Sinonasal Pathology Research Articles

The Impact of Sinonasal Pathology on Obstructive Sleep Apnea

The Impact of Sinonasal Pathology on Obstructive Sleep Apnea

Sinonasal Anatomic Variations in the Adult Population: CT Examination of 1200 Patients.

The nasal cavity and paranasal sinuses are one of the most frequently anatomically varied regions. Their size and shape vary from person to person, and ethnic origin may have a role in this variety. Recognizing this variations is so important for ear nose throat (ENT) specialists because they predispose to sinonasal pathologies and affect the complication rate and success of endoscopic sinus surgery. This study aimed to determine the frequency of sinonasal anatomic variations on paranasal sinus computed tomography (CT) in the Turkish population. Patients who had undergone paranasal sinus CT with any complaints between 2013 and 2020 and aged over 18 years were included in the study. A total of 1209 patients who had undergone paranasal sinus CT were examined for coronal, axial, and sagittal plans retrospectively by two ENT professionals, and anatomical variations were evaluated. To assign the frequency of anatomic variations in a healthy population, patients who had previously undergone paranasal sinus and nasal surgery, who had nasal polyposis, and for whom CT evaluation was not possible due to intense sinusitis were excluded from the study. Among 1209 patients, 644 were male and 565 were female. The mean age of the patients was 33.7 years. The most common sinonasal anatomical variations were nasal septal deviation and agger nasi cells, while the least common variation is the supreme turbinate. No variation was found in 48 (3.9%) CTs. Almost all patients had at least one sinonasal anatomical variation. These variations should be known by the professionals who have interest in sinonasal disease and surgery.

Supraorbital Ethmoid Air Cell - Its Role in Sinonasal Pathologies.

The supraorbital ethmoid air cell (SOEC) is an anatomical variation of the ethmoid air cell system that pneumatizes the orbital plate of the frontal bone. It affects the frontal recess configuration by opening posterior and lateral to the frontal sinus ostium. This cross-sectional observational study includes 100 patients with Supra orbital ethmoid air cells including various pathologies. We picked up the first 100 patients who had SOEC in all the CT PNS done for various sinonasal pathologies. The incidence of the cell was about 43%. The most common type was the cell extending up to the medial wall of the orbit which was noted in 37% of the cases. Cribriform plate was low-lying in patients with SOEC and the most common type was Keros 3 in about 49% of the study group. 83 patients had anterior ethmoid artery (AEA) lying away from the skull base hanging freely in the mesentery. The most common pathologies observed in patients with supraorbital ethmoid cells were chronic rhinosinusitis followed by mucoceles. The recurrence rate of sinusitis is high in patients with SOEC. The recurrences were mostly because of mistaking the SOEC to be frontal sinus or incomplete removal of partition between them. study stresses the importance of SOEC and its orientation preoperatively to avoid complications during and after the surgery. Detailed preoperative evaluation with the CT helps the surgeon to identify the cells, their extent and associated anatomical variations thereby preventing damage to AEA, cribriform plate and lateral lamella and can get good results.

Assessing the usefulness of tubomanometry as a diagnostic tool in Eustachian tube dysfunction.

This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis.

Rhinolithiasis: Clinical Findings, Treatment Approach, and Associated Pathologies: A Single-Center Experience

Aim: To identify the characteristics of rhinolithiasis in terms of its clinical, radiological, and surgical features in the largest case series in the literature. Material and Methods: A rhinolithiasis series comprising 32 cases that were treated at a single tertiary care center between 2014 and 2019 was reviewed retrospectively. The patients’ demographic characteristics, clinical features, rhinolith localization, accompanying sinonasal pathologies, and surgical data were noted. All patients underwent surgery via an endoscopic approach under general anesthesia, and any concomitant sinonasal pathology was treated during the same session. The patients were followed up with endoscopic examinations at the postoperative first and sixth months. Results: The sample consisted of 19 female (59.4%) and 13 male (40.6%) patients, with a mean age of 35.53±15.06 years. The most common symptoms were nasal malodor (65.6%), nasal congestion (53.1%), and purulent nasal discharge (15.6%). Rhinoliths were located in the right nasal cavity in 17 cases and the left nasal cavity in 15 cases. The most common localization of rhinoliths was between the septum and the inferior turbinate (65.6%). A nidus was detected in only four cases (12.5%), of which three belonged to an ectopic tooth. The most common concomitant nasal pathology was chronic rhinosinusitis (34.4%), followed by septal deviation (25%) and allergic rhinitis (9.4%). Endoscopic rhinolith excision was performed in 17 patients (53.1%), while surgical intervention was required for additional pathologies in 15 patients (46.9%). The most common simultaneous surgical intervention was septoplasty (15.6%). Conclusion: Rhinolithiasis should be considered in cases presenting with unilateral nasal symptoms that persist or worsen after initial treatment. Since the treatment of rhinolithiasis is surgical excision, the appropriate approach is the preoperative detection of pathologies which require additional surgery that can be simultaneously undertaken with rhinolith excision.

Exploring cytologic features and potential diagnostic challenges of metastatic NUT carcinoma to the parotid gland: A case report and a comprehensive literature review.

NUT carcinoma (NC) is a highly aggressive, poorly differentiated carcinoma that harbors a t(15:19) translocation, leading to the fusion of the NUTM1 gene. While the upper aerodigestive tract along the midline (head, neck, thorax, and mediastinum) is commonly reported as the primary site of NC, subsequent cases have emerged in diverse locations. Achieving a definitive diagnosis based solely on morphology is challenging; however, it can be achieved using immunohistochemistry (IHC) specific to the NUT antibody or by demonstrating the characteristic BRD4::NUTM1 fusion. Accurate and timely diagnosis can potentially inform patient management and guide treatment. While histologic documentation of NC is commonly found, there is a limited description of its cytologic features. A 39-year-old male with a history of sinonasal squamous cell carcinoma (SCC) presented with a right parotid mass aspirated via fine needle aspiration cytology (FNA). Histologic examination of the previous sinonasal pathology reviewed at our institution revealed sheets of primitive-appearing, monotonous, undifferentiated cells with distinct, prominent nucleoli. Additionally, there were foci of abrupt keratinization, accompanied by a notable neutrophilic infiltrate. The initial diagnosis of SCC was reclassified to NC and confirmed through NUT IHC and molecular testing. Although the parotid FNA initially suggested the possibility of a variety of small round blue cell tumors, it exhibited morphological similarities to the sinonasal tumor, leading to the diagnosis of metastatic NC. Cytomorphologic features of NC are limited and can overlap with various small round blue cell tumors. Correct classification is especially pivotal in the era of targeted therapy, considering the ongoing development and evaluation of BET inhibitors targeting BRD4.

Sino-nasal Outcome Test (SNOT22) score in adult population with no known sino-nasal disease.

This cross-sectional study aimed to establish normative values for Sino-Nasal Outcome Test (SNOT-22) score in adult Indian population without known sino-nasal diseases. The purpose was to fill a critical knowledge gap, providing insights into how various host factors influence SNOT-22 scores which seek to serve as reference for clinical studies, facilitating comparisons of symptom severity and aid in patient counselling based on specific score patterns. One thousand and twelve adults meeting inclusion criteria participated in the study. Participants provided demographic information, occupation details, addiction history, and medical background. They completed SNOT-22 questionnaire, grading their symptoms on Likert scale of 0-5 based on severity experienced in the past 2weeks. The collected data were analysed to derive meaningful insights. Mean SNOT-22 score for the study population was 6.80, with 90% scoring below 15, and 40% within 0-3 range. Females exhibited significantly lower mean scores than males. Residents of rural areas reported higher scores than urban counterparts. Education levels had no significant influence on scores. Occupational exposure to aeroallergens, addiction (especially tobacco), and a history of allergies, bronchial asthma, or atopy were associated with significantly higherSNOT-22 scores. Principal component analysis identified four distinct domains, with the nasal symptom domain consistently emerging as the major contributor to differences in subgroups with significantly different total SNOT-22 scores. The normative data and subgroup analyses established in this study serve as a foundation for future research, aiding clinicians in predicting symptoms and providing tailored counselling for individuals with sino-nasal pathologies.

Adaptation and validation of the Spanish version of NOSE-Perf questionnaire for septal perforations

Background and objectiveSeptal perforation (SP) cause heterogeneous symptoms depending on the anatomical location, highlighting scabs, nasal obstruction and/or epistaxis. The use of questionnaires to determine the quality of life in different pathologies is increasing in sinonasal pathologies and in patients with SP the NOSE-Perf questionnaire was constructed, currently validated in English. The aim of this study is the translation, cross-cultural adaptation, and validation of the NOSE-Perf questionnaire into Spanish. Material and methodsProspective single-centre study of 81 patients (38 with SP and 43 controls), visited in the rhinology section of a tertiary hospital. Adaptation and translation NOSE-Perf into Spanish and validation using the NOSE and NOSE-Perf questionnaire in Spanish. ResultsSignificant differences were found in the mean NOSE-Perf score and in the mean NOSE score (IC95% = 21.2–26.9; p < 0.001 and IC95% = 53.8–70.5; p < 0.001) between SP group and control group. Pearson's correlation between the two questionnaires NOSE-Perf and NOSE in the SP group was 0.74 (95% CI = 0.56−0.86; p < 0.001). In the control group it was r = 0.85 (95%CI = 0.73−0.91; p < 0.001). Cronbach's alpha coefficient of the NOSE-Perf was 0.95 (IC 95% = 0.93−0.96) for internal consistency. The reliability evaluation was carried out by test-retest, and a strong Pearson correlation was obtained between the questionnaires r = 0.94 (CI95% = 0.85−0.97; p < 0.001) and r = 0.89 (95%CI = 0.77−0.95; p < 0.001). ConclusionsThe Spanish version of the NOSE-Perf is as reliable and valid as the English version, which makes it possible to assess the impact on quality of life that it causes in patients with perforations in the Spanish-speaking population.

Role of magnetic resonance imaging in sinonasal pathology: a review

The last several years have seen a considerable advancement in the treatment of sinonasal diseases. The advent of minimally invasive functional endoscopic sinus surgery has led to an increased understanding of the anatomy and function of the sinonasal region, making previously inaccessible areas safe to operate in. The advancement in imaging of the sinonasal tract has been associated with the evolution of endoscopic sinus surgery. The imaging of sinonasal pathology has progressed from conventional radiographs (plain films) to computed tomography (CT) and magnetic resonance imaging (MRI). Technological advancements in CT and MRI have given a precise differential diagnosis and greater detail about the anatomical extent of sinonasal pathologies. Because the high water content of the inflammatory state causes a markedly enhanced signal on T2-weighted scans, MRI can currently distinguish between retained secretions and inflammatory responses from the mass of the tumor. The invasive lesions affecting the soft tissues outside of the sinonasal region are more easily distinguished by MRI. MRI largely took the position of CT scan for malignant sinonasal lesions due to its superior capacity to distinguish between inflammation and tumor and its increased sensitivity for intracranial extension. MRI can be more useful than a CT scan in demonstrating the degree of soft tissue abnormalities and in identifying lesions that have returned after surgery.

Pre-Operative Computed Tomography Scan Assessment of Variations in Olfactory Fossa Depth among Adults

Abstract Context: The paranasal sinus Computed Tomography (CT) scan is important in the evaluation of patients with sino-nasal pathologies and serves as a tool for navigation during endoscopic sinus surgery (ESS). The risk of skull base injury during ESS is assessed using the depth of the olfactory fossa, which has been shown to have racial variations. We aimed to use Keros classification to study the variations in the depth of the olfactory fossa at a specialized tertiary ENT hospital in Kaduna, Northwest Nigeria. Setting and Design: It was a retrospective cross-sectional study conducted at the radiology department of the National Ear Centre, Kaduna. Materials and Methods: All CT scans of the paranasal sinuses from January 2021 – January 2022 were retrieved and reviewed. Coronal CT scans of patients, 18 years and above, were included. Those who had skull-based surgery and those with tumors of the paranasal sinuses were excluded. Statistical Analysis Used: Data were entered in Statistical Product and Service Solutions (SPSS) version 25. Results: A total of one hundred and six (106) CT scans were studied which resulted in 212 depths of olfactory fossa measurements. The age range of participants was 18–81 years with a mean age of 41.1 ± 14.18 years. The male-to-female ratio was 1:1.08. Keros type II was found to be the most prevalent (68.4%) generally, as well as across gender and laterality distribution, with statistically significant difference between males and females, and no significant difference between the right and left sides. Conclusion: Type II Keros classification was the most common across gender and laterality distributions, with statistically significant differences between males and females. Cognizance of individual variations in preoperative assessments and surgical planning is imperative in ensuring safe and satisfactory surgical outcomes. We recommend further studies with a larger sample size and from different regions of the country.

Anatomical Variants of the Uncinate Process: A Challenge in the Endoscopic Surgery of the Nose and Paranasal Sinuses.

Importance To identify the anatomical variants of the uncinate process relevant to surgical intervention during the nose and paranasal sinus surgeries. Objective To evaluate the frequency of anatomical variants of the uncinate process in a population of northeast Mexico and compare it with another population. Methods Retrospective study, descriptive and analytical, randomly selected patients with radiological evaluation at Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico. Images were obtained from the Radiology Department. A total of 149 patients aged from 18 to 79 years with paranasal sinus-CT performed between January 2019 and December 2021 were analyzed. The variables evaluated wereuncinate process anatomical variations by age group, radiological classification of the superior attachment of the uncinate process, and morphological variations. Main outcomes and measures The primary study outcome was the determination of the most frequent insertion of uncinate process in the northeast Mexican population. Results The 149 CT scans comprised71 females with a mean age of 38.28 ± 16.7 years and 78 males, with a mean age of 41.8 ± 15.01 years. The most frequent uncinate process of superior attachment was type one, observed in 57.7% of males (n=45) and 50.7% of females (n=37) (p=0.494). Type onewas most observed on the right side (57.7%). Type four was the second most common type, present in 12.8% of males (n=10) and 12.7% of females (n=9) (p=0.82). Conclusion Knowledge about the types of variations in the insertion of the uncinate process is fundamental prior to any endoscopic sinus surgery. The surgeon must be familiar with this detail when approaching patients with sinonasal pathology.

Optical Coherence Tomography as a Tool for Imaging the Sinonasal Mucosa in Patients: A Systematic Review.

Objectives: To summarize the current applications and potential uses of optical coherence tomography (OCT), a noninvasive imaging modality that uses near-infrared light to produce cross-sectional, high-resolution images of biologic tissues, for evaluating the sinonasal mucosa in patients. Methods: Original articles utilizing OCT to image the sinonasal mucosa in patients were identified from the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases using the search phrase: "Optical Coherence Tomography" AND (sinonasal OR intranasal OR sinus OR nose OR sinusitis OR rhinitis OR olfactory). Strength of evidence, quality of evidence, and risk of bias were measured using validated scales. Study results were qualitatively assessed. Results: Out of 1662 original records identified through database searching, 9 studies were included in the systematic review. Levels of evidence ranged from III to IV and quality of evidence ranged from moderate to very low. Endoscopic OCT systems as well as OCT systems integrated with surgical microscopes were described in the literature. Applications of OCT for imaging the sinonasal mucosa included identifying morphological patterns unique to individual diseases, detecting mucosal structural changes after medical therapies and procedures, and evaluating mucociliary clearance. Conclusions: Most studies investigating OCT imaging of the sinonasal mucosa featured small sample sizes and lacked control groups. While OCT imaging could be a useful adjunct for diagnosing sinonasal disorders and monitoring response to treatment in the future, additional high-quality studies are necessary to determine if the use of OCT imaging can lead to improved diagnostic accuracy and health outcomes for patients with sinonasal pathologies.

The Role of Classification of Endoscopic Sinus Surgery in Surgical Planning

Endoscopic sinus surgery being an approach, there is no proper classification system to address the extent of surgery required for Sinonasal pathologies. The current study attempts to propose and evaluate the role and efficacy of a classification system for endoscopic sinus surgery in addressing various Sinonasal and skull base pathologies. Materials and methods: It's a prospective study that included 50 patients. We classified ESS into six types based on the extent of surgery. After thorough evaluation, depending on the extent of the disease, all 50 patients were planned and treated according to the classification. Patients were followed for one year.

Preoperative Orbital CT Scan Findings in Patients with Nasolacrimal Duct Obstruction and its Impact on Surgical Planning

Background: External dacryocystorhinostomy (DCR) failure is sometimes due to pathologies located within the nasal cavity. Preoperative computerized tomography (CT) scan is useful in the assessment of nasolacrimal drainage and adjacent anatomical structures; however, it is not routinely performed before DCR. The present study evaluates abnormal findings in CT scans of patients with nasolacrimal duct obstruction (NLDO) and its effect on changing treatment approaches. Methods: This prospective descriptive cross-sectional study included 162 patients with NLDO. All the patients underwent a supine axial CT scan. Patients with signs of rhinosinusitis, sinus mucositis, nasal septal deviation, nasal polyps or masses, and turbinate deformities were referred to an otolaryngologist. The rest of the patients underwent external DCR. The demographics and radiologic characteristics of the patients undergoing CT scan and their effect on changing treatment approaches were evaluated. Results: The study participants included 162 patients with a mean±SD age of 62.5±14.0 years (age range of 35-93 years). The percentage of endonasal DCR in cases with an abnormal nasal cavity on CT scan was almost 30% higher compared to those without this problem (59.6% vs. 30.2%). Septum deviation and turbinate deformity led to 3.6-fold and 3.9-fold changes in the surgical approach, respectively. Conclusion: A significant association existed between the sinonasal pathologies in patients with NLDO and changing surgical approaches. It is believed that a preoperative CT scan is necessary to detect such pathologies and manage them appropriately.

Computed Tomographic Study of Variants of Deviated Nasal Septum in Adult Population: A Descriptive, Cross-sectional, Hospital-based Study

Background: Deviated nasal septum (DNS) is an influential variant of the sinonasal region due to its possible association with varied sinonasal pathologies, mid-facial (skeletal or occlusal) disharmonies and orofacial pain disorders. The aim of the study is to document the prevalence of DNS and to observe and assess the radiographic attributes of its types in adults. Materials and Methods: It is a descriptive cross-sectional study in which, after getting ethical approval, computed tomography paranasal sinus volumes of 100 adult subjects are collected from the medical college on the basis of convenience sampling. Paediatric subjects and patients with a previous history of mid-facial trauma, malignancy or surgery are excluded from the study. DICOM data thus collected are retrospectively analysed by RadiAnt DICOM viewer to determine the prevalence of DNS to study its association across gender and with increased (&gt;1 mm) mucosal thickening of the maxillary sinus. DNS is recorded by Mladina’s classification and by septal deviation angle, and association is studied by the Chi-square test and Mann–Whitney U test. Results: The overall prevalence of DNS is 82%. Association of deviated septum with gender and mucosal thickening of the sinus lining is not statistically significant. Overall type V (spur) deviation is most common; however, in subjects with thickened mucosal lining type III (“C” or reverse “C”), deviation is found to be most prevalent. All the cases of type VI deviation have a tilted nasal floor, a finding of dental surgeon’s interest. “Bridging Spur,” an uncommon form of spur deformity, is also recorded in one case. Conclusions: Deviated septum is far more common than straight septum in the adult population. Types III, II and IV are more frequent in subjects with increased mucosal thickening. Association of type VI with tilted floor and rare variants like “Bridging spur” is also reported.

Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists.

A patient-reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin-E (IgE)-mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs. As physicians who treat patients of all ages for common sinonasal pathology in the clinic and operating room in addition to frequently providing testing and management of allergic diseases, rhinologists are well positioned to aid in delabeling patients with inaccurate penicillin allergies. This viewpoint highlights the consequences of inaccurate penicillin allergy designation in the clinic and perioperative period and explores misconceptions regarding cross-reactivity between penicillins and cephalosporins. Opportunities are explored for shared decision-making with colleagues in other specialties, such as anesthesiology, and practical recommendations are provided to aid rhinologists when faced with a patient who holds a questionable history of penicillin allergy. Rhinologists can play an active role in delabeling patients with inaccurate penicillin allergies with the goal of ensuring appropriate antibiotic use for future medical encounters.

Head and neck venous thrombosis secondary to pediatric otolaryngologic infection.

Head and neck venous thrombosis is a rare but potentially devastating complication of childhood otolaryngologic infections. This study examines the presentation and management of this condition. A retrospective chart review was performed on all pediatric patients with otolaryngologic infections complicated by cranial and cervical venous thrombosis at a tertiary children's hospital from 2007 to 2018. Patient demographics, presentation, site of infection, thrombosis location, implicated pathogen, length of hospital stay, need for surgery, and anticoagulant regimen were assessed. This study included 33 patients (mean age, 7.5 years; age range, 0.8-17 years; 19 [58%] male). The most common infection source was otologic (n=20), followed by ophthalmic and sinonasal pathology (n=9), and neck infections (n=4). The most common site of thrombosis secondary to ear pathology was the sigmoid sinus. The ophthalmic veins were the most common site of thrombosis for ophthalmic/sinonasal infections. Nine CN VI palsies, one CN VII palsy, and one CN III palsy were observed. Twenty-six subjects (79%) required surgical intervention. All those who experienced a nerve palsy required surgery. Length of hospitalization significantly differed with the stay for a neck infection complicated by thrombosis longer compared to otologic and sinonasal infections (F[2,30]=7.08, p=0.003). Length of hospital stay was significantly correlated with admission temperature (r=0.506, p=0.003) and CRP (r=0.400, p=0.03) but not WBC (r=0.181, p=0.31). Culture growth predominantly isolated a single causative organism rather than polymicrobial involvement. Forty-eight species were identified, most (n=41/48, 85%) being Gram-positive bacteria. Alpha-hemolytic Streptococcus was the most common isolate from children with vessel thrombosis secondary to ear infections, with Streptococcus pyogenes predominant in sinonasal infections and Staphylococcus aureus the most common in neck abscesses. There was significant variability in anticoagulation management within the patient population, but no bleeding complications were documented. Most patients had no evidence of underlying thrombophilia (n=15); for those with positive hypercoagulability screens, the most common positive marker was the presence of lupus inhibitor (n=6). Venous thrombosis resulting from adjacent otolaryngologic infection is a serious complication requiring proper recognition and management. The involved vasculature and cranial nerve findings are dependent on the anatomic location of the underlying infection. Cranial neuropathies in the presence of these infections should prompt evaluation for possible thrombosis.

Otolaryngology Considerations of Pituitary Surgery: What an Endocrinologist Should Know.

Endoscopic endonasal skull base surgery is the preferred surgical approach for the management of pituitary adenomas. Perioperative management of pituitary lesions requires multidisciplinary care and typically includes a dual surgeon team consisting of a neurosurgeon and an otolaryngologist. The involvement of the otolaryngologist allows for a safe surgical approach with excellent intraoperative visualization of the tumor to enable an effective resection of the tumor by the neurosurgeon. Detection and treatment of sinonasal pathology is essential prior to surgery. Patients may experience sinonasal complaints following endoscopic transsphenoidal surgery, although this is typically temporary. Sinonasal care in the postoperative period can expedite recovery to baseline. Here we discuss the perioperative factors of endoscopic pituitary surgery that endocrinologists should be aware of, ranging from preoperative patient selection and optimization to postoperative care, with a particular emphasis on anatomic and surgical factors.

Different Modalities for Management of Pediatric Epiphora.

This study assessed the efficacy and safety of different modalities for managing nasolacrimal duct obstruction and epiphora in children over one year. We performed a non-randomized prospective study on 98 children (149 eyes) with epiphora and no history of lacrimal operation. The selected candidates attended the ENT and ophthalmology outpatient clinics of Minia University Hospital, seeking to treat epiphora that may or may not be associated with sinonasal pathology. Nasolacrimal operations involved a joint approach involving an otorhinolaryngologist and an ophthalmologist. Ninety-eight children (149 eyes) were identified. Ages varied from 1 to 12 years old. Conservative measures were successful in 32.6% of children. Silicone stents were used in 27.5% of the interventions with a mean time to removal of 3-6 months. The success rate for dacryocystorhinostomy (DCR) was 85.7%. Revision surgery was performed in 10% of probing cases, 8% of intubation cases, and 14.3% of DCR patients. The concomitant chronic sinonasal problems were evident in 62.2% of patients. Conservative measures, probing, endonasal nasolacrimal intubation, endoscopic DCR, and external DCR are safe and effective procedures forepiphora in children. Also, correcting concomitant nasopharyngeal or sinonasal diseases in epiphora patients is crucial for successful management, overcoming recurrence, and minimizing morbidity.

Validation of a three-dimensionally printed simulator for training in endoscopic sinonasal surgery.

The ability to incorporate different materials in the construction of 3-D printed models has resulted in the ability to mimic a variety of anatomical structures such as cartilage, mucosa and bone. The aim of this study was to evaluate the face and content validities of a model as a training tool for endoscopic sinus surgery. Twenty-six delegates and ten teaching faculty members were invited to complete a post-hoc questionnaire survey. The survey consisted of a 22-question 5-point Likert scale to assess the model's realism (face validity) and its effectiveness as a training tool (content validity). Over 80% of the delegates agreed or strongly agreed that the appearance of anatomical structures within the model was realistic and mimicked actual sinus anatomy. In addition, a similar proportion agreed or strongly agreed that the application of instruments on the composite materials of the model realistically mimicked bone. All faculty agreed that the model was useful to develop hand-eye coordination and was a useful training tool for endoscopic sinus surgery. Overall, the sinus model received high scores regarding its use for training surgeons, especially to develop camera and instrument handling skills. The results of this study suggest that otolaryngology doctors in their early or intermediate stage of training would benefit most from a clinical-based modular programme. The model requires further development in areas such as the realism of mucosa, incorporation of sinonasal pathology and having more complex anatomy to be useful for the training of more advanced surgeons.