Rhinosinusitis Patients Research Articles

Association of autoimmune disorders with chronic rhinosinusitis in adults

IntroductionIncreasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis compared to rhinitis. GoalTo investigate the association between autoimmune disorders and rhinosinusitis. MethodsWe performed a case-control study of patients referred to West Virginia University from August 2020 to October 2022 for rhinologic complaints. Rhinosinusitis patients were diagnosed with either chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). These patients were compared to non-rhinosinusitis patients. Patients' characteristics, comorbidities, and type of treatment of autoimmune disorders were reviewed. ResultsThe sample consisted of 527 rhinosinusitis [184 CRS without nasal polyps (CRSsNP), 263 CRS with nasal polyps (CRSwNP) and 80 RARS patients] patients and 564 non-rhinosinusitis patients. Patients with rhinosinusitis were more likely to be older, males, have asthma, and have current and past smoking history (all with p-value < 0.05). Autoimmune disorders, primary antibody deficiency, and immunomodulator agents were more common in rhinosinusitis patients (16.5 % vs 9.4 %, OR = 1.9, p < 0.001; 5.1 % vs 0.5 %, OR = 10.1, p < 0.001; and 3.8 % vs 1.1 %, OR = 3.7, p = 0.003 respectively). Multivariate logistic regression adjusting for confounders showed that autoimmune disorders were strongly associated with rhinosinusitis [OR = 1.6, 95 % CI = 1.10–2.48], whereas the immunomodulators did not reach statistical significance [OR = 2.4, 95 % CI = 0.87–6.47]. Subgroup analysis showed the autoimmune disorders did not significantly differ between CRS and RARS groups [OR = 1.0, 95 % CI = 0.5–2.1], or between the CRSsNP and CRSwNP groups [OR = 0.9, 95 % CI = 0.5–1.7]. ConclusionAutoimmune disorders are associated with rhinosinusitis, both CRS and RARS, independently of other risk factors.

Snoring in patients withchronic rhinosinusitis after endoscopic sinus surgery.

In patients with chronic rhinosinusitis (CRS), we assessed quality of life (QOL) of chronic rhinosinusitis (CRS) patients with different self-reported snoring frequencies after endoscopic sinus surgery (ESS), and explored factors associated with pre-ESS snoring and post-ESS snoring reduction. This prospective cohort study was conducted in a tertiary referral center in Chengdu, China. Adult patients withmedically recalcitrant CRS receiving initial ESS were engaged. Self-reported snoring was measured at baseline and 3-year follow-up, along with Sino-Nasal Outcome Test-22 and snoring visual analog scale assessment. Mouth breathing (MB), demographics, behavior, comorbidity factors, and objective CRS severity were considered. In 210 patients who completed this study, 63 (30%) patients reported pre-ESS habitual snoring, and post-operative habitual snoring was observed in 52 (25%) patients. The presence of self-reported snoring was correlated with worse CRS QOL at baseline and 3-year follow-up. Obesity (odds ratio [OR] = 4.30; 95% confidence interval [CI], 1.64-11.28; p < 0.01) and posterior-to-anterior ethmoid sinus ratio greater than one (PE/AE, OR = 0.32; 95% CI, 0.10-0.99; p = 0.05) were associated with pre-ESS snoring in univariable and multivariable analysis. The post-operative reduction of snoring frequency was related with patient age over 65 (OR = 11.55; 95%CI, 1.35-98.79; p = 0.03) and bilateral opacification in the Lund-Mackay system (OR = 8.04; 95%CI, 1.24-51.90; p = 0.03) in multivariable analysis. Pre-operative snoring and MB were associated with increased risk of post-operative snoring (p < 0.01 for each comparison). Post-ESS, self-reported snoring was associated with worse CRS QOL. Obesity and PE/AE > 1 were risk factors of pre-operative snoring. Advanced age and bilateral opacification were associated with greater improvement of snoring after ESS.

Sinonasal microbiome and inflammatory profiles in fungal ball and chronic rhinosinusitis

ObjectiveFungal balls (FB) are the main form of non-invasive fungal rhinosinusitis found in immunocompetent hosts. Bacterial coinfection affects clinical symptoms. We investigated the sinonasal microbiome and inflammatory profiles in FB and chronic rhinosinusitis (CRS) patients. MethodsThirty-three participants were prospectively recruited. Nasal swab samples and sinonasal tissues were collected from controls, and FB and CRS patients. DNA extraction and microbiome analysis using V3-V4 region 16S rRNA sequencing were performed. Inflammatory cytokine levels in the sinonasal tissues, blood eosinophil counts, and serum total IgE were measured. ResultsNo significant differences were observed in species richness or evenness measures. The phylogenetic tree demonstrated that the FB samples were different from the controls. The sinus bacteria composition differed among the groups. At the phylum level, Firmicutes in FB were significantly depleted compared with those in CRS, while Proteobacteria were more enriched in FB than that in controls and CRS. At the genus level, in FB, Staphylococcus and Corynebacterium were significantly decreased compared to those in the controls. The prevalence of Haemophilus was the highest in FB. Blood eosinophil counts and IL-5 and periostin levels in the sinonasal tissue of the FB group were significantly lower than those in the CRS group. ConclusionsFB patients had different microbiome compositions and fewer type 2 inflammatory profiles than CRS patients did. However, whether these findings cause FB or result from bacterial and/or fungal infection remains unclear. Further studies are needed to reveal how these differences occur and affect the development of FB and clinical symptoms.

Itraconazole versus steroids in post operative cases of allergic fungal rhinosinusitis: a randomized controlled trial

This study was aimed to compare the effect of oral steroids and itraconazole in reducing the recurrence in allergic fungal rhinosinusitis (AFRS) patients undergoing ESS. In this randomized controlled trial, 50 patients of both sexes aged between 15-60 years with AFRS were subjected to functional endoscopic sinus surgery (ESS). In the post-operative period, patients were randomly divided into 2 groups containing 25 patients each. Group A received systemic steroid followed by topical steroid. Group B received oral itraconazole. Patients were followed at the end of 6, 10 and 14 weeks after surgery. Sinonasal outcome test 22 (SNOT-22) Lund Kennedy endoscopic score (LKES), AEC and serum total IgE were repeated at each post-operative visit and compared with the preoperative values. Repeat NCCT nose and PNS was done at 14th week to look for recurrence. Statistically significant difference was seen between the two groups in AEC, LKES and SNOT-22 with group A showing more significant improvement than group B, but not in serum IgE and Lund Mackay computed tomography (LMCT) score. The group A had 24% (n=6) recurrence rate, while group B had 44% (n=11) recurrence rate. The difference in the two groups in recurrence was not statistically significant. We evaluated multiple parameters including radiological and endoscopic scores to find the difference between the two drugs and found steroid to be superior than itraconazole.

Exploring the impact of inflammatory endotypes on olfactory function and quality of life in chronic rhinosinusitis patients

ObjectivesThe aim of this observational cross-sectional study was to determine the endotypic inflammatory pattern of a sample of patients with CRS in Brazil, correlate it with olfactory function, and evaluate the clinical severity of the disease. MethodsIn this cross-sectional study, 73 CRS patients were recruited. Patients were classified into type 2 and non-type 2 endotypic patterns based on IgE and eosinophilia levels. All subjects performed the University of Pennsylvania Smell Identification Test (UPSIT®) and responded to the Sino-Nasal Outcome Test (SNOT-22). ResultsThe majority of patients had type 2 CRS (n=57, 78.1%). Patients with type 2 CRS compared to non-type 2 CRS had a higher prevalence of nasal polyps (93% vs. 12.5%), asthma (40.3% vs. 12.5%), and non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD, 17.5% vs. 0%). Type 2 patients also had significantly lower UPSIT® and higher SNOT-22, Lund-Kennedy, and Lund-Mackay scores. ConclusionOur study provides evidence that type 2 CRS is associated with a higher prevalence of nasal polyps, asthma, and NERD, as well as decreased olfactory function and worse quality of life scores. These data will contribute to the body of knowledge on CRS and the development of treatments for this disease in Brazil. Level of evidence3.

Therapy of acute rhinosinusitis in patients with allergic rhinitis: possibilities for implementing advanced control of inflammation

Introduction. Allergic rhinitis (AR) in conjunction with acute infectious rhinosinusitis (ARS) can lead to increased inflammation and contributes to a more severe course of ARS.Aim. To study the effect of some non-sedating H1-antihistamines on the severity of clinical presentations in adult patients with ARS and underlying AR as part of routine medical practice.Materials and methods. Group 1 (75 patients) and Group 2 (85 patients) were generated through simple randomization from the patient population with ARS and underlying AR, who were prescribed benzhydryl-piperazinyl-butylmethylxanthine succinate (Teoritin® MF, 4 mg/day) or desloratadine (INN, 5 mg/day), respectively. The course of therapy was 14 days. The estimated parameters included changes in indices of nasal symptoms, rhinoscopic and non-nasal symptoms during follow-up visits, time to reach zero indices, the proportions of patients, whose symptoms reduced after 3 and 7 days of treatment, the need for the use of nasal decongestants and changes in quality of life measures.Results and discussion. During the first 3 days of treatment, nasal breathing improved in 91% (95% CI 81–96%) of patients in Group 1 vs 56% (95% CI 45–67%) in Group 2, p &lt; 0.001; rhinorrhea was relieved in 76% (95% CI 65–85%) and 62% (95% CI 51–72%) in Groups 1 and 2, respectively. By Day 7 of treatment, complete restoration of nasal breathing was observed in 71% of patients in Group 1 (95% CI 59–80%), and in 41% (95% CI 31–52%) in Group 2 (p = 0.014); rhinorrhea was relieved in 61%(95% CI 49–72%) of patients in Group 1 and 37% (95% CI 27–48%) in Group 2, p = 0.001. Decongestants were used by 20%(95% CI 12–31%) of patients in Group 1, and by 35% (95% CI 25–47%) of patients in Group 2, p = 0.031. The between-group difference was significant in terms of duration and frequency of adjuvant therapy, p &lt; 0.05.Conclusion. In comparison with desloratadine, it provided a more pronounced reduction of nasal and non-nasal symptoms, as well as relief of rhinoscopic signs of inflammation in a shorter time. The use of Teoritin® MF contributed to the reduction in the need (duration and frequency) for nasal decongestants.

Gabapentin and postoperative pain and opioid consumption: A double-blind randomized controlled trial of perioperative pain management for sinus surgery

BackgroundThe link between post-operative narcotic prescription and opioid misuse has spurred a nationwide effort to reduce perioperative opioid use. Previous work has suggested that perioperative gabapentin may reduce post-operative pain and opioid consumption across different procedures, although the optimal regimen remains to be defined. MethodsChronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS) with or without septoplasty were randomized to receive a 7-day pre- and post-operative course of placebo or gabapentin, starting at 300 mg daily and titrated to 300 mg three times daily, in a double-blind fashion. Primary endpoint was pain level using a validated visual analog scale (VAS). Secondary endpoints included post-operative opioid consumption and side effects, as well as modified Lund-Kennedy endoscopy, Lund-Mackay, and SNOT-22 scores. ResultsAnalysis of 35 patients (20 gabapentin, 15 control) showed no significant difference in mean postoperative VAS (p = 0.18) or postoperative opioid consumption between the placebo and gabapentin groups (2.3 and 4.8 oxycodone tablets respectively, p = 0.18). 15 of 35 patients did not require any post-operative oxycodone tablets, and only two patients required more than six tablets. ConclusionPreliminary results show no significant change in pain after FESS with or without septoplasty in patients taking 7-day pre- and post-operative gabapentin versus placebo. Results also showed no significant difference in opioid consumption between the treatment and placebo groups. Post-operative pain scores and opioid requirements are both quite low following FESS. Many patients do not need opioids at all, suggesting that routine initial post-operative opioid prescriptions can be limited accordingly.

Effect of Adding Physiotherapy Program to the Conservative Medical Therapy on Quality of Life and Pain in Chronic Rhinosinusitis Patients.

: To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients. : Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer. : Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann-Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group. : The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.

The application of enhanced recovery after surgery (ERAS) in chronic rhinosinusitis patients undergoing endoscopic sinus surgery: A systematic review and meta-analysis.

Enhanced recovery after surgery (ERAS) has become extensively practiced and has shown encouraging benefits. Within recent years, ERAS has also been increasingly performed in chronic rhinosinusitis (CRS) patients undergoing endoscopic sinus surgery (ESS). However, the actual efficacy of ERAS in CRS patients undergoing ESS is not completely clear, and the related evidence remains weak. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of ERAS in the perioperative management of CRS patients receiving ESS. We searched randomized controlled trials in PubMed, Web of Science, EMBASE, Cochrane CENTRAL, Ovid, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, Wanfang, and VIP Database up to February 2023, to analyze the effectiveness and safety of ERAS in ESS perioperative management of CRS patients. We appraised the methodological quality in the included RCTs using the Cochrane Collaboration tool and assessed the quality of evidence with the Recommendations Assessment, Development and Evaluation (GRADE) tool. Meta-analysis, subgroup analysis, and sensitivity analysis were carried out with the the software Review Manager 5.3 and Stata 12.0. In addition, potential publication bias was detected by Begg's test, Egger's test, and funnel plot test. Twenty-eight studies involving 2636 patients were included within this study. In comparison with the standard care (SC) group, the ERAS group had the advantages in the following aspects: length of stay (MD = -2.50, 95%CI: -3.04 to -1.97), pain scores (MD = -1.07, 95%CI: -1.46 to -0.67), anxiety score (SMD = -2.13, 95%CI: -2.83 to -1.44), depression score (SMD = -2.42, 95%CI: -3.13 to -1.71), hospitalization expenses, and quality of life. At the same time, the ERAS group presented a markedly lower incidence of adverse events in comparison to the SC group, such as overall complications (RR = 0.28, 95%CI:0.20 to 0.41), postoperative nausea and vomiting (RR = 0.33, 95%CI:0.21 to 0.50), facial edema (RR = 0.20, 95%CI:0.11 to 0.38), low back pain (RR = 0.28, 95%CI:0.16 to 0.49), urinary retention (RR = 0.12, 95%CI:0.05 to 0.30) and haemorrhage (RR = 0.19, 95%CI:0.07 to 0.55). The results showed that the ERAS protocol is effective and safe in CRS patients who undergo ESS. However, Due to the limited overall methodological quality included studies, caution should be exercised in the interpretation of the results. More high-quality, multiple-centre, and large-sample studies are in demand in the future to further validate its clinical efficacy.

Characteristic of Anatomical Variations in Paranasal Sinus CT-Scan of Chronic Rhinosinusitis Patients at the ENT Clinic Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar in 2021

Background: Anatomical variations and pathological processes in the nose and paranasal sinuses have been widely studied by experts. Many anatomical variations cause chronic sinusitis by causing obstruction of the osteomeatal complex (OMC) and influencing mucociliary transport patterns. Methods: This is a retrospective study based on radiology data of all rhinosinusitis cases that performed a computed tomography scan of the paranasal sinuses at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar for one year (January 2021 to December 2021). The sample of this study was all rhinosinusitis patients undergoing surgery, both male and female, from January 1 to December 31, 2021. Results: Based on the results of the research data, the highest anatomical variation was concha hypertrophy in as many as 26 people (38.2%). Conclusion: The most common anatomic variation is concha hypertrophy. Preoperative CT scan examination is essential because it can be helpful as navigation for sinus surgeons. Early detection of anatomic variations is the key for surgical planning and the prevention of complications.

Comparison of Fungal and Non-Fungal Rhinosinusitis by Culture-Based Analysis.

Incidence of fungal rhinosinusitis has increased in recent few years. We investigated the differences in microbiological findings between patients with fungal and non-fungal rhinosinusitis by growing microbiological cultures from samples obtained from sinus surgery. Using the Chang Gung Research Database, we enrolled all chronic rhinosinusitis (CRS) patients who had ever undergone sinus surgery from 2001 to 2019 and had microbiological culture during sinus surgery. Enrolled patients were divided into fungal and non-fungal groups, based on fungal culture and surgical pathology. A total of 898 patients were diagnosed with fungal rhinosinusitis and 2884 with non-fungal rhinosinusitis. The fungal group had a higher age distribution (56.9 ± 13.1 vs. 47.0 ± 14.9), a larger proportion of females (62.4% vs. 37.0%), more unilateral lesions (80.4% vs. 41.6%), a lower incidence of the need for revision surgery (3.6% vs. 6.0%, p = 0.004), and a higher proportion of Pseudomonas aeruginosa in the culture (14.3% vs. 4.6%, p < 0.001). This large-scale study showed that Pseudomonas aeruginosa are more commonly found in patients with fungal rhinosinusitis and in patients who needed revision surgery, suggesting that efforts aimed at eliminating Pseudomonas are needed in order to improve the disease outcomes of patients with fungal rhinosinusitis.

Systematic nursing strategy for chronic rhinosinusitis patients with polyps undergoing endoscopic sinus surgery and its effect on their outcomes

Systematic nursing strategy for chronic rhinosinusitis patients with polyps undergoing endoscopic sinus surgery and its effect on their outcomes

Anatomical variations of the Paranasal sinuses in Javanese patients with Chronic Rhinosinuitis

Variations in paranasal sinuses anatomy are common and vary among populations. Having clear picture of paranasal sinuses anatomy of a chronic rhinosinusitis patients is essential in surgical planning. This study was done to know paranasal sinuses anatomical variations of chronic rhinosinusitis in Javanese patients by Ct-scan. Retrospective chart survey from medical record of the ORL-HNS outpatient unit at Dr. Soetomo hospital Surabaya during the period January 2019 to December 2020. The data of age, gender, anatomical variations of paranasal sinuses and Keros classification of 55 patients who met the inclusion and exclusion criteria were obtained and recorded. The most common paranasal sinuses anatomical variations were deviated nasal septum (71%), concha bullosa (27%) and ager nasi (22%). Genderwise, anatomical variations were seen more in males. Based on Keros classification, type II(47%) is the most frequently found. The high incidence of paranasal sinuses anatomical variations, emphasize the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

Introduction: Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a “one airway, one disease” relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the “one airway, one disease” concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone. Methods: A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients’ clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE). Results: The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05). Conclusions: Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.

Impact of recurrent acute rhinosinusitis on quality of life.

Quality of life (QoL) in patients with recurrent acute rhinosinusitis (RARS) is understudied. QoL for RARS patients is similar to chronic rhinosinusitis patients, although objective disease severity is lower. QoL of RARS patients is similarly affected during active and inactive infection.

Z-Form Extracellular DNA in Pediatric CRS May Provide a Mechanism for Recalcitrance to Treatment.

We examined sinus mucosal samples recovered from pediatric chronic rhinosinusitis (CRS) patients for the presence of Z-form extracellular DNA (eDNA) due to its recently elucidated role in pathogenesis of disease. Further, we immunolabeled these specimens for the presence of both members of the bacterial DNA-binding DNABII protein family, integration host factor (IHF) and histone-like protein (HU), due to their known role in converting common B-DNA to the rare Z-form. Sinus mucosa samples recovered from 20 patients during functional endoscopic sinus surgery (FESS) were immunolabelled for B- and Z-DNA, as well as for both bacterial DNABII proteins. Nineteen of 20 samples (95%) included areas rich in eDNA, with the majority in the Z-form. Areas positive for B-DNA were restricted to the most distal regions of the mucosal specimen. Labeling for both DNABII proteins was observed on B- and Z-DNA, which aligned with the role of these proteins in the B-to-Z DNA conversion. Abundant Z-form eDNA in culture-positive pediatric CRS samples suggested that bacterial DNABII proteins were responsible for the conversion of eukaryotic B-DNA that had been released into the luminal space by PMNs during NETosis, to the Z-form. The presence of both DNABII proteins on B-DNA and Z-DNA supported the known role of these bacterial proteins in the B-to-Z DNA conversion. Given that Z-form DNA both stabilizes the bacterial biofilm and inactivates PMN NET-mediated killing of trapped bacteria, we hypothesize that this conversion may be contributing to the chronicity and recalcitrance of CRS to treatment. NA Laryngoscope, 134:1564-1571, 2024.

SINONASAL ANATOMICAL VARIATIONS IN PATIENTS WITH CHRONIC RHINOSINUSITIS

Objective: The nose and paranasal sinuses have a wide range of structural changes that are best diagnosed with computed tomography (CT). Anatomical variations are minor anatomical defects that occur around the osteomeatal complex that can block paranasal sinus drainage and ventilation. The purpose of this study was to determine the prevalence of structural abnormalities of the nose and paranasal sinuses in chronic rhinosinusitis (CRS) patients. Methods: This cross-sectional study included 100 patients with CRS who visited the ENT outpatient department and had been suffering from the condition for more than 3 months without responding to medical treatment. CT PNS scans were used to determine the prevalence of anatomical abnormalities in these patients. Results: The majority of the patients were between the ages of 31 and 40 years. The most common presenting symptom was nasal obstruction (86%), followed by headache (60%). The most prevalent anatomical abnormality encountered in our study was a deviated nasal septum (70%) and concha bullosa occurring in 35% of cases. Conclusion: In our study, the most frequent anatomical variation was a deviated nasal septum. Patients with prolonged symptoms who are not improving with appropriate medical care are advised to get a CT scan to find any structural changes.

Safety of Antibiotic Irrigations for Acute Exacerbations of Chronic Rhinosinusitis in Patients with Identical Drug Allergies or Adverse Reactions: A Pilot Study.

Objectives: The use of topical antibiotics in the treatment of acute exacerbation of chronic rhinosinusitis (AECRS) represents a viable option prior to initiation of parenteral antibiotics when no oral antibiotic alternatives are available due to patient allergy or adverse reactions. The main objectives of this pilot study were to determine the safety and efficacy of antibiotic irrigations in the treatment of AECRS in patients with documented adverse reactions to the oral form of the drug. Methods: A retrospective review was performed of patients diagnosed with AECRS treated with antibiotic irrigations. Inclusion criteria included a documented allergy or adverse event to the systemic form of the same antibiotic. Patient demographics, medical history, prior sinus surgery, nasal endoscopy findings, and microbiology results were obtained. Side effects to the antibiotic irrigations were recorded. Results: Six patients met the inclusion criteria resulting in 7 treated cases of AECRS. Four patients with adverse effects to oral trimethoprim/sulfamethoxazole (TMP/SMZ) received TMP/SMZ irrigations, and 1 patient with an adverse reaction to oral ciprofloxacin was treated with ciprofloxacin irrigations. One patient with adverse effects to both oral TMP/SMZ and levofloxacin was treated with TMP/SMZ and levofloxacin irrigations, respectively during 2 separate AECRS episodes. Following treatment, 1 case (14.3%) resulted in complete resolution of infection, 1 (14.3%) had partial improvement, and 5 (71.4%) had minimal to no endoscopic improvement at the subsequent clinic visit. There were no adverse reactions to antibiotic irrigations among the entire cohort. Conclusions: Currently, no prior study has examined whether adverse reactions to a systemic antibiotic also occur when the medication is delivered topically via sinonasal irrigations. Our findings suggest that topical administration of antibiotics may be a safe alternative for patients with adverse effects to the systemic form.

Rehabilitation of a Post-Covid Rhinosinusitis Patient with Exenterated Orbital Defect Using a Self-Retained Silicone Prosthesis - A Case Report

A 56-year-old female patient reported to the Department of Prosthodontics for the replacement of right eye. The patient gave a history of covid 1.5 years back and was diagnosed with diabetes for which she was prescribed oral antidiabetic drugs. The patient was apparently alright for 1-year post-covid treatment, after which she noted swelling around the right eye with gradual loss of vision and loss of movement of the right eyeball. It was diagnosed as post-covid acute invasive fungal rhinosinusitis. The patient underwent exenteration for the same.&#x0D; On examination, an orbital defect was noted, measuring 3.7cm mediolaterally, 3.5 cm superoinferiorly and with depth of 3.6 cm (measured at deepest point). The floor of the defect was completely healed with no signs of inflammation/ bleeding/ pus discharge, and with mild scarring at the base [Figure 1]. Patient’s written consent was obtained for the use of original photographs for publication.

A study on olfactory improvement assessed with butanol threshold test in chronic rhinosinusitis patients after fess at a tertiary care centre in Malabar region

Background: Chronic Rhinsinusitis is a hetreogenous disorder with a broad range of etiologic factors involving mucosa of nasal cavity and paranasal sinuses. Olfactory dysfunction has been reported in approximately 60-80% of patients who suffer from CRS. Methods: Hospital based prospective observational study in the department of ENT, KMCT medical college, Mukkam done in Patients diagnosed with CRS who require FESS having anosmia or hyposmia as an additional symptom. Calculated sample size was 87. Butanol threshold test was done in patients before undergoing FESS and at 1st week,6th week and 24 weeks following FESS and improvement noted. Independent sample t test and ANOVA were used to test statistical significance Results: Out of 87 subjects, 36% belonged to age group of 36-45 years 15-25 years was the least involved group and majority of patients had nasal obstruction (83.9%) or nasal discharge (81.6%). 69% of patients experienced facial pain and 79.3% had post nasal discharge. Pre operative BTT showed a mean value of 4.89.BTT at 1st week post op showed a mean value of 3.63. At 6 weeks post op BTT value showed significant difference from pre op value with a mean of 2.05 and at 24 weeks post op the mean BTT was 1.70 Conclusions: Summarising the results from our study we affirm that FESS improves olfactory function substantially in CRS patients especially in patients with polyps.