Paranasal Research Articles

Oncocytic sinonasal papilloma in the nasal and paranasal sinuses: a case report and review of the literature.

Oncocytic sinonasal papilloma (OSP) is an uncommon, benign neoplasm characterized by papillary growths arising from the Schneiderian mucosa of the nasal and paranasal sinuses. OSP accounts for about 3-6% of all sinonasal papillomas (SPs), and clinically is often confused with inverted sinonasal papilloma (incidence 73%). Although SP shares some of the clinical characteristics of OSP, the pathogenesis differs and it is very important to distinguish between them. Here we present a case of OSP in the nasal and paranasal sinuses of a 67-year-old Japanese male, who complained of persistent left-sided nasal obstruction. A benign nasal paranasal tumor was diagnosed, and endoscopic sinus surgery was performed. Histopathologically, the tumor cells exhibited an exophytic and endophytic growth pattern, composed of multilayered eosinophilic columnar epithelium with finely granular cytoplasm, and forming microcysts filled with mucin or microabscesses. The epithelium was PTAH-positive, and showed positivity for cytokeratin-7 with oncocytic features. A review of the literature revealed 166 cases of OSP in the nasal and paranasal sinuses, with an overall recurrence rate of about 15%. Here we report a case of OSP in the nasal and paranasal sinuses for which PTAH staining specific for oncocytes was useful, together with a review of the relevant literature.

Extramedullary Plasmacytoma of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx: Report of Two Cases and Review of Literature

Abstract Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm occurring outside the bone marrow, predominantly in the head and neck region. Representing 3%–5% of all plasma cell neoplasms, EMP poses significant diagnostic and therapeutic challenges due to its rarity and,proximity to vital structures. We report two cases of EMP involving the nasal cavity, paranasal sinuses, and nasopharynx. A 30-year-old male presented with right diplopia, headache, and bilateral nasal blockage. Examination revealed a nasopharyngeal mass with bony erosion and multiple osteolytic lesions. Histopathology and immunohistochemistry confirmed plasmacytoma, and systemic involvement was excluded. The patient underwent chemoradiotherapy with satisfactory outcomes. A 27-year-old female presented with nasal bleeding, progressive nasal blockage, facial swelling, snoring, and anosmia. Imaging revealed a mass originating from the left maxillary sinus extending to adjacent structures. Histopathology and immunohistochemistry confirmed plasmacytoma. Systemic workup was negative. The patient was treated with radiotherapy, with a good treatment outcomes. EMP of the nasal cavity, paranasal sinuses, and nasopharynx is rare, particularly in younger patients. Accurate diagnosis and appropriate treatment, often involving radiotherapy, are crucial for favorable outcomes. Awareness and a high index of suspicion are essential for early diagnosis and management.

Impact of nasal septum deviation on the sphenoid bone pneumatization: a retrospective computed tomography study

Background Deviated nasal septum (DNS) changes aerodynamic airflow pattern and increases nasal resistance that may affect paranasal sinus pneumatization. Objectives To explore the relationships among DNS, sphenoid bone pneumatization and surrounding neurovascular structures. Material and Methods The paranasal sinus CT images of DNS patients (n = 100) and patients without DNS (n = 60) between 2020 and 2022 were retrospectively analyzed. Sphenoid bone pneumatization and anterior clinoid processes (ACP) length were measured while surrounding neurovascular structure types were assessed. Results In the DNS group, the indicators demonstrating sphenoid bone pneumatization were significantly (p < 0.001) greater than that in the control group. There were no statistically significant differences in the indicators demonstrating the positions of vidian canal (VC) and foramen rotundum (FR) between two groups. Regarding proportion of different neurovascular structure grades, the findings were significant (p < 0.05) between two groups. The corrected sphenoid sinus area also correlated with surrounding neurovascular structure types. Conclusions and significance Severe DNS is significantly related to the sphenoid bone pneumatization and surrounding neurovascular structure. This suggests that clinicians should be aware of the anatomical variation of sphenoid bone pneumatization and the cranial base structures in DNS patients.

Effect of endoscopic sinus surgery on eustachian tube function in adult patients with chronic rhinosinusitis

BackgroundChronic rhinosinusitis (CRS) is a frequent chronic heterogeneous inflammatory disease of the upper airways and paranasal sinuses persistent for ≥ 12 weeks causing considerable healthcare expenses and reduction of patients’ quality of life due to severe tiredness and disappointment as well as diminished cognitive function. CRS is commonly associated with eustachian tube (ET) dysfunction.Aim of the studyTo evaluate the effect of endoscopic sinus surgery on ET function in the form of (tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score), in adult patients with CRS.MethodThis non-randomized clinical trial study was conducted at the Otorhinolaryngology department, the Faculty of Medicine, Cairo University, on 40 patients > 18 years old, suffering from CRS with or without sinonasal polyposis who are indicated for endoscopic sinus surgery (ESS) and were recruited from Otorhinolaryngology department’s outpatient clinic in the period from November 2022 to June 2023. All selected patients were subjected to a full history taken, a full general examination, and a local otorhinolaryngology examination. Routine preoperative laboratory investigation including complete blood count (CBC), liver and kidney function tests, and coagulation profile. An electrocardiogram (ECG) examination was done routinely for all patients above 40 years old. Radiological examination included the following: preoperative CT nose and paranasal sinus, axial and coronal soft tissue cuts, and bone windows. Assessment of ET function was done using the ET dysfunction questionnaire (ETDQ-7), Valsalva maneuver, and tympanogram. ET function was reevaluated 6 weeks post-operative in the form of an ETDQ-7, Valsalva maneuver, and tympanogram.ResultsThe ages of selected patients ranged from 21 to 45 years old with mean ± SD = 30.98 ± 10.24 years old. 52.5% of patients were males. Our results showed a statistically significant postoperative improvement in the Valsalva maneuver and the tympanogram type of both ears compared to preoperative with a p-value < 0.001. Similar results were found regarding the assessment of ET function using ETDQ-7 items and the total score (15.35 ± 4.92 vs 26.12 ± 7.79 respectively) with p-value < 0.001.ConclusionA significant improvement in ET function in the form of tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score, following endoscopic sinus surgery in adult patients with CRS with or without sinonasal polyposis.

Association between nasal cross-sectional areas and obstructive sleep apnea identified using acoustic rhinometry and computed tomography.

Obstructive sleep apnea (OSA) is a prevalent disorder associated with severe comorbidities. Anatomical variations, including nasal diseases, have been identified as potential contributing factors. This study aimed to explore the relationship between nasal cross-sectional areas (CSAs) and OSA, using both acoustic rhinometry (AR) and computed tomography (CT). A retrospective analysis was conducted on 355 individuals who underwent polysomnography (PSG), paranasal sinus CT, and AR. Clinical characteristics were compared among the non-OSA, mild OSA, moderate OSA, and severe OSA patients. Multiple logistic regression was used to determine the influence of nasal cross-sectional areas (CSAs) on the risk of developing moderate or severe OSA, with adjustments for sex, age, and body mass index. Significant associations between specific AR-measured CSA values of anterior nasal region and moderate-severe OSA were identified upon adjusting for confounders (p = 0.034, 0.010, and 0.025, respectively). The lower CSA measurements between the right and the left sides showed a stronger correlation with moderate-severe OSA than the summed values, suggesting the importance of the narrower nasal passage in OSA severity. No significant impact of CSA values on the development of severe OSA was observed. Nasal CSA measured using AR appears to be a better method for verifying its association with OSA than CT. Nasal CSAs at the anterior region of the inferior turbinates play a crucial role in developing OSA, independent of other known risk factors.

Otolaryngological manifestations of cystic fibrosis in children: A systematic review.

Cystic fibrosis (CF) is the most common autosomal recessive disorder in the Caucasian population. Otolaryngological manifestations pose a significant impact on the quality of life of children with CF. The primary aim of this review is to provide a state of the art update of current literature on the otolaryngological manifestations of CF in children. We systematically reviewed the PubMed, Cochrane Library, Embase and Web of Science databases, for prospective studies including pediatric patients with cystic fibrosis, reporting on otolaryngological manifestations. After assessment of the risk of bias and quality of the included studies, data were extracted. The search retrieved 6745 unique items after duplicate removal. After three selection rounds and quality assessment, 38 articles were ultimately retained for data extraction. The total number of participants in the studies was 1981. Most studies were prospective cohort studies (n=28). The articles were divided into six groups (ear/speech disorders - aminoglycoside ototoxicity (n=10); otolaryngology-related quality of life (n=5); nasal and paranasal sinuses (n=11); sleep disorders (n=3); paranasal sinuses imaging (n=5); other (n=4)). The most common otolaryngological manifestation of children with CF is chronic rhinosinusitis, but CF can have other otolaryngological-related pathologies such as hearing loss, middle ear problems, sleep apnea syndrome, and decreased smell and/or taste functions. We found a considerable gap in the literature if we would draw evidence-based conclusions on diagnosis and management of otolaryngological manifestations in children with CF.

Massive pneumocephalus after Valsalva maneuver in sphenoidal meningocele.

Pneumocephalus, defined as the presence of gas within the intracranial space, typically results from head trauma, surgery, or diagnostic/therapeutic procedures that disrupt the dura. However, spontaneous or non-traumatic pneumocephalus is rare. This video article presents a case report of a 64-year-old woman referred to the Department of Otolaryngology with a severe frontal headache and clear nasal discharge (rhinorrhea) after performing the Valsalva maneuver to relieve ear fullness. The patient had previously been diagnosed with sphenoidal meningocele and was awaiting skull base reconstruction surgery. A computed tomography (CT) scan of the brain and paranasal sinuses revealed significant pneumocephalus, with a defect in the sellar floor and cerebrospinal fluid (CSF) pooling in the sphenoid sinus. An endoscopic trans-sphenoidal repair of the CSF leak was promptly performed, and a post-operative CT scan showed complete resolution of the pneumocephalus. At the 2-month follow-up, the defect had healed optimally, with no intracranial complications observed. Pneumocephalus is a rare clinical condition, and prompt, accurate diagnosis, along with early intervention, is crucial to prevent neurological complications.

Improved adaptive multi-threshold method for automatic identification of rhinosinusitis in paranasal sinus images

Improved adaptive multi-threshold method for automatic identification of rhinosinusitis in paranasal sinus images

Isolated Tuberculoma Involving Multiple Paranasal Sinuses with Aggressive Features in an Immunocompetent Individual Masquerading as a Malignant Neoplasm: A Rarity Unveiled with Review of Literature

Isolated Tuberculoma Involving Multiple Paranasal Sinuses with Aggressive Features in an Immunocompetent Individual Masquerading as a Malignant Neoplasm: A Rarity Unveiled with Review of Literature

Long-term effects of dupilumab on chronic rhinosinusitis with nasal polyps: A step towards clinical remission.

Clinical remission, defined as the absence of disease activity and symptoms, is an emerging goal in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to evaluate the long-term effects of dupilumab on patients with CRSwNP, with or without asthma, and explore the potential for achieving clinical remission. A two-year prospective study was conducted on 109 patients with CRSwNP, with or without asthma, who were eligible for dupilumab as an add-on therapy. Comprehensive assessments, including clinical, laboratory, and radiological evaluations, were performed before and after treatment. Clinical remission of CRSwNP was defined as 12 months of dupilumab treatment, no exacerbations requiring oral corticosteroids (OCS), no need for nasal sinus operation, no anosmia or hyposmia, a Sino-Nasal Outcome Test (SNOT-22) score under 20, and a Lund-Mackay score (LMS) below 10. For those with comorbid asthma, clinical remission was defined as an asthma control test (ACT) score of 19 or higher, no asthma exacerbations, and no need for OCS. Dupilumab significantly improved CRSwNP outcomes in both groups, including SNOT-22 scores, nasal polyp size (LMS), and anosmia/hyposmia. Comorbid asthma was highly prevalent (79.8%), and patients with asthma had significantly larger nasal polyps, both before and after dupilumab therapy, despite similar symptom improvement. Higher fractional exhaled nitric oxide (FeNO) and blood eosinophil count (BEC) levels, along with anosmia/hyposmia, predicted larger polyp size. Dupilumab also significantly improved asthma outcomes, increasing forced expiratory volume in 1s (FEV1) and decreasing FeNO. Clinical remission was achieved in 11% of patients, with a slightly lower rate in those with asthma (7.3%). Dupilumab treatment can achieve clinical remission in CRSwNP. However, comorbid asthma appears to reduce the likelihood of remission and is associated with larger nasal polyps, even with similar symptom improvement. Asthma may independently influence polyp development, potentially impacting long-term outcomes in CRSwNP.

Incidence, Potential Mechanisms, and Clinical Significance of Cavernous Sinus Air Sign

Background/Objectives: The cavernous sinus air sign, historically linked to trauma or venous sinus thrombosis, has recently been reported in association with retrograde venous air embolism, often without clinical significance. Despite this, its exact prevalence, etiology, and clinical relevance remain unclear. This study aims to systematically evaluate the incidence of the cavernous sinus air sign in patients undergoing CT angiography (CTA) and to assess its potential clinical implications. Methods: We retrospectively analyzed data from patients who underwent CTA between January 2021 and December 2021. The cavernous sinus air sign was defined radiologically as air-density foci within the cavernous sinus, with Hounsfield units lower than those of orbital fat. Key variables included clinical indications for CTA, evidence of venous reflux of contrast media, the laterality of contrast injection, and the presence of brachiocephalic vein stenosis. Comparative analyses were performed to identify factors associated with the occurrence of the cavernous sinus air sign. Results: Among the 2,821 patients evaluated, the cavernous sinus air sign was identified in 35 cases (1.2%). Notably, none of these patients had a history of trauma or venous sinus thrombosis. Follow-up CT imaging was available for 27 of the 35 cases (77.1%), and in all instances, the cavernous sinus air sign resolved spontaneously. A statistically significant association was found between the cavernous sinus air sign and left-sided peripheral intravenous contrast injection, observed in 8.6% of affected patients compared to 1.5% in those without the sign (p = 0.001). Venous reflux into the internal jugular vein was also more frequent in patients with the air sign (34.3% vs. 14.1%, p = 0.001). These findings suggest a mechanical component, likely related to retrograde air embolism, influenced by anatomical and procedural factors. Conclusions: The isolated presence of the cavernous sinus air sign, in the absence of relevant clinical conditions, is most likely a benign, incidental finding associated with retrograde air embolism.

Head and neck cancer registry of Japan.

The Head and Neck Cancer Registry, supported by the Japan Society for Head and Neck Cancer, was re-established in 2012 after renewal of the contents and methods of registration. The registry registers patients with previously untreated, histologically confirmed malignant tumors of the head and neck, including the oral cavity, larynx, hypopharynx, oropharynx, nasopharynx, nasal cavity and paranasal sinus, major salivary gland, and cervical nodal involvement with an unknown primary. The total number of registered patients reached more than 150,000 as of June 2024. We have published reports of important real-world evidence from the registry data. We believe that this nation-wide, organ-based registry aids understanding of the epidemiology and treatment strategies of head and neck cancer, in addition to hospital-based and national cancer registries in Japan.

Chronic rhinosinusitis unveiling a two decades ethmoid foreign body: a case report

We report a case of a 50-year-old female who presented with rhinosinusitis-like symptoms, which she had been experiencing intermittently for over two decades. Her medical history revealed a nasal surgery performed approximately 22 years ago, after which she continued to experience unresolved symptoms despite multiple treatments. A Computed Tomography (CT) scan of the paranasal sinuses revealed findings with ethmoiditis, prompting the decision for endoscopic sinus surgery to address the underlying pathology. During surgery, there was a 3 cm gauze discovered after opening the posterior ethmoid sinus. We highlight an unexpected foreign body inside the ethmoid sinus based on an unidentified picture from the CT scan, which we accidentally discovered during endoscopic surgery. This case underscores the importance of considering a retained foreign body as a potential cause of chronic rhinosinusitis, even many years after the initial surgical intervention. The unexpected identification of the gauze, which was not clearly depicted in the preoperative CT scan, highlights the challenges in diagnosing retained foreign bodies within the complex anatomy of the sinuses. The report discusses the clinical presentation, diagnostic challenges, and management of this unusual case, contributing valuable insights to the literature on chronic rhinosinusitis and retained foreign bodies in the sinonasal region.

P-1911. Covid-19 Associated Mucor-Aspergillosis Incidence, Management and Outcome analysis

Abstract Background The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis as well as mixed mucormycosis and aspergillosis in these patients is very much concerning. COVID19-associated Mucor-Aspergillosis was detected in significant numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucor-aspergillosis(CAMA). Histopathology image showing aspergillosis and mucormycosis Histopathology of CAMA Methods A multicenter ambispective study across three tertiary health care centers in Southern part of India was conducted during April-October 2021and the patients were followed up for a period of 30 months till April 2024. Surgical Debridement specimen (Maxillectomy) of CAMA Surgical Debridement specimen (Maxillectomy) of CAMA Results Among the 56 cases of CAMA, mucor-aspergillosis affecting the nasal sinuses was the commonest, affecting 29(51%) of the patients, orbital extension seen in 15(26%), pulmonary (n=8, 14%), gastrointestinal (n=2, 3%), isolated cerebral (n=1) and disseminated mucor-aspergillosis in 1 patient. Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAMA patients. The CAMA associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucor-aspergillosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucor-aspergillosis patients. Conclusion The incidence of mucor-aspergillosis increased immensely during the second wave of COVID in India, and hence clinicians should be aware and have up-to-date knowledge of the predisposing factor, clinical signs and symptoms, diagnostic modalities and treatment strategies of the various types of CAMA. Also, the treating physicians should remember the predisposing factor involved in the development of CAMA, the improper use of glucocorticoid, and should manage COVID cases accordingly with the appropriate drugs, thus preventing increase in CAMA cases. Multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome. Disclosures All Authors: No reported disclosures

Histological Type-Specific Behavior in Sarcomas: Analysis of Head and Neck Cancer Registry of Japan.

The goal of this study was to better understand the epidemiology, clinical characteristics, and treatment outcomes of head and neck sarcomas using real-world data from Japan. Using the Japanese Head and Neck Cancer Registry, we identified 438 patients who were pathologically diagnosed with head and neck sarcoma between 2011 and 2020. We compared epidemiological, clinical, and prognostic data for the different histological types of sarcoma. The top five most common histopathological types were rhabdomyosarcoma, osteosarcoma, chondrosarcoma, leiomyosarcoma, and liposarcoma. The most common primary sites were the nasal cavity and paranasal sinuses. The overall cohort had clinical, pathologic, and occult lymph node positivity rate (OLR) of 18%, 15%, and 2%, respectively. Clinical lymph node positivity was highest in rhabdomyosarcoma (46%), followed by angiosarcoma (26%), with leiomyosarcoma, chondrosarcoma, and liposarcoma accounting for less than 10%. The 3-year overall survival rate was 74.8% among the 147 patients with available prognostic information. The histological type with the lowest 3-year overall survival was undifferentiated pleomorphic sarcoma (54%), followed by leiomyosarcoma (65%), and angiosarcoma (69%). In six of seven histological types, the 3-year locoregional-free survival rate was less than 70%. Sarcomas of the head and neck most commonly occur in the nasal cavity and paranasal sinuses. The prevalent histological type depended on the primary site. Rhabdomyosarcoma and angiosarcoma are histological types with a high risk of cervical metastasis. In the head and neck region, there are numerous histological types many of which lack local control. Level 3 Laryngoscope, 2025.

Fungal infection among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery

Background: Chronic rhinosinusitis (CRS) involves persistent inflammation of the nasal passages and sinuses, often attributed to Aspergillus species as a primary etiological agent. Effective treatment involves complete eradication of fungal pathogens and restoration of sinus function, commonly achieved through functional endoscopic sinus surgery (FESS). This study aimed to evaluate the clinical and radiological features, assess the prevalence and identify the mycological profile of fungal rhinosinusitis. Methods: This study was a prospective observational analysis involving a cohort of 50 patients treated at the Tirunelveli Medical College between June 2017 and July 2017. Nasal sinus tissues and secretions were collected for mycological and bacteriological analysis. Samples were processed on the same day, with fungal elements identified via KOH mount and cultured on Sabouraud dextrose agar. Bacterial cultures were grown on MacConkey agar and species identification was performed using biochemical tests. Results: Fungal culture results showed that 72% of the patients had a negative culture, while 28% had a positive culture. Among the 50 patients, 36 did not have diabetes or hypertension. All sinuses were involved in 40 patients and 24 had nasal polyps, with bilateral polyps being the most common. The most frequently isolated fungal species was Aspergillus. KOH positivity was strongly correlated with culture positivity, with 9 out of 10 KOH-positive patients also being culture-positive, while KOH negativity was associated with culture negativity in 35 out of 36 patients. Conclusions: CRS significantly affects quality of life, with fungal infections being a notable cause, especially in patients with unilateral sinus involvement. Effective treatment requires endoscopic sinus surgery, followed by antifungal therapy.

Impact of risk factors in craniofacial mucormycosis.

Craniofacial mucormycosis is a highly lethal infectious disease. This study aims to assess and analyze multiple variables, including clinical, socioeconomic, and biochemical markers, to identify and examine risk factors for mortality associated with this mycotic infection. A retrospective analysis was conducted on 38 patients who sought medical attention at the Otolaryngology and Head and Neck Surgery Division of a tertiary-level hospital in Monterrey, Mexico. A broad range of variables was analyzed: clinical features, including the extent of mucormycosis infection; socioeconomic factors such as monthly income, marital status, geographical residence, educational level, and insurance status; as well as biochemical markers, including glucose levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and immune cell counts, specifically neutrophils (NEU) and lymphocytes (LYM). Statistical analysis was conducted using SPSS v26. Risk factors for mortality were evaluated using Cox regression. Overall survival (OS) was assessed with the Kaplan-Meier method. The Fisher's exact test and the Chi-square test were used for categorical variables. For median comparisons, the Student's t-test and Mann-Whitney U test were applied; with normality assessed using the Shapiro-Wilk test. A p-value <0.05 was considered statistically significant. Mucormycosis was associated with higher mortality in men (p=0.032). The disease primarily affected the paranasal sinuses (p=0.021) and was associated with increased mortality when involving the orbit (p=0.035). Additionally, compromised lymphocyte counts (LYM) (p=0.034) and lower educational levels (p=0.009) were associated with higher mortality. Individuals residing in rural areas also exhibited an elevated risk of mortality (p =0.023). Prevention strategies should focus on high-risk groups to reduce the mortality rate of craniofacial mucormycosis, particularly targeting men and individuals residing in rural areas. Special emphasis should be placed on those without education or health insurance. Early diagnosis and appropriate management are crucial for improving outcomes.

Diffuse Large B-Cell Lymphoma with Plasmablastic Differentiation: Case Report

Introduction: Plasmablastic lymphoma is a subtype of diffuse large B-cell lymphoma. It is more frequent in immunosuppressed patients, with the oral cavity being the most common site of involvement, with less frequency in other extranodal regions such as paranasal sinuses, orbit, skin, bone and soft tissues. It is aggressive and has a poor prognosis, with an average survival of 1 year [1]. Clinical Case: We present he clinical case of a 69-year-old male patient, derived from neurosurgery due to a tumor in the frontal region of two weeks' evolution, nasal ventilatory insufficiency of the left nostril of 2 years' evolution, for 2 months he presented recurrent epistaxis. On physical examination a tumor in the frontal region was evident. CERS plus bicoronal craniectomy, resection of the rhinosinusal tumor was performed. Discussion: Plasmablastic lymphoma is a subtype of diffuse large B-cell lymphoma. It is more frequent in immunosuppressed patients, the oral cavity being the most common site of involvement, less frequently in other extranodal regions as in the case of the patient of rhinosinusal origin [5]. Conclusion: It is a diagnostic challenge, both its clinical and histological characteristics are ambiguous, which reduces the capacity for an accurate and rapid diagnosis, it requires intensive treatment with chemotherapy, however, it has a poor prognosis [7].

Sinonasal Mass in the Setting of Prior Maxillofacial Surgery and Solid Organ Malignancy

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB.

Diagnosis and Interpretation of Sinonasal Diseases by Nasal Endoscopy

Aims The study aims to emphasize the efficacy of nasal endoscopy in diagnosing nasal pathology over clinical examination. As well as to define applications of nasal endoscopy. Methodology Total number of cases were 75 patients retrospectively recorded. The research was carried out at the Al-Salam Teaching Hospital; ear nose and throat department in Nineveh Province, Iraq. Patients who presented with nasal symptoms such as nasal obstruction, runny nose, bleeding from the nose, nasal mass, foul breath, and foreign body in the nose, and patients who were older than 20 years old were eligible for inclusion in the study. Patients who had an acute infection of the nose and paranasal sinuses, as well as patients who were younger than 20 years old, were not allowed to participate. Authors performed both a comprehensive history and an ENT examination. Results Highest percent for age range distributed equally between (20-29 and 30-39 Years) with a percent 44.0% for each group. Female show the outmost percent (57.3 %). Nasal discharge; bleeding and obstruction record the peak percent with slight differences subsequently (21.3, 18.7 and 17.3). More than quarter of patients show no complications. Twelve patients manifest synechia as the maximum one. Conclusion Nasal endoscopy offers high diagnostic accuracy in patient with sinonasal complaints. Also, can be considered as gold standard tool in patient having sinonasal complaints. Vision control, has less bleeding, minimal complication, and early postoperative recovery reflect why the nasal endoscopy crucial.