Sinonasal Pathology Research Articles

The role of Narrow Band Imaging (NBI) in the diagnosis of sinonasal diseases.

Narrow band imaging (NBI) endoscopy is an optical method that helps to characterise tissue vasculature. Its appli- cation in sinonasal pathology remains scarce and a systematic study of its application to rhinology is lacking. The aim of this study is to analyse and describe the normal sinonasal mucosa under NBI light and to characterise the microvascular features of various sinonasal pathologies. We also want to suggest a classification of the patterns, peculiar to this district, and to evaluate whether they can be indicative of a specific physiological or pathological condition. Digital videos and images under white light and NBI of 103 patients (82 evaluated) with 29 sinonasal pathologies and 55 controls (33 evaluated). were independently analysed by three otolaryngologists and the final pattern was then arranged for each image, reaching an agreement between the individual evaluations. Once the appearance of normal sinonasal (SN) mucosa was established (SN1), four patterns for the pathological mucosa were described and a working classification was proposed (SN2, SN3, SN4, SN5). We calculated specificity (80.6% vs 90.6%), sensi- tivity (20% vs 38.5%), PPV (46.1% vs 50%), NPV (54.7% vs 85.7%) and accuracy (53% vs 80.3%) of the ability of SN4 and SN5 pattern to discriminate between benign and malignant nasal neoformations. This is the first study to propose a systematic NBI description and a classification of the vasculature of healthy and pathological mucosa in the sinonasal tract. Our preliminary results show that this technique can help in the workup of several rhinologic conditions and especially in distinguishing benign from malignant tumors.

Comparative validity evaluation of para-nasal sinus diseases using conventional radiography and computed tomography in a tertiary care hospital of Madhya Pradesh

<p class="abstract"><strong>Background:</strong> Sinonasal diseases include a wide spectrum ranging from inflammatory conditions to neoplasms, both benign and malignant and with the advancement in medical sciences and technology, and the ability to detect and control most illnesses, time has witnessed a momentous evolutionary change in medical practice. Objectives of the present study was to assess the demographical profile of sinonasal diseases patients and to compare the role of X-ray and computed tomography (CT) in the diagnosis of sinonasal diseases.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on 100 cases presenting in the ENT OPD, patients admitted in ENT ward and cases referred from medical and surgical departments of G. R. Medical College and J. A. Group of Hospitals, Gwalior, who had chronic sinonasal symptoms. All the collected data was analyzed using SPSS15.0 and frequencies, validity of both the modalities were compared. </p><p class="abstract"><strong>Results:</strong> The mean age was 33.75 years with youngest patient of 5 years and oldest being 85 years of age. CT had a good sensitivity and specificity for bacterial sinusitis (95.1%, 93.2%), fungal sinusitis (80%, 97.9%), single nucleotide polymorphism (90%, 88.6%), benign lesions (75%, 97.7%), malignant lesions (78.6%, 98.8%) respectively with a p value of <0.001, reflecting a highly significant level.</p><p class="abstract"><strong>Conclusions:</strong> Present study proves the significance of CT in diagnosing sinonasal pathologies and guiding their management. However, the importance of X-ray as a preliminary investigation, especially in acute or chronic cases which cannot be ignored.</p>

Tympanometric Findings among Adults with Chronic Nasal Obstruction Due to Sinonasal Pathology

Background: The nasal obstruction is one of the causes that affect the middle ear function, but the physiological mechanism of this effect is not well understood. This study aims at 1st; evaluation of the middle ear function among adults with chronic nasal obstruction due to sinonasal pathology using tympanometry, and 2nd, at comparison between the anatomical and mucosal inflammatory causes of nasal obstruction and its impact on the middle ear function. Patients and Method: A prospective case study of (310) adult patients with chronic nasal obstruction were subjected to tympanometry for study of middle ear pressure in the private ENT clinic for a period of two years in the Salah Al-Deen governorate. Results: this study found that (13%) of adults with chronic nasal obstruction had abnormal tympanogram (type B or C), (17.2%) was due to mucosal inflammation and (7%) due to anatomical and structural cause. Commonly one ear affected (unilateral) was (67.5%). Myringotomy and aspiration of middle ear found that (64%) had OME and VT was inserted. Conclusion: The study statistically proved that adults with chronic nasal obstruction due to mucosal inflammation differs from others due to anatomical and structural causes in the followings; 1.The incidence of abnormal tympanogram (type B and C) is more. 2.The type B (OME) was more than type C (Eustachian tube dysfunction). 3.In the treatment ,it was found that the need to VT insertion was more.

Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery.

Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. We screened 2829 ESS procedures from 2010-2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund-Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months' follow-up. Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction (P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction (P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores (P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively (P < .001). Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.

Role of Computed Tomography in Determining the Spectrum of Paranasal Sinuses Pathologies in Saudi patients

Background and Objective: Now-a-days computed tomography (CT) has become the investigation of choice for the diagnosis of the paranasal sinuses (PNS) pathologies. This study was designed with an aim to determine the role of computed tomography in classification the spectrum of PNS pathologies in Saudi patients. Materials and Methods: A total of 100 PNS CT patients were prospectively examined during the period extending from October 2018 to October 2019. A 128 detector CT scanner (Workstation Intellispace ISP; Philips, Netherlands), was applied to investigate patients with suspected PNS abnormalities at Radiology and Medical Imaging Department at King Khalid Hospital and Prince Sultan Center for Health Services in Al-Kharj, Saudi Arabia. Results: Out of the 100 patients – 56% males and 44% females with male to female ratio of 1.3:1 – Maxillary sinuses were the most sinuses that affected by sinusitis (68%) and the frontal sinuses was the last one (30%). The most common pathology seen was sinusitis in 79% cases. Atrophy, polyp and hypoplastic disease were detected in (1%) of cases. Most common anatomical variations were closed osteomeatal complex (86%), inferior nasal turbinates muscle hypertrophy (54%) and deviated nasal septum (83%). Conclusion: The CT was able to characterize the PNS diseases along with their extension. The most common pathology was sinusitis with 68, 55, 35 and 30% in the maxillary, ethmoid, sphenoid and frontal sinuses, respectively. Most common anatomical variant seen was nasal septum defect while the most commonly sinus involved was maxillary. It proves the better sensitivity (98.04%), specificity (80%) and accuracy (97.02%) of CT in the evaluation of various sinonasal pathologies.

Topical Vitamin D May Modulate Human Sinonasal Mucosal Responses to House Dust Mite Antigen.

Respiratory epithelium is a key defense against inhaled pathogens. Vitamin D3 (VD) has been suggested to modulate airway inflammation; however, its effect on innate airway defenses, the physical barrier, mucociliary apparatus, and cytokine release remains unclear. To investigate the outcomes of VD application prior to challenge in an in vitro model of human sinonasal epithelium, through assessment of epithelial transepithelial resistance (TER), cilia beat frequency (CBF), and interleukin (IL)-6 release, and secondarily to determine whether topical VD is beneficial to patients with inflammatory sinonasal pathology. Primary human sinonasal epithelial cells from patients with eosinophilic chronic rhinosinusitis (eCRS) and healthy controls were cultured in air-liquid interface (ALI). Well-differentiated cultures from each patient were pretreated for 24 hours with 4 different VD doses. Toxicity was quantified at 24 hours in unchallenged ALI by lactate dehydrogenase (LDH) assay. Innate responses were assessed by measuring TER and CBF before and up to 24 hours after house dust mite Dermatophagoides pteronyssinus challenge. IL-6 release was evaluated 24-hour postchallenge. Fifteen patients (53 ± 13.5 years, 60% females, 53% eCRS) representing 120 ALI wells were assessed. VD (0, 25, 50, 150 IU/mL) released less LDH than vehicle, indicating noncytotoxicity (0.15 ± 0.02; 0.15 ± 0.00; 0.14 ± 0.02; 0.11 ± 0.01 vs 0.17 ± 0.03, P = .004). VD increased TER for eCRS wells at 5 minutes (50 IU/mL: Δ6.76 ± 3.93 vs Δ3.87 ± 2.46, P = .04) and 24 hours (50 IU/mL: Δ0.88 ± 0.49 vs Δ0.40 ± 0.42, P = .02; 150 IU/mL: Δ1.06 ± 0.58 vs Δ0.47 ± 0.46, P = .01). CBF increased at 1 hour for eCRS wells (50 IU/mL: Δ0.62 ± 0.14 vs Δ0.41 ± 0.13, P = .001; 150 IU/ml: Δ0.60 ± 0.13 vs Δ0.38 ± 0.11, P < .001). IL-6 release was similar between normal and eCRS wells. Topical VD supplementation in eCRS patients may be beneficial for innate epithelial defenses. VD is noncytotoxic and does not adversely affect the physical barrier, mucociliary apparatus, or IL-6 release. Further studies should clarify its potential as a therapeutic agent.

Normal Anatomical Variants of the Paranasal Sinuses at Computed Tomography Scanning

Background: Recognition of PNS (Paranasal sinus) anatomic variants is particularly important in preoperative workup of patients with sinonasal pathology. CT (computed tomography) scanning can give exquisite details on sinus anatomy and pathology and is the main modality used to image the paranasal sinuses so the aim of the study isto evaluate certain anatomic variants of the paranasal sinuses in patients referred to the CT unit in Al-Immamain Al-Kadhymain Medical City. Patients and Method: We retrospectively analyzed the CT scans of the paranasal sinuses for patients referred to the CT unit in Al-Immamain Al-Kadhymain Medical City/Baghdad, Iraq for a period of 12 months . All the patients included in the study underwent standard CT scan of the PNS. Results: A net sample size of 188 was analyzed by the current study. Female: Male ration was (1.26:1).The incidence of septal deviation in the study sample was (51.06%) slightly more cases were deviated to the right (51.4%) than to the left (48.95%).Paradoxical middle turbinate’s were observed in(18.6%), middle turbinate aeration was observed in (58.5%) on the right and (53.1%) on the left. The incidence of variant air cells were as follows: Onodi (24.4%), Haller (11.1%), and Aggernasi (87.7%). Conclusion:The percent of most of the anatomical variants in our study sample was approximate to the percent published in the literature with the most common anatomic variants encountered being septal deviation followed by aerated middle turbinate’s whether unilateral or bilateral. The most frequent air cell was Aggernasi present in 87.7%.

To Study the Role of Nasal Septal Deviation and Its Relation to Sinonasal Pathology.

Rhinosinusitis is an extremely prevalent disorder that has a significant impact on the quality of life of affected individuals. Nasal septal deviation may either cause osteomeatal obstruction or may interfere with proper airflow and potentially predispose to sinusitis. This study was aimed to findThe incidence of various types of DNS andTo find co relation between NSD and sinus pathologyThis work was done on 100 cases with clinical features of deviated nasal septum and co existing features of rhinosinusitis. Detailed nasal endocopic examination was done. DNS was classified according to Mladina system of classification. CT PNS was done in all cases and rhinosinusitis documented according to Lund-Mackay scoring system. Finally an attempt was made to correlate DNS and Rhinosinusitis.Type II and Type I deviations were the most common types of septal deviations found. 84% of the patients with DNS had rhinosinusitis. There was a statistically significant correlation between nasal septal deviation and rhinosinusitis with p value ≤ 0.05. Our study also significantly correlates the predisposition of rhinosinusitis on the same side as DNS. We hereby conclude that in a case of DNS, co-existent rhinosinusitis should be ruled out, first by detailed history taking and then if warranted by CT-PNS. Such chronic patients treated by septoplasty alone may never be relieved of their symptoms. Thus combined septopasty and FESS is advisable.

A prospective study of deviated nasal septum giving rise to other ENT pathologies

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The deviated nasal septum (DNS) is a commonly occurring clinical condition that often causes nasal obstruction. This study, included two groups of subjects 100 each. The group A consists of subjects having DNS with nasal symptoms. The group B consists of subjects having DNS without nasal symptoms but with ear and throat symptoms. The present study makes an effort to review the types and its associated pathology.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was carried out in the Department of ENT, Government Medical College and Hospital, Nagpur from September 2016 to October 2018. Data was collected and analysed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age 31.17 years in group A and 30.07 years in group B, with male to female ratio of 1.17:1 in group A and 1.04:1 in group B. Left-sided septal deviation was more common than right-sided deviation. The most common symptoms in group A was nasal obstruction (94%) and in group B was otorrhoea (80%)."C" shaped DNS was the most common type in both the groups. Out of total 200 subjects comprising both the groups, 70 (35%) subjects had significant sinonasal disease, 138 (69%) subjects had ear pathology, 69 (34.5%) had Eustachian tube dysfunction, 35 (17.5%) had throat pathology. In this study, “S” shaped deviation was more prone to be associated with ENT pathology.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; “S” shaped DNS was maximally associated with sinonasal pathology and there was a high correlation between the side of septal deviation to the side of ear pathology, particularly in asymptomatic DNS.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Tympanometric Findings among Adults with Chronic Nasal Obstruction Due to Sinonasal Pathology

Background: The nasal obstruction is one of the causes that affect the middle ear function, but the physiological mechanism of this effect is not well understood. This study aims at 1st; evaluation of the middle ear function among adults with chronic nasal obstruction due to sinonasal pathology using tympanometry, and 2nd, at comparison between the anatomical and mucosal inflammatory causes of nasal obstruction and its impact on the middle ear function.Patients and methods: A prospective case study of (310) adult patients with chronic nasal obstruction were subjected to tympanometry for study of middle ear pressure in the private ENT clinic for a period of two years in the Salah Al-Deen governorate.Results: this study found that (13%) of adults with chronic nasal obstruction had abnormal tympanogram (type B or C), (17.2%) was due to mucosal inflammation and (7%) due to anatomical and structural cause. Commonly one ear affected (unilateral) was (67.5%). Myringotomy and aspiration of middle ear found that (64%) had OME and VT was inserted.Conclusion: The study statistically proved that adults with chronic nasal obstruction due to mucosal inflammation differs from others due to anatomical and structural causes in the followings; 1.The incidence of abnormal tympanogram (type B and C) is more. 2.The type B (OME) was more than type C (Eustachian tube dysfunction). 3.In the treatment ,it was found that the need to VT insertion was more.

Significant polyomic and functional upregulation of the PAPP-A/IGFBP-4/5/IGF-1 axis in chronic rhinosinusitis with nasal polyps.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with epithelial expansion and polyp survival. However, the molecular mechanism of this aberrant proliferation is unclear. The purpose of this study was to interrogate derangements of the pappalysin-A/insulin-like growth factor binding protein/insulin-like growth factor-1 (PAPP-A/IGFBP-4/5/IGF-1 axis) as a major contributing factor to polyp growth in CRSwNP. Matched tissue and exosomal proteomic arrays including PAPP-A, IGFBP-4, IGFBP-5, and IGF-1 were quantified using aptamer-based methods/Western blots for proteomic analysis and whole-transcriptome sequencing/quantitative polymerase chain reaction (qPCR) for transcriptomic analysis in CRSwNP and control patients. Functional PAPP-A assays were then performed in both tissue and exosomes (set 1: n = 20 per group; validation set 2: n = 26 per group). Tissue and exosomal PAPP-A was significantly overexpressed in CRSwNP compared to controls on both a transcriptomic and proteomic level (p < 0.0001). Known inhibitors of PAPP-A (stanniocalcin-1/-2) were significantly downregulated (p < 0.0001) as were PAPP-A cleavage products (IGFBP-5 p < 0.0001). PAPP-A function was shown to be increased 5-fold to 6-fold in tissue and exosomes. Upregulated tissue and exosomal PAPP-A signaling is significantly associated with CRSwNP and may be an important factor in the promotion of epithelial proliferation and polyp growth. These data lend further support to the emerging concept of exosomal functional and polyomic analyses as a method to study sinonasal pathology.

Advantages of Computed Tomography (CT) in Endoscopic Septopasty

Background and objective: Nasal obstruction is the most frequent presentation to the otolaryngologist all over the world. Symptoms are multisystem involvement such as headache, epistaxis, ophthalmological, otological, upper and lower respiratory tract infections; and many more. Septoplasty is commonly performed for nasal septal deviation as a primary indication of nasal airway obstruction. Physical examination, anterior rhinoscopy and nasal endoscopy are considered the gold standard for detecting septal deviation. Computed tomography (CT) can also be used to evaluate the nasal septum, anatomical variants and unveils the associated sinonasal diseases. This study aimed to find out the advantages of CT in endoscopic septoplasty for all out benefits to the patients. Patients and methods: 168 patients of nasal septal deviation were selected from 2015 to 2018 in the Bangladesh Medical and Popular Medical College Specialized Hospital. Age ranged between 10 years to 70 years of age. CT scanning in both coronal, axial and sagittal sections had been done in all patients after proper history taking, physical examination, anterior rhinoscopy and nasal endoscopy. Endoscopic septoplasty alone and/or other ancillary procedures were performed in all 168 patients under general anesthesia. Results: Amongst 168 patients, male was 116 (69%) and female was 52 (31%) with a ratio 2.2:1. Maximum 58 (35%) reported in 31 to 40 years and 48 (29%) was found in 21 to 31 years of age. Hypertrophied inferior turbinate (HIT) 54 (32%) and 48 (29%) concha bullosa (CB) were associated with 168 septal deviation. Associated pathologies like maxillary antral cyst 68 (40%) and maxillary sinusitis 62 (37%) were documented. Conclusion: CT scanning unveils the abnormal anatomic variants and associated sinonasal pathologies along with nasal septal deviation. Endoscopic septoplasty, correction of the anatomical variants and complete surgical clearance of the sinonasal pathologies can give the patient a grand success.

Jordan smell test: a pilot study

Objective An objective smell test is essential to identify the level of smelling sensation and provide information on changes in olfaction after treatment. The aim of this study is to describe a simple, portable, inexpensive, and reliable olfaction identification test in the Arab population (Jordan smell test). Patients and methods Seven odorants that are familiar to Arab people were selected for this smell test. In academic tertiary medical center setting, odor discrimination testing in patients with sinonasal disease and in nonsmoker healthy volunteers was performed, and the results were compared with appropriate statistical formulas. Results A total of 25 healthy volunteers and another 25 age-matched and sex-matched patients with sinonasal pathology were evaluated with our smell test. Volunteers scored 13.2 in Jordan smell test, whereas the score was 9.2 in the patients (P Conclusion Jordan smell test is a novel, office-based, and easy administrable method to objectively assess olfaction sensation in the Arab population. The test is flexible to changes in its different variables, such as the type or number of odors. Further studies with a larger number of participants in different Arab countries are needed to validate our results.

Sphenopalatine Foramen Computed Tomography Landmarks.

The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ± 2.4, 8.5 ± 1.38, 36.4 ± 2.6, 34.6 ± 4.26, 8.1 ± 1.27, and 13.7 ± 1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638). Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.

The relationship between ethmoid roof and cribriform plate dimensions and degree of septal deviation angle by computerized tomography

Background Endoscopic sinus surgery (ESS) is a common operation for the management of sinonasal pathologies. The surgeons dealing with ESS should understand the crucial complex anatomy of the anterior cranial base to avoid the intracranial violation during ESS. Objective The aim of this work was to investigate the relationship between degree of septal deviation angle and the dimensions of cribriform plate (CP) and ethmoid roof by evaluation of the paranasal computed tomography. Patients and methods A total of 40 patients, comprising 20 females and 20 males, with age ranging from 18 to 60 years, were selected according to inclusion and exclusion criteria from the outpatient ENT clinics of El-Hussein and Bab-El-She’reya Hospitals from November 2017 to January 2019. Results The severity of deviation did not affect the dimensions of the ethmoid roof and CP in terms of depth and width, except right ethmoid roof width (direct proportion) and the left cribriform width (inverse proportion). There was a significant direct relationship between ipsilateral and contralateral ethmoid roof (ER) width and between ipsilateral and contralateral ER depth. This study showed no significant relation between ipsilateral and contralateral CP width. High rate of asymmetry between CP and ethmoid roof in this study (100%) was noted. Conclusion In cases of deviated nasal septum, the increase in the severity of septum deviation raises the possibility of the increasing right ethmoid roof width and of decreasing the left cribriform width, and this possibility should be taken into consideration to avoid iatrogenic injury during ESS.

Rhinolithiasis, a Rare Entity: Analysis of 31 Cases and Literature Review

OBJECTIVE:Rhinolithiasis is a rare condition which results from deposition of salt around a endogenous or exogenous nidus. In the literature, most of the reports are single case studies. In this study, we aimed to present the characteristics, symptoms, diagnosis, and treatment methods of 31 rhinolithiasis cases and to focus on the current literature.METHODS:We retrospectively reviewed 31 rhinolithiasis cases which have been diagnosed and treated in a tertiary care center between January 2014 and December 2018. Patient characteristics, presenting symptoms, concomitant sinonasal disorders, and type of surgery were noted. Descriptive statistics were carried out.RESULTS:Mean age was 25.4±15.7. The cases were comprised 14 female patients (45.2%) and 17 male patients (54.8%). The most common presenting symptom was nasal obstruction (71%). Malodorous unilateral rhinorrhea was present in 17 patients (54.8%). Epistaxis snoring and sleep apnea were other rare symptoms. In 21 of the cases (67.7%), rhinolith was located between inferior turbinate and septum which was the most common location seen in our series. The number of patients who were under the age of 18 was 13, in 2 of them, rhinolith was found to be formed around a plastic bead, and in 2 of them, fruit seeds were the nidus. The most common concomitant sinonasal pathology was septal deviation which was detected in 20 of the patients (64.5%), adenoid vegetation and nasal polyposis were other disorders. In 20 of the patients (64.5%), simple removal of the rhinolith using a forceps with the help of a rigid nasal endoscope was performed. Eight of the 17 patients had severe deviation and septoplasty was performed at the same time, which was the most common concomitant surgical intervention (25.8%). In 3 patients (9.6%), functional endoscopic sinus surgery was performed at the same time.CONCLUSION:Our series is one of the largest series in the literature. The most common presenting symptom was nasal obstruction followed by malodorous rhinorrhea. Accompanying sinonasal disorders should be addressed to improve the outcome. Rigid or flexible endoscopic examination should be used to detect a rhinolith. Computed tomography scan can diagnose a hidden rhinolith in a patient with nasal obstruction.

Sample collection for laboratory-based study of the nasal airway and sinuses: a research compendium.

Collection of biologic samples from the nasal cavity and paranasal sinuses is of critical importance to the study of infectious or inflammatory conditions that affect both upper and lower airways. Numerous techniques for the study of ex-vivo samples exist, with specific applications, strengths, and weaknesses associated with each of them. In this compendium we summarize the available methods for collection of primary human samples and incorporate expert discussion of the pros, cons, and applications associated with each technique. An expert panel containing members of the American Rhinologic Society's Research and Grants Committee compiled this educational reference. Rationale for use and the potential advantages and disadvantages are discussed. Research protocols and key references are enumerated. Sampling of the nasal cavity and paranasal sinuses can be achieved through a number of methods. Nonspecific sinonasal secretions may be collected via forced exhalation, nasal lavage, and nasal spray aspiration. Targeted collection of sinonasal secretions may be achieved via endoscopic placement of absorbent matrices. Nasal cytology or collection of superficial epithelium may be completed via brushing or scraping of endonasal structures. Collection of mucosal biopsies may be completed via sinonasal explant or full-thickness biopsy. Multiple sampling techniques are available to collect biologic samples from the sinonasal cavity. These techniques differ in their ease of application, reproducibility, sample yield, and utility for different sinonasal pathologies or research goals. An appreciation of the benefits and drawbacks of each approach will allow investigators to select the techniques most appropriate for achieving research objectives.

The Use of Imaging to Detect Intracranial Tumors in Idiopathic Olfactory Dysfunction: A Systematic Review.

Objectives To review the literature regarding the use of intracranial imaging as a screening tool for idiopathic olfactory loss (IOL) and to review the incidence of identifying a sinonasal or intracranial neoplasm as a result of intracranial imaging. Methods A systematic review of published English-language literature was performed using PubMed, Ovid MEDLINE, Scopus, and Cochrane databases. Results Of the 694 available abstracts, 5 met inclusion criteria for this review. Out of 470 eligible patients, intracranial imaging identified tumors causing IOL in 8 patients (1.7%). Tumor detection rates ranged from 0% to 4.9%. Of the 470 eligible patients, intracranial imaging detected intracranial or sinonasal pathology, excluding tumors, causing IOL in 53 patients (11%). The findings ranged from 0.77% to 23%. Of the 604 eligible IOL patients, 470 (81%) underwent intracranial imaging, ranging from 53% to 100%. Conclusions In most cases, diagnostic imaging in IOL patients is frequently ordered. This study finds computed tomography or magnetic resonance imaging to be an important recommendation given to all patients with IOL. Although the overall rate of detecting tumor from diagnostic imaging is low, it is important to offer diagnostic imaging to this subset of patients to avoid missing tumors at an early stage.

The Relationship between Ethmoid Roof, Cribriform Plate Dimensions and Degree of Septal Deviation Angle

Background: endoscopic sinus surgery (ESS) is a common operation for the management of sinonasal pathologies, the surgeons dealing with endoscopic sinus surgery should understand the crucial complex anatomy of the anterior cranial base to avoid the intracranial violation during ESS. Objective: the aim of this work is to investigate the relationship between degree of septal deviation angle and the dimensions of cribriform plate and ethmoid roof by radiological paranasal CT evaluation. Patients and methods: forty patients, 20 females and 20 males, were selectively collected according to inclusion and exclusion criteria from the out-patient E.N.T clinics of El-Hussein and Bab-El-She'reya Hospitals from November 2017 to January 2019 with their age ranged from 18 – 60 years old. Results: the severity of deviation didn’t have impact on the dimensions of the ethmoid roof and cribriform plate in terms of depth and width except right ethmoid roof width (direct proportion) and the left cribriform width (inverse proportion). There was a significant direct relationship between ipsilateral and contralateral ER width and between ipsilateral and contralateral ER depth. This study showed no significant relation between ipsilateral and contralateral CP width. High rate of asymmetry between CP and ethmoid roof in our study (100 %) was noted. Conclusion: in cases of deviated nasal septum, this study suggests that the increase in the severity of septum deviation rises the possibility of the increasing right ethmoid roof width and of decreasing the left cribriform width and this possibility should be taken into consideration to avoid iatrogenic injury during ESS.

Modeling Microdebrider-Mediated Ophthalmic Damage: A Word of Caution in Endoscopic Sinus Surgery.

The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.