphasises on a thorough evaluation of nose and paranasal sinuses in all cases of COM for comprehensive management of the disease. Its detection and management is equally important as the ear surgery per se.&lt;/p&gt;

Laserowa dakriocystorinostomia – zastosowanie laserów w leczeniu niedrożności dróg łzowych

Obstruction of the nasolacrimal duct, impeding the proper outflow of tears from the conjunctival sac to the nasal cavity, is a common disorder that is clinically manifested as tearing. Dacryocystorhinostomy is the creation of a direct fistula between the tear sack and the nasal cavity. The surgical approach may be external or endoscopic with or without a laser. Laser dacryocystorhinostomy is now a recognized procedure for the treatment of lacrimation resulting from nasal-lacrimal duct obstruction. The method has many advantages over conventional treatment. These advantages include: the absence of external scars, the possibility of simultaneous treatment of nasal cavity pathology, sparing of the medial lining of the eyelids, intact tear pump mechanism. The laser treatment time is also shorter with a comparable success rate to classic surgery. The introduction of a laser for tear-ditch surgery made it possible to treat tear-lacrimal obstruction in a simpler and less invasive way.

The initial experience of using the drain implant to eliminate epiphora in patients with rhinogenous pathology

The pathology of upper lacrimal pathways associated with cicatrical strictures and obliteration, anatomical features of this zone is an essential problem of epiphora occurrence. The diseases of nasal cavity and paranasal sinuses play a significant role in the etiopathogenesis of this kind of epiphora. The search of new methods of preventing or eliminating epiphora, also caused by rinological pathology, is reasonable.&#x0D; Aim: To estimate the efficacy of drainage implant HEALAFLOW (Aptissen, Switzerland) in patients with complains on epiphora and concomitant nasal cavity pathology.&#x0D; Material and methods. 29 patients (50 eyes) with complains on permanent (more than 6 months) epiphora were under the supervision. Ge nerally accepted ophthalmological, dacryological, rhinological examinations, including cone-ray computer tomography of the paranasal sinuses with preliminary contrast of the lacrimal pathways were carried out. Patients were divided into two groups. 15 people (28 eyes) composed the main group (I). 14 people (22 eyes) formed a control group (II). In I group the drainage implant HEALAFLOW (Aptissen, Switzerland) was inserted in 1 day after operation aimed on elimination of nasal cavity pathology. Patients of the II group instillation of Tobradex according to the scheme and moistening drops were prescribed.&#x0D; Results. According to dacryological examination 29 patients (50 eyes) with complains on epiphora had normal passive lacrimal pathway passablness, but delayed or negative results of probes characterizing active passablness. All 29 patients had a rhinological pathology, which was eliminated by the otorhinolaryngologist with the operation at the first stage. In I group 9 patients noticed an increased epiphora immediately after the administration of HEALAFLOW in lacrimal pathway, which lasted during the first 24 hours after the procedure. Based on the results of the follow-up examination, after 3 months, all patients showed an improvement, expressed in the absence or decrease of epiphora. It should be noted that in the I group (after the insertion of the implant) the positive effect was more expressed. In the I group 12 of 15 patients didnt have epiphora and in 3 patients it decreased. In the II group 7 patients didnt have epiphora and in 6 patients it decreased.&#x0D; Conclusion. Insertion of drainage implant HEALAFLOW in the lacrimal pathway after elimination of rhinological pathology in patients with complains on epiphora is safe, well tolerated and produces a positive drainage effect. This allows to recommend the implant to patients with tear-off device abnormality in the complex treatment of tear outflow disorders.

Air exchange in the maxillary sinus in the postoperative period after maxillary sinusotomy through the inner and middle nasal airway

There are many computer models that describe the airflow in various anatomical variants and the pathology of the nasal cavity and paranasal sinuses. The data that describe the Reynolds number and airflow velocity in the different section of the nasal cavity of the patients with cyst of the maxillary sinus are very different. The results of operation of the maxillary sinusotomy through the middle nasal airway are disjointed and contradictory. There is also a little information of aerodynamics in the odontogenic pathology of the maxillary sinus. Purpose: Calculate airflow velocity in various sections of the nasal cavity, and air exchange in the maxillary sinus in patients with cysts of the maxillary sinus in the postoperative period after endonasalmaxillary sinusotomy through the lower and middle nasal airway. Material and methods: 112 patients with maxillary sinus cyst were examined. Patients were divided into three clinical groups. The first group, 41 people, included patients who had removed the cysts of the maxillary sinus through the lower nasal airway, as well as intact structures of the middle nasal passage remained. The second group included 38 patients who had removed the maxillary sinus cyst through the middle nasal airway. In the third group, were selected 33 patients, who had not been diagnosed with nasal and nasal sinus pathology, but they were examined by an ENT specialist before implantation of the teeth. Computer tomography of nasal sinuses was performed for all patients. The Planmeca Tomography, manufactured in Finland, was used, with the further processing of information using the software Romexis Viewer. Using the Romexis Viewer software and MeshLabit was measured the size of the anatomical structures of the nasal cavity and nasal sinuses, the calculation of air flow velocity at the airways of the nasal cavity, the calculation of the Reynolds number. To calculate the parameters of external respiration, all patients were examined for external respiration using a mask spirometer. Statistical processing of the obtained data was carried out using SPSS software 13. Results: The rate of air flow that passes through the nasal cavity on the inhalation and exhalation in the postoperative period in patients with cysts of the maxillary sinus that has undergone endonazal maxillary sinusotomy through the lower nasal airway, is statistically no different from those patients who had no pathology of the nasal cavity and nasal sinuses. The volume of air exchange in the case of removal maxillary cyst through the lower nasal airway does not statistically differ from the volume of air exchange in patients without pathology of the nasal cavity and nasal sinuses.

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3h at night to 6, 8h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

Diagnostic Evaluation of Chronic Nasal Obstruction Based on Nasal Endoscopy and CT Scan Paranasal Sinus.

Evaluation of the accuracy of objective diagnostic modalities for nasal obstruction and their comparison to each other to reach the correct diagnosis with minimum cost and highest accuracy. This study was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, Chirayu Medical College and Hospital, Bhopal from August 2016 to September 2017. A total of 50 patients from age group 1-70years irrespective of sex with complaints of chronic nasal obstruction, which were unresponsive to routine appropriate medical therapy, were selected for this study. Comparative study among findings of nasal endoscopy and CT scan of the paranasal sinuses done. After clinical examination, patients were subjected to high resolution computed tomography (HRCT) of paranasal sinuses and diagnostic nasal endoscopy (DNE). The diagnostic results of both modalities were compared. The most common symptoms were nasal obstruction and nasal discharge 100%, followed by post nasal drip 62%. The complaints related to eye and ears were less frequent, found in 4% only. CRS (Chronic Rhinosinusitis) was most common pathology of nose for nasal obstruction which is in 72% cases. Sinonasal polyp is present in 20% of cases. Inverted papilloma in 4% cases. Granulomatous disease (Rhinosporidiosis) in 2% cases. Malignancy in 2% cases. In this series of 50 cases, nasal endoscopy revealed various pathological abnormalities mainly in the osteomeatal area. These include mucopurulent discharge in middle meatus seen in 100% of cases (50 patients). This could not be revealed in HRCT. Oedematous and polypoid infundibular mucosa/polyp in nasal cavity in 28% cases (14 patients) where it was not diagnosed in HRCT in three patients. Hence DNE proved superior to HRCT. Other abnormalities detected on nasal endoscopy were septal deviation 80% of cases (40 patients), inferior turbinate hypertrophy 66% of cases (33 patients), middle turbinate hypertrophy/concha bullosa in 48% of cases (24 patients). DNS was diagnosed in 42 patients in HRCT other causes of nasal obstruction such as Agar nasi cell is detected in 16% (8 patients), medialised uncinate process in 16% (8 patients), paradoxical MT in 30% cases were diagnosed more accurately in nasal endoscopy than HRCT. So nasal endoscopy proved better than CT scan. Nasal obstruction is the most common presenting complaint in day to day otolaryngology practice. Nobody would disagree with the role of CT scan and diagnostic nasal endoscopy in diagnosing the nasal and paranasal pathologies. But as a treating physician we are always concerned about early diagnosis and cost effectiveness. At the same time we also have to consider about patient waiting and work load. In this study we attempted to find out whether diagnostic nasal endoscopy can be better then CT scan, so that we can treat our patient appropriately. Though there has been an increased demand for imaging the paranasal sinuses with coronal CT because of functional endoscopic sinus surgery, nasal endoscopy is a better option in diagnosing and assessing the extent of disease and anatomy.

Virtual Surgery for Patients With Nasal Obstruction: Use of Computational Fluid Dynamics (MeComLand®, Digbody® & Noseland®) to Document Objective Flow Parameters and Optimise Surgical Results

IntroductionComputational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. MethodsA group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. ObjectiveTo present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. ResultsThe combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. ConclusionsCFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand®, DigBody® and NoseLand® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction.

Our experience with spreader graft in septorhinoplasty by open approach

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spreader graft being one of the best method for volumetric expansion of internal nasal angle to address the nasal valve pathologies, popularised by Sheen.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; To evaluate its functional effect on relieving nasal obstruction secondary to nasal valve pathologies, our study was conducted in 40 patients (35 male and 5 female; mean age 28 years) having both external nasal deformity and nasal obstruction. NOSE scale was used to assess functional improvement. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of total 40 patients (22 patients with saddle nose deformity, 10 crooked nose and 8 nasal dorsum deformity), 35 patients (87.5%) were fully satisfied with functional outcome as assessed by NOSE score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Spreader graft is good way to handle nasal obstruction secondary to narrow internal nasal angle. &lt;/p&gt;

Epistaxis in children: a clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Epistaxis is a common condition among children. Most cases are due to vascular fragility in the nasal vestibule aggravated by digital trauma. Epistaxis is rare below 2 years. 30% of children of all children between 0-5 years, 56% aged between 6-10 years, 64% of those aged between 11-15 years have had at least 1 episode of epistaxis in their lifetime.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective analysis was done on 56 patients of nasal bleed, at Institute of child health and Hospital for children / Madras Medical College, Chennai, between June 2015 - June 2016. The records of children were analysed. All the patients under went blood investigation. The statistical analysis was done for the age group. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 56 cases of nasal bleed enrolled in our study, out of which 35 were boys and 21 girls. The most common age group was between 6-10 years accounting for 27 cases. In laterality of nasal bleed right side was common. The most common site in nostril noted was from little’s area of nasal septum in 27 cases. The most common cause was idiopathic in 15 cases. Most of the cases were managed conservatively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Epistaxis is a common clinical condition among the paediatric age group. In all cases, ENT examination should be done to rule out nasal pathology or foreign body in nasal cavity and haematology workup is necessary. Majority of nasal bleed stops with digital pressure.&lt;/p&gt;

Evaluation of superior concha bullosa by computed tomography.

Concha bullosa is generally regarded as pneumatisation of the middle turbinate in the nose. However, pneumatisation may also be seen in the superior and inferior turbinate. Computed tomography (CT) of paranasal sinuses is extremely helpful for the examination of this inaccessible area. Coronal CT sections of paranasal sinuses are particularly useful for surgical anatomy, as these images show nearly the same regions as the endoscopic examinations. The aim of this retrospective study was to evaluate the presence, incidence and unilaterality-bilaterality of superior turbinate pneumatisation and concomitant nasal pathologies. A total of 1000 patients who underwent CT of the paranasal sinuses because of headaches, nasal obstructions, anosmia, facial pain or facial trauma were evaluated retrospectively. Among the 1000 patients, superior pneumatized turbinate was seen on CT images of the paranasal sinuses in 149 (14.9%) cases. Of these patients, 84 were female, 65 were male, and the mean age was 38.14years. Among 149 patients, 58 patients had bilateral superior pneumatized turbinate and the remaining 91 patients had unilateral superior pneumatized turbinate. 60.4% of the patients with superior pneumatized turbinate also had middle pneumatized turbinate. The superior pneumatized turbinate is an anatomical variation with an incidence ranging from 12.2 to 50%. The present study revealed that there is no relationship between volume size of the superior pneumatized turbinates and sinusitis, nasal septum deviation and paradoxical middle concha. It is very important to define anatomical variations in the preoperative CT evaluation of the paranasal sinuses.