Septal Perforation Research Articles

Clinical Study of Septal Deviation and Its Association with Sinusitis

Introduction: Aim: To establish association between Septal deviation and sinusitis along with the clinical profile of Chronic Rhinosinusitis in Deviated nasal septum. Methodology: A cross sectional study of 50 patients attending ENT department of VIMS, Bellary with symptoms of chronic rhinosinusitis were included. Nasal trauma, Nasal polyposis, Septal perforation, Allergic rhinitis, Aggressive fungal infections, Odontogenic sinusitis, Neoplasia, Patients <15 yrs of age, Immunodeficiency and mucociliary disorders, Prior history of nasal or sinus surgery, Other anatomic abnormalities were excluded. Included patients underwent detailed clinical examination, Diagnostic nasal endoscopy, X-ray or computed tomography of Paranasal sinuses. Results: Among 50 patients with chronic rhinosinusitis, 36 patients were found to have Deviated nasal septum. Male preponderance was observed in both sinusitis and septal deviation population. Bilateral maxillary sinus (28%) was the most common presentation in CTPNS. We found that significant association was found between anterior and posterior ethmoid sinusitis with Left sided S shaped obstructed or impacted type of deviated nasal septum. Conclusion: Chronic rhinosinusitis is most common rhinological problem encountered worldwide which has greater propensity to cause morbidity. Deviated nasal septum can be associated with significant sinonasal disease, especially a S-shaped obstructed and impacted type of DNS which showed statistically significant correlation with sinus disease in our study. Also, DNS to left, in general, was associated with higher incidence of sinuses disease than central and DNS to right. This study brings to light various presentations of DNS implicated in causation of chronic sinusitis which will influence the treatment decisions and also reduce the morbidity caused by it. Keywords: Chronic Rhinosinusitis (CRS), Deviated nasal septum (DNS)

Instillation of a Dry Powder in Nasal Casts: Parameters Influencing the Olfactory Deposition With Uni- and Bi-Directional Devices.

Nose-to-brain delivery is a promising way to reach the central nervous system with therapeutic drugs. However, the location of the olfactory region at the top of the nasal cavity complexifies this route of administration. In this study, we used a 3D-printed replica of a nasal cavity (a so-called “nasal cast”) to reproduce in vitro the deposition of a solid powder. We considered two different delivery devices: a unidirectional device generating a classical spray and a bidirectional device that relies on the user expiration. A new artificial mucus also coated the replica. Five parameters were varied to measure their influence on the powder deposition pattern in the olfactory region of the cast: the administration device, the instillation angle and side, the presence of a septum perforation, and the flow rate of possible concomitant inspiration. We found that the unidirectional powder device is more effective in targeting the olfactory zone than the bi-directional device. Also, aiming the spray nozzle directly at the olfactory area is more effective than targeting the center of the nasal valve. Moreover, the choice of the nostril and the presence of a perforation in the septum also significantly influence the olfactory deposition. On the contrary, the inspiratory flow has only a minor effect on the powder outcome. By selecting the more efficient administration device and parameters, 44% of the powder can reach the olfactory region of the nasal cast.

Endoscopic Techniques for Nasal Septal Perforation Repair: A Systematic Review.

Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR. A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed. A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months). ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure.

Evaluation of septal perforation size using a novel measuring device.

Nasal septal perforations can be managed with a septal button prosthesis. While they do not restore the physiological function of the septal mucosa, they are able to improve laminar nasal airflow. With the development of septal buttons sized specifically to perforations, accurate measurement of perforations has become more important for patient satisfaction and comfort. This task can be difficult to accomplish in the clinical setting. In this study, 2 new instruments developed to measure septal perforations were evaluated for accuracy and ease of use. Two types of measuring devices ("sizers") were created via 3D printing. One type included six serial, progressively sized instruments (serial sizers) and the other included two instruments with several size gradations (graded sizers). Septal perforations of varying sizes were surgically created in five fresh-frozen cadaver heads. Using a headlight and nasal speculum, 15 otolaryngology trainees and consultants were asked to measure the perforations (length × height) via four different methods: "eyeball" estimation, a ruler, the serial sizers, and the graded sizers. They were also asked to evaluate the methods themselves. An accurate measurement was defined as ± 1mm of the true measurement. A combination of Chi-square analysis and ANOVA was used to assess the accuracy and ease of use of the four methods. Chi-square analysis showed that the sizers were more accurate than the two traditional methods (eyeball and ruler) for measuring perforation length (73% vs. 44%, p = 4.8 × 10-7) and height (71% vs. 50%, p = 0.0003). ANOVA showed that the eyeball method overestimated perforation length significantly more than the other three methods (p = 0.002), and was also significantly less accurate than the other three methods (p < 0.001). Chi-square analysis did not show any correlation between participant training experience and measurement accuracy for any of the three methods. Participant comments and scores demonstrated a clear preference for the two sizers over the traditional methods. The two novel sizers studied here were significantly more accurate and easier to use than traditional methods for measuring nasal septal perforations. With broader implementation and study of these devices, there is potential to improve patient care surrounding septal perforations.

Initial experience of left bundle branch area pacing using stylet-driven pacing leads: A multicenter study.

Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads (LLL) with fixed helix design. This registry study explores the safety and feasibility of LBBAP using stylet-driven leads (SDL) with extendable helix design in a multicenter patient population. This study prospectively enrolled consecutive patients who underwent LBBAP for bradycardia pacing or heart failure indications at eight Belgian hospitals. LBBAP was attempted using SDL (Solia S60; Biotronik) delivered through dedicated delivery sheath (Selectra3D). Implant success, complications, procedural, and pacing characteristics were recorded at implant and follow-up. The study enrolled 353 patients (mean age 76 ± 39 years, 43% female). The mean number of implants per center was 25 (range: 5-162). Overall, LBBAP with SDL was successful in 334/353 (94%), varying from 93% to 100% among centers. Pacing response was labeled as left bundle branch pacing in 73%, whereas 27% were labeled as myocardial capture. Mean paced QRS duration and stimulus to left ventricular activation time measured 126 ± 21 ms and 74 ± 17. SDL-LBBAP resulted in low pacing thresholds (0.6 ± 0.4 V at 0.4 ms), which remained stable at 12 months follow-up (0.7 ± 0.3, p = .291). Lead revisions for SDL-LBBAP occurred in 5 (1.4%) patients occurred during a mean follow up of 9 ± 5 months. Five (1.4%) septal coronary artery fistulas and 8 (2%) septal perforations occurred, none of them causing persistent ventricular septal defects. The use of SDL to achieve LBBAP is safe and feasible, characterized by high implant success in low and high volume centers, low complication rates, and stable low pacing thresholds.

Adverse Drug Reactions of Intranasal Corticosteroids in the Netherlands: An Analysis from the Netherlands Pharmacovigilance Center.

BackgroundIntranasal corticosteroids are one of the cornerstone treatment options for allergic rhinitis and chronic sinusitis complaints. Safety information in the summary of product characteristics may not be representative for observations in daily clinical practice. The Netherlands Pharmacovigilance Center (Lareb) collects post-marketing safety information, using spontaneous reporting systems.ObjectiveOur objective was to analyse reports of adverse drug reactions associated with intranasal corticosteroids reported in the Dutch spontaneous reporting database of the Netherlands Pharmacovigilance Center Lareb to obtain insight into real-world safety data.MethodsWe retrospectively examined all adverse drug reactions of intranasal corticosteroids reported to the Netherlands Pharmacovigilance Center Lareb, entered into the database from 1991 until 1 July, 2020.ResultsIn total, 2263 adverse drug reactions after intranasal corticosteroid use were reported in 1258 individuals. Headache (n = 143), epistaxis (n = 124) and anosmia (n = 57) were reported most frequently. Nasal septum perforation (reporting odds ratio 463.2; 95% confidence interval: 186.7–1149.7) had the highest reporting odds ratio, followed by nasal mucosal disorder (reporting odds ratio 104.5; 95% confidence interval 36.3–301.3) and hyposmia (reporting odds ratio 90.8; 95% confidence interval 45.1–182.7). Moreover, 101 (4.5%) reports were classified as serious by Lareb, including reports of Cushing’s syndrome, adrenal cortical hypofunction and growth retardation.ConclusionsMany side effects are consistent with the safety information in the summary of product characteristics of intranasal corticosteroids. Several serious (systemic) side effects are reported and it is important to realise that intranasal corticosteroids may contribute to the development. Healthcare providers and patients should be aware of the potential (individual) adverse drug reactions of intranasal corticosteroids. This information could help in discussing treatment options.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00301-x.

ISOLATED CARTILAGINOUS PERFORATION IN EHLERS-DANLOS SYNDROME: A FEATURE OF THE DISEASE?

TYPE: Case Report TOPIC: Allergy and Airway INTRODUCTION: Ehlers Danlos syndrome (EDS) is a genetic connecting tissue disorder affecting collagen formation and function. It can affect every organ system in the body. Clinically it manifests with skin hyper-elasticity, joint hypermobility and atrophic scarring [1,2]. EDS is associated with distinctive facial features, including epicanthal folds, palpebral ptosis, sunken eyes, hypo/hypertelorism, infraorbital creases, hypoplastic auricular lobe, retrognathia and anteverted nostrils [5]. Although EDS is known to be associated with septal deviation [6], there is little further description in the literature with regards to this. CASE PRESENTATION: A 55 year old female patient with known EDS presented to rhinology clinic with symptoms of left sided nasal obstruction. On clinical examination, she had a deviated septum to the left and nasal polyps. There was no history of trauma and she had tried Sterimar and steroid nasal sprays with no symptomatic benefit. During the septoplasty procedure, it was found that the patient had an isolated cartilaginous septal perforation, with an intact covering of mucoperichondrium on either side of the septum (Figure 1). DISCUSSION: EDS is mostly associated with mutations that affect type I, type III and type V collagen [3] , so why EDS is associated with septal deviation is unclear. CONCLUSIONS: To the best of the authors’ knowledge, there are no reports in the literature with regards to septal perforation in EDS patients, which makes the case more interesting as to whether the septal perforation in this case is an incidental finding or part of EDS that is yet poorly understood. DISCLOSURE: Nothing to declare. KEYWORD: ehlers-danlos

The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum.

Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined. Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum. A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days. In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure. Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.

Comparison of Trans-septal Suturing Technique With Polyvinyl Alcohol Sponge-Based Nasal Packing for Hemostasis in Septoplasty.

IntroductionDespite the theoretical advantages of bleeding control, there is increased morbidity in postoperative pain, sleep disturbance, allergy, toxic shock syndrome, and mucosal injury with the nasal packing in septoplasty procedure for deviated nasal septum. Trans-septal suturing after septoplasty has been advocated as an effective alternative to conventional nasal packing. The current study aims to compare the frequency of subjective symptoms, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora between the trans-septal suturing technique and nasal packing in septoplasty surgery.MethodsWe prospectively recruited all adult septoplasty patients for a one-year duration. Trans-septal nasal suturing was done for hemostasis after septoplasty in the case group. Anterior nasal packing after septoplasty was performed in the control group. The postoperative subjective symptoms were evaluated, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora. Procedure-related complications were compared between the two groups.ResultsA total of 50 patients were recruited for the study (25 in each group). The postoperative symptoms evaluation suggested that the number of patients with postoperative pain was significantly higher in the control group on both occasions. Besides pain, a significantly higher number of patients in the control group had symptoms of nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora.ConclusionTrans-septal suture technique is an effective alternative to nasal packing with a low risk of nasal pain, bleeding, postnasal drip, epiphora, headache, dysphagia, and sleep disturbance. In addition, there is a low risk of complications like nasal bleeding, septal hematoma, septal perforation, and synechiae formation. The only disadvantage of trans-septal suturing compared to PVA-coated nasal packing is the increase in the operative time.

Direct comparison of delivery systems and electrodes with and without stylets for stimulation of the left bundle branch area in patients with indications for cardioresynchronization therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background Currently, there are only two commercially available systems for left bundle branch (LBB) pacing, that use fundamentally different technologies: with and without stylets electrodes. These systems have not been directly compared in patients with LBB block and CRT indication by LBB area pacing. Purpose The primary endpoint is the achievement of the LV subendocardium according to intraoperative echocardioscopy. Secondary endpoints: number of attempts, time of implantation, time of fluoroscopy, electrode stability, depth of implantation in the IVS, QRS duration, LV activation time (Stim-LVAT). Methods 116 patients with LBB block and indications for CRT in the period 2020-2021 underwent electrode implantation into the LBB area. Select Secure 3830, 69 cm, 4.1 F pacing lead with delivery system C315 HIS was implanted in 60 pts (M system group). Delivery system Selectra 3 D and standard electrodes with stylet and active fixation Solia S 60 cm, 5.9 F was implanted in 56 pts (B system group). The implantation of the electrode over the interventricular septum (IVS) was carried out under constant echocardiographic control. Results Primary endpoint was achieved in 53 from 60 pts (88.3%) M system group and in 52 from 56 pts (92.3%) B system group (P=0.1). Septal thickness (cm) at the site of implantation was 1.16 ± 0.25 and 1.28± 0.42, lead depth (cm) - 1.3 ± 0.23 (7-16) and 1.44± 0.42 (8-27) accordingly (not strictly perpendicular in all cases). The number of lead deployment attempts (screwing) to achieve the optimal result were 4.5 ± 2.3 and 2.6 ± 0.5 (P=0.01), the number of full revolutions in each attempt - 14.3 ± 5.8 and 6.2 ± 2.7 respectively (P=0.002). The mean time of lead implantation in LBB area was 19.0 ± 6.8 minutes in M system group and 8.6 ± 4.8 min in B system group (P=0.01), fluoroscopic exposure time: 4.4 ± 2.6 min and 3.0 ± 1.3 min (P=0.03) accordingly. Acute perforation of the LV septum was noted in 1 (1.6%) pts in M system group and 3 (5,6%) patients in B system group and corrected by immediate electrode repositioning. No patient showed loss of capture nor lead dislodgment during follow-up (12.4 ± 5.6 month). A significant decrease in QRS duration was observed in patients both groups: 164±19 versus 121±18 ms (M group), and 168±21 versus 119±20 ms (B group), P=0.08. Stim-LVAT was 84±10 ms (M group) and 78±12 ms (M group), P=0.1 and met the criteria LBB area pacing in pts with LBB block. Conclusion Both systems have shown the ability to reach the LV endocardium and overcome LBB block. Biotronik systems were more convenient and effective at achieving LV subendocardium, especially in cases of hypertrophied and fibrotic IVS, but were associated with a high risk of IVS perforation. The development of delivery systems and electrodes specifically designed for LBB area pacing (optimally 4 F with fixed Helix and stylet) in different IVS anatomy is urgent and necessary.

Initial experience of left bundle branch area pacing using stylet-driven pacing leads: a multicenter study

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads (LLL) with fixed helix design. This study is the first to explore in a multicenter population the safety and feasibility of LBBAP using stylet-driven leads (SDL) with extendable helix design. Methods This study prospectively enrolled all consecutive patients who underwent LBBAP for anti-bradycardia pacing or heart failure indications at 8 Belgian hospitals. LBBAP was attempted either using SDL or LLL delivered through dedicated delivery sheaths. Implant success, complications, procedural and pacing characteristics were recorded at implant and follow-up. Results The study enrolled 412 patients (mean age 74 ± 38 years, 44% female). LBBAP with SDL and LLL was successful in 334/353 (94%) and 52/59 (88%) respectively (p=0.058). Implant success for LBBAP using SDL varied from 93 to 100% among centers. Mean paced QRS duration and stimulus to left ventricular activation time were comparable for SDL and LLL (126 ± 21ms versus 125 ± 22ms, p=0.861 and 74 ± 17 and 75 ± 21ms, p=0.756). SDL LBBAP resulted in low pacing thresholds (0.6 ± 0.4V at 0.4ms), which remained stable at 1, 6 and 12 months of follow-up. Lead revisions for SDL LBBAP occurred in 5(1.4%) patients: 2 dislodgements at day 1, 1 late septal perforation at week 3, 1 Twiddler’s syndrome at 5 months, 1 lead fracture at 6 months. Conclusion This multicenter study confirms the safety and feasibility of LBBAP using SDL, which is characterized by high implant success, low complication rate and low and stable pacing thresholds.

Preliminary study on left bundle branch area pacing in children: Clinical observation of 12 cases.

Left bundle branch area pacing (LBBAP) maintains electrical and mechanical synchronization of the ventricles. It is a relatively physiological pacing mode, with low and stable pacing threshold and wider indications. LBBAP in children has been rarely reported. This study observed 12 children attempted LBBAP from January 2019 to January 2021 in the department of pediatric cardiology of Anzhen Hospital prospectively. Clinical data, pacing parameters, electrocardiograms, intracardiac electrograms, echocardiographic measurements and complications were recorded at implant and during follow-up. The 12 patients aged between 3 and 14 years old and weighted from 13 to 48 kg. Eleven patients were diagnosed with third-degree atrioventricular block and 1 patient (case 4) suffered from cardiac dysfunction due to right ventricular apical pacing (RVAP). Left bundle branch area pacing was successfully achieved in all patients with narrow QRS complexes and V1 lead showed changes like right bundle branch block in the pacing electrocardiogram. Left ventricular ejection fraction in case 4 recovered on the 3rd day after LBBAP. The median of left ventricular end diastolic diameter Z score of the 12 patients decreased from 1.75 to 1.05 3 months after implantation (p < 0.05). The median of paced QRS duration was 103 ms. The median of pacing threshold, R-wave amplitude and impedance were 0.85 V, 15 mV and 717 Ω respectively and remained stable during follow-up. No complications such as loss of capture, lead dislodgement or septal perforation occurred. Left bundle branch area pacing can be performed safely in children with narrow QRS duration and stable pacing parameters. Cardiac dysfunction caused by long-term RVAP can be corrected by LBBAP quickly.

Incidence and Predisposing Factors of Postoperative Infection after Rhinoplasty: A Single Surgeon's 16-Year Experience with 2630 Cases in an East Asian Population.

This study evaluated the incidence and clinical characteristics of postoperative infection following rhinoplasty. This article is a retrospective review of 2630 East Asian rhinoplasty cases performed by a single surgeon (Y.J.J.), from July of 2003 to June of 2018. There were 1595 male patients (69.9 percent) and 687 female patients (30.1 percent), and the median age was 31 years. The incidence of infection was compared between primary and revision cases and analyzed according to the materials used. The authors evaluated the organisms cultured and the timeframe of infection development and intervention. There were 2134 primary and 496 revision cases. Materials included autologous costal cartilage (413 cases), conchal cartilage (572 cases), homologous fascia lata (829 cases), homologous costal cartilage (102 cases), Gore-Tex (373 cases), and silicone (32 cases). The authors identified 22 cases (0.84 percent) of postoperative infection, 18 of which were revision. Revision surgery had a 19-fold greater infection rate than primary surgery (3.63 percent versus 0.19 percent). Women were 3.6 times as likely to develop an infection ( p = 0.002). The infection rate using autologous costal cartilage was 3.39 percent, and that for simultaneous correction of a septal perforation was 8.57 percent. In 11 cases (50 percent), infection developed within 1 month after surgery (12 ± 7 days). Methicillin-resistant Staphylococcus aureus was cultured in eight cases. Infection manifested at the nasal tip in 45 percent and the caudal septum/columella in 32 percent of cases. Twenty cases (90.9 percent) underwent surgical débridement. Revision rhinoplasty in women, requiring the use of costal cartilage or simultaneous correction of septal perforation, showed a higher risk of postrhinoplasty infection, which usually manifested at the nasal tip and caudal septum/columella and needed to be managed by surgical débridement. Therapeutic, IV.

Electrophysiological characteristics of septal perforation during left bundle branch pacing.

Left bundle branch pacing (LBBP) provides a low and stable threshold by direct capture of left bundle fibers on the left ventricular subendocardium. As the procedure involves the deployment of the pacing lead deep inside the septum, septal perforation is a potential complication. The purpose of this study was to analyze the morphology of intracardiac electrograms and unipolar pacing parameters to identify septal perforation in patients undergoing LBBP. Patients who had undergone successful LBBP between January 2020 to November 2021 were retrospectively included in the study. LBBP was attempted in 219 patients and was successful in 212 (96.8% success rate). Septal perforation during lead deployment was identified in 30 patients (14.1%). Peak troponin release was 188 ± 162 pg/mL. Mean unipolar impedance during septal perforation was 404.6 ± 19.9 Ω (400-450 Ω in 16 patients [53.3%]; <400 Ω in 14 patients [46.7%]). A cutoff <450 Ω for diagnosing septal perforation had high sensitivity (100%) and specificity (96.6%). Current of injury amplitude reduced from 15.4 ± 11.6 mV just before perforation to 0.9 ± 0.6 mV after perforation. Based on morphology, unfiltered unipolar electrograms were classified into 2 patterns: (1) type I (QS) seen in 20 patients (67%) due to complete perforation (mean unipolar impedance 402.5 ± 20.4 Ω); and (2) type II (RS/rS) seen in 10 patients (33%) due to partial perforation, with 80% showing capture (mean impedance 411 ± 21.3 Ω). All 30 patients underwent successful reimplantation at a new site. No patient developed lead dislodgment during mean follow-up of 9.9 ± 6.7 months. Although considered one of the concerns of LBBP, septal perforation, when recognized promptly during implantation by unipolar parameters and treated by reimplantation, would be benign and not associated with an unfavorable outcome.

Unexpected Beneficial Effect of Dexamethasone Administration after Septoplasty Procedure: As Prospective Cohort Audit

Background and Objectives: Septoplasty is one of the most common surgical procedures in specialty of otorhinolaryngology. Therefore, there are frequent thoughts regarding this procedure to improve its conditions from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of big issues regarding this procedure is the post-operative sequel and complications namely post-operative pain, oro-facial edema, air way obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation. Therefore, this study was conducted prospectively to confirm the effect of intravenous administration of dexamethasone on outcomes of this procedure as compared to the effect of oral administration of ketoprofen as well as paracetamol after septoplasty procedure. Patients and Methods: Two- thousands and two- hundred thirteen patients aged from 4 years to 65 years presented at ENT department-Althowra central teaching hospital as well as Altarahom private clinic-elbyda city-Libya at period in between September 2005 to January 2022 as cases of DNS with variable patterns of septal deformities for septoplasty. Five hundred thirty- one patients were received oral paracetamol who represent group-A, 753 received oral ketoprofen that constitutes group-B, while remaining 929 were administrated by intravenous dexamethasone and classified as group-C. As prospective analytic study, three groups compared in relation to significant postoperative complications risk namely post-operative pain, oro-facial edema, airway obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation. In addition, these groups compared for any significant difference regarding the period of postoperative hospitalization, which can be used, as objective indicator to measure the postoperative morbidity rate. Results: Dexamethasone as well as ketoprofen administration caused significant improvement in pain intensity as compared to paracetamol group. On the other hand there was significant reduction in the incidence of post-operative oro-facial edema, air way obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation among group-B and C as compared to group-A. Conclusion: Dexamethasone can be considered as potent analgesic drug after septoplasty procedure and in same time, it plays significant role in the improvement of outcomes of this common procedure as compared to the other commonly used non-steroidal anti-inflammatory drugs.

False Positive Reaction to Vdrl Test with Prozone Phenomenon in a Case of Lepromatous Leprosy

Abstract The venereal disease research laboratory (VDRL) test, a nontreponemal test for syphilis, may under a certain set of conditions give false positive results in patients who are not infected with Treponema pallidum. A false positive reaction is defined as a positive reaction to nontreponemal tests, and a negative reaction to treponemal tests, in the serum of a patient who has no history or clinical evidence of syphilis or other treponematosis. A prozone phenomenon in nontreponemal tests is seen largely with secondary syphilis due to high-titer samples that show nonreactive results unless the specimens are diluted. We report here perhaps the first case of lepromatous leprosy, which had a false positive reaction to the VDRL test with the prozone phenomenon. The case initially presented to the outpatient clinic with complaints of epistaxis with nasal stuffiness. The finding of septal perforation on nasal endoscopy is what led to the initial suspicion of syphilis and the subsequent syphilis workup. It was only when the false positive reaction to VDRL test with the prozone phenomenon was noted that the search for other causes was made, which eventually lead to the diagnosis of lepromatous leprosy.

Frequency of Septal Perforation in Sub-Mucous Resection of Nasal Septum

Objectives: In this study, the efficacy of sub-mucous resection (SMR) in the management of patients presented with deviated nasal septum (DNS) was assessed with particular emphasis on the post-operative septal perforation. Methods: A descriptive study was carried out for six months (i.e., from October 2021 to March 2022) at the Ear, Nose and Throat (ENT) Department of Hayatabad Medical Complex, Peshawar, Pakistan. Results: A total of 203 patients who presented with DNS were included herein, where the male to female ratio was 1.39:1 while the mean age was 30 ±3.74 (range= 20-60) years. The majority patients presented with S type DNS (80; 39%), followed by C type DNS (75, 37%) while the spur type DNS was seen in only 48 (24%) cases. After SMR, 08 (4%) cases of septal perforation were observed with anterior rhinoscopy. Conclusions: These results demonstrate the fact that post-surgical septal perforation is a critical clinical complication. Keywords: septoplasty, DNS, sub-mucous resection, septal perforation, rhinoscopy

Feasibility and safety of left bundle branch area pacing invery elderly patients (≥80 years).

Left bundle branch area pacing (LBBAP) has emerged as a promising physiologic pacing strategy. Though many clinical studies have established the feasibility and safety of LBBAP, the data for very elderly patients are lacking. This study aimed to assess the feasibility and safety of LBBAP in very elderly patients (≥80 years). Two hundred and forty consecutive patients who received LBBAP implantation were retrospectively enrolled in the present study. Inclusion criteria were patients with atrioventricular block, atrial fibrillation with a slow ventricular response, and heart failure with bundle branch block. The patients were divided into two groups: those aged ≥80 years and those aged <80 years. LBBAP implantation was successfully performed in 48 of 53 (90.6%) very elderly patients and 162 of 187 (86.5%) counterparts. In the very elderly group, the mean (standard deviation [SD]) age was 84 (3) years, mean (SD) paced QRS duration was 112.4 (9.0), and the mean (SD) stimulus to R wave peak time was 82.0 (14.2) ms. Mean (SD) pacing thresholds and mean (SD) R wave sensing were 0.61(0.21) V and 12.1 (4.7) mV at implant. Pacing parameters in very elderly patients were similar to those in their counterparts. During a median follow-up of 6 months, pacing parameters remained stable. Five patients in the very elderly group developed complications (1 with septal perforation during the procedure, 1 with pocket hematoma, 1 with pacing threshold increase, and 2 with micro lead dislodgement during follow-up). LBBAP is safe and effective in patients ≥80 years old. LBBAP can be considered as an alternative method for delivering physiological pacing in this special population.

A new red algal crust from New Zealand: Apophlaea darchinoae sp. nov. (Hildenbrandiales)

ABSTRACT New Zealand’s algal flora is still far from fully explored, and new taxa continue to be discovered. The taxonomy of the red algal order Hildenbrandiales, consisting mostly of crustose members, is controversial as descriptions are largely based on limited morphological features. The order Hildenbrandiales is also in a close, apparently obligate, relationship with an endophytic fungus. Apophlaea is a genus in this order currently comprising two described species, both endemic to New Zealand. The morphology of this genus is more complex than that of other members of the Hildenbrandiales as it consists of extensive upright thalli. Sampling of Apophlaea in New Zealand, especially in the southern part of the North Island, has led to the discovery of a genetically distinct entity, that is only crustose. We propose a new species for this entity, Apophlaea darchinoae sp. nov., which is found on rocks in the high intertidal zone. This species has the typical tetrasporangial conceptacles of Apophlaea and no other reproductive structures were observed, and it consists of filaments that are laterally joined by secondary pit connections. Apophlaea darchinoae can be found in sympatry with A. sinclairii in the north of the North Island. We provide molecular evidence for the distinct nature of A. darchinoae and provide observations of extensive fungal filaments within this new species.

Initial Experience with Left Bundle Branch Area Pacing with Conventional Stylet-Driven Extendable Screw-In Leads and New Pre-Shaped Delivery Sheaths.

Until recently, left bundle branch area pacing (LBBAp) has mostly been performed using lumen-less fixed screw leads. There are limited data on LBBAp with conventional style-driven extendable screw-in (SDES) leads, particularly data performed by operators with no previous experience with LBBAp procedures. In total, 42 consecutive patients undergoing LBBAp using SDES leads and newly designed delivery sheaths (LBBAp group) were compared with those treated with conventional right ventricular pacing (RVp) for atrioventricular block (RVp group, n = 84) using propensity score matching (1:2 ratio). The LBBAp was successful in 83% (35/42) of patients, with satisfactory pacing thresholds (0.8 ± 0.2 V at 0.4 ms). In the LBBAp group, the mean paced-QRS duration obtained during RV apical pacing (173 ± 18 ms) was significantly reduced by LBBAp (116 ± 14 ms, p < 0.001). Compared with the RVp group, the LBBAp group showed more physiological pacing, suggested by a much narrower paced-QRS duration (116 ± 14 vs. 151 ± 21 ms, p < 0.001). The pacing threshold was comparable in both groups. The LBBAp group revealed stable pacing thresholds for 6.8 ± 4.8 months post-implant and no serious complications including lead dislodgement or septal perforation. The novel approach of LBBAp using SDES leads and the new dedicated pre-shaped delivery sheaths was effectively and safely performed, even by inexperienced operators with LBBAp procedures.