Turbinate Hypertrophy Research Articles

Efficacy of Erb-Laser on Inferior Turbinate Hypertrophy: A Retrospective and Cohort Study.

ObjectivesNasal obstruction (NO) is a very common complaint in the practice of otolaryngology. The cause of NO can be due to inferior turbinate hypertrophy (ITH), which may be a result of allergic rhinitis, hyperreactivity, hormonal causes, rhinitis medicamentosa or idiopathic. The most commonly used treatments today include local nasal or systemic corticosteroids, cauterization or microdebrider, or thermal ablation with radiofrequency, coblation or ablative laser (mainly carbon dioxide or diode lasers), and submucosal reduction. Erbium YAG laser in non-ablative and SMOOTH thermal mode is considered as a non-invasive treatment and could be a novel and safe alternative.The aim of this study was to evaluate the safety and performance of a new Erb-laser treatment protocol on bilateral ITH, during and after 3 sessions of treatment throughout 6 months.MethodsThis retrospective study was carried out over 30 patients with complaints of NO, sneezing, itching, discharge, and nasal congestion refractory to medical management from July 2019 to December 2020 in the Department of Otorhinolaryngology of a private hospital in Famagusta, North Cyprus. Symptoms were evaluated subjectively by using NO Score and Visual Analog Scale (VAS). Patients were evaluated at the post-procedural 1st-week, and 1st-, 3rd-, and 6th-month postoperatively. During each follow-up visit, symptoms were reassessed by VAS and NO Score.ResultsDifferences between pre-operative and post-operative VAS and NO Scores were statistically significant. All patients had significant symptomatic improvements, which started from the post-operative 1stweek and persisted throughout the follow-up period. The active laser treatment showed high improvement during and after the procedure, regarding NO, and decreased the nasal burden on quality of life.ConclusionErbium YAG laser treatment is a simple, safe, effective, and non-invasive method effective on ITH, with minimal damage on the nasal mucosa. It can be done as an office procedure, with minimal complications. This method will provide a great advantage in the future treatment of NO.

Surgical interventions for inferior turbinate hypertrophy.

Nasal obstruction can be induced by various causes; however, inferior turbinate hypertrophy is considered the most frequent cause of this anatomical malfunctioning condition. The current surgical interventional study was focused on comparing the final outcomes of partial inferior turbinectomy (PIT) and powered endoscopic turbinoplasty (PET). The criterion followed for deciding the successfulness of each surgical method was the rate of occurrence of postoperative complications such as bleeding, crustation, and atrophic rhinitis. Fifty patients who suffered from nasal obstruction were randomly divided into two groups: PIT group, with 25 patients, of which 15 (52%) were males and 10 were (48%) females, at an average age of 27.40 ± 7.7 years, and PET group, with 25 patients, out of which 14 (48%) were males and 11 (62%) were females, at an average age of 26.68 ± 6.82 years. The surgical operations were performed at the Department of Otolaryngology, Al-Diwaniyah General Teaching Hospital, Diwaniyah City, Iraq, during the period between March 2015 and March 2020. The PET group showed significantly lower incidence (P < 0.05) of bleeding and crustation than those from the PIT group; however, no significant differences (P > 0.05) were observed between PIT and PET in the occurrence of atrophic rhinitis. PET showed promisingly less postoperative complications when compared to PIT.

Comparison of Endonasal and External Septoplasty for Treatment of Buckled Caudal Septal Deviation

To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome. Descriptive Analysis. ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020. Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups. Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively. Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. Key Words: Nasal septum, Nasal surgical procedures, Deviated nasal septum, Caudal deviation septum, Septoplasty, Septorhinoplasty, Nasal obstruction symptoms evaluation (NOSE) score, Visual analogue scale (VAS).

Comparative Study between Nasal Endoscopic Findings and Nose and Paranasal Sinus Computerized Tomography in diagnosis of Nose and Paranasal Sinuses Diseases

Background: Nasal obstruction is common in otorhinolaryngology outpatient visitors. The diagnosis of such compliant is by history, clinical examination and diagnostic procedures. Nasal endoscopy and computerized tomography scan are common diagnostic investigations. Nasal obstruction is either anterior or posterior (nasal septal deviations, hypertrophied turbinate pathological cyst, polyps, mass etc), or postnasal obstruction (hypertrophied turbinate, adenoid hypertrophy, nasopharyngeal cyst or nasopharyngeal tumors).&#x0D; Aim of study: Prospective study to compare endoscopic finding and computerized tomography of nose, paranasal sinuses and postnasal space as diagnostic methods for nasal obstruction and other nose, paranasal sinuses and post nasal space diseases.&#x0D; Subjects and methods: 80 patients with nasal obstruction between the age of 12-60 years old.All patient were examined by nasal endoscopy (rigid or flexible) under local anaesthesia (10 % xylocaine spray and cotton wicks soaked with ephidren 0.5 % and xylocaine 2 % ) and nose, paranasal sinuses and post nasal space C.T. scan,weather without contrast or with it, bone window or soft tissue according to the lesion. &#x0D; Results: Both nasal endoscopy and C.T. scan were an important tools for diagnosis of nasal diseases and complementary to each other.&#x0D; Conclusion: Endoscopic examination of the nose gives a real view of nasal structures, postnasal space, any mass or polyps present.Computerized tomography is an accurate diagnostic method of the Nose, paranasal sinuses and post nasal spaces anatomical variations or pathologies.

Predictors of Long-Term Nasal Obstruction Symptom Evaluation Score Stability Following Septoplasty With Inferior Turbinate Reduction.

Determine the postoperative Nasal Obstruction Symptom Evaluation (NOSE) score stability between 1 and ≥6 months after septoplasty with inferior turbinate reduction (ITR). Education level and occupation were evaluated to determine their effects on NOSE score stability during the postoperative period. Retrospective case series. This was a retrospective case series. Patients were included if they underwent septoplasty with ITR for nasal obstruction due to septal deviation and inferior turbinate hypertrophy. NOSE scores were collected preoperatively, and at 1 and ≥6 months postoperatively. Education level and occupation were collected postoperatively via telephone survey. Changes in NOSE scores were compared between the different time points. Education level and occupation were analyzed to determine if they affected NOSE scores. There were 98 patients included, and 56 were male (57.1%). Mean NOSE scores preoperatively and at 1 and ≥6 months postoperatively were 72.1, 17.1, and 12.0, respectively. Patients demonstrated a statistically and clinically significant reduction in NOSE score at 1 month (-54.9, P < .001) and at ≥6 months postoperatively (-60.0, P < .001). The mean 6.2-point decrease in NOSE score from 1 to ≥6 months was statistically, but not clinically significant. There were no significant differences in NOSE score changes based on educational level and occupation. Patients achieved statistically and clinically significant reductions in NOSE scores at 1 months, with no clinically significant differences in NOSE scores at ≥6 months, suggesting NOSE score stability between these postoperative time points. Neither education level nor occupation influenced NOSE scores. 4 Laryngoscope, 131:E2105-E2110, 2021.

A PROSPECTIVE STUDY ON ASSOCIATION BETWEEN DEVIATED NASAL SEPTUM AND SINUSITIS AT ENT DEPARTMENT OF SKMCH, MUZAFFARPUR, BIHAR

Background: Chronic sinusitis (CS) is an extremely prevalent disorder. It affects up to two percent of the world population. It has a significant impact on the quality of life of people. Basically, the word “sinusitis‟ refers to a group of disorders characterized by inflammation of mucosa of nose and paranasal sinuses. Deviated Nasal septum is one of the most common disorder that presents up to 62% of the population. Its role in the pathogenesis of chronic sinusitis remains uncertain. Methods: Two groups were included in this study.Each group had 30 cases with Midline nasal septum &amp; Deviated nasal septum. This study conducted in the Department. of ENT, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. The duration of the study was over a period of six months from August 2019 to January 2020. Results: We were studied two groups, 30 cases involved in group I of Midline nasal septum and in group II 30 cases involved with Deviated nasal septum. In this study we showed symptom &amp; sign of rhinoscopy. In the group I, 14 cases had congested nasal mucosa followed by 10 cases of nasal discharge, 4 cases of inferior turbinate hypertrophy &amp; 2 cases of Middle turbinate hypertrophy. Conclusions: that management of chronic maxillary sinusitis should include simultaneous treatment of any anatomical variation. For treating chronic sinusitis along with deviated nasal septum, nowadays treatment of choice is Septoplasty along with Functional Endoscopic Sinus Surgery (FESS). FESS technique is used for managing sinus infection and ostial obstruction.

Mini Inferior Turbinoplasty-Tunneling Technique Versus Conventional Partial Inferior Turbinectomy in Adults: A Comparative Study

Background: Inferior turbinate reduction is a well-described procedure performed whenever medical treatment for patients with hypertrophic inferior turbinates or vasomotor rhinitis fails. There are several techniques of turbinate reduction that include turbinectomy, submucous diathermy, inferior turbinoplasty, cryotherapy, CO2 laser turbinoplasty, Coblation channelling and others. Each technique is associated with its own short-term and long-term complications such as bleeding, crusting and recurring of the turbinate hypertrophy.Materials and Methods: We studied 80 patients attending the ENT department outpatients at Aswan university hospital from June 2018 to June 2019. All patients were clinically and radiologically diagnosed with bilateral inferior turbinate hypertrophy without response to medical treatment. Patients were randomized to two groups: Group A patients that underwent Mini turbinoplasty using tunnelling techniques and Group B patients that had conventional partial inferior turbinectomy Technique.Results: The intraoperative time was longer in group A patients who had turbinoplasty-tunneling technique compared to group B who had conventional partial turbinectomy. However, intraoperative blood loss and nasal Packing were required mostly in group B patients. Postoperative bleeding and crustations were significantly higher in group B patients. There was no significant difference regarding the percentage synechia between both groups. Nasal obstruction symptom markedly improved in group B patients.Conclusion: The current study revealed that Conventional Partial Inferior Turbinectomy is better than Mini Inferior Turbinoplasty Tunneling Technique regarding relief of symptoms of nasal obstruction.

Transseptal Suturing With Turbinate Coblation in Nasal Septoturbinoplasty.

Transseptal suture-assisted septoplasty and coblation are two techniques that can effectively treat septal deviation and inferior turbinate hypertrophy without the need for post-operative packing. In the existing literature, however, the early post-operative symptoms and surgical outcomes of the combination of these 2 procedures have not been addressed. This retrospective study included 65 patients who underwent concomitant nasal septoturbinoplasty. The patients were divided into two groups: the transseptal suture-assisted septoplasty and inferior turbinate coblation group (no-packing group: 33 patients) and the conventional septoturbinoplasty group with merocel packing (packing group: 32 patients). The post-operative symptoms within 14 days, complications and surgical outcomes at 3 months after surgery were recorded and analyzed. The patients in the no-packing group experienced less nasal obstruction on the first, second and third days post-operatively than those in the packing group (P < 0.000, P < 0.000, and P = 0.043, respectively). The patients in the no-packing group also had less nasal bleeding (P = 0.000 and P = 0.001), dry mouth sensation (P = 0.016 and P = 0.034) and swallowing disturbance (P = 0.013 and P = 0.012) on the first and second days post-operatively, respectively. In terms of orbital symptoms, the patients in the packing group had more severe epiphora (P = 0.031) and swelling sensations (P = 0.040) on the first day post-operatively. Transseptal suturing and coblation-assisted septoturbinoplasty can be considered to prevent packing-related comorbidities and reduce post-operative discomfort.

A Novel Classification of Relationship Between Nasal Septum and Inferior Turbinate Associated With Nasal Airway Obstruction in Patients With Unilateral Alveolar Cleft.

This study aims to investigate nasal morphologies associated with nasal airway obstruction in unilateral alveolar cleft patients. A total of 234 unilateral alveolar cleft cases were performed cone beam computed tomography scans. The digital imaging and communication in medicine data were imported into Simplant Pro software. The radiographic features including nasal septum deviation and inferior turbinate hypertrophy as well as nasal airway volume and sinusitis were analyzed. A new radiographic classification of relationship between nasal septum and inferior turbinate (NS-IT) on the cleft side was proposed and three types of NS-IT relationship (type I, II and III) were identified in 234 cases. The statistical analysis revealed that the nasal airway volume on non-cleft side was significantly higher than that on cleft side in each of three types (P < 0.0001), while no difference of nasal airway volume on non-cleft side was found among three types. In addition, the nasal airway volume on non-cleft side in type I and II was significantly higher than that in type III (P < 0.0001). Also, type III presented higher rate of maxillary sinusitis (P = 0.0154) and ethmoid sinusitis on cleft side (P = 0.0490) than type I and II. The other indexes including clinical variances were not significant among three types. Unilateral alveolar cleft patients with type III NS-IT relationship could have nasal airway obstruction and higher rate of maxillary and ethmoid sinusitis on cleft side, which may be taken into account at primary cleft repair and alveolar bone grafting treatment.

Comparison of the efficacy of two different local anesthetics in inferior turbinate reduction

The present study compares the local anesthetic efficacy of EMLA® cream and lidocaine injection used in the radiofrequency reduction of the inferior turbinate. The study included a total of 124 patients with inferior turbinate hypertrophy and who underwent turbinate reduction under local anesthesia. The operations were performed 15min after a lidocaine injection and 30min after EMLA cream application. The respondent patients were asked to interpret such situations as intraoperative pain, discomfort during the procedure, choking sensation and difficulty swallowing using the Visual Analogue Scale (VAS). The EMLA cream patients (Group A) were found to have a lower level of discomfort, choking sensation and difficulty swallowing than the lidocaine patients (Group B), while there was no substantial difference in pain between the two groups. It is concluded that EMLA® cream is an effective alternative to lidocaine injection during inferior turbinate reduction procedures.

Clinical outcome following septoplasty with or without inferior turbinate reduction

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deviation of nasal septum towards one side is often associated with over growth of inferior turbinate, which occupies expansive space of contralateral nasal cavity. The enlargement of inferior turbinate can be due to mucosal elements or bony expansion. Many surgeons are of the belief if septoplasty is done, compensatory hypertrophy regresses on its own. There are others who argue that these changes are not spontaneously reversible and should be corrected in conjunction with nasal septal surgery. Otherwise surgery may relieve the obstruction on one side of nose but leave other side of obstructed because of relocation of septum towards hypertrophied turbinate.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective interventional randomized comparative study is carried out from 1&lt;sup&gt;st&lt;/sup&gt; November 2017 to 31&lt;sup&gt;th&lt;/sup&gt; March 2019, with a sample size of 40 patients. Patients were divided in two surgical groups; group A, with conventional septoplasty done and group B, with reduction of inferior turbinate along with conventional septoplasty done. Post operatively patients’ symptoms will be evaluated using nasal obstructions evaluation scale (NOSE) and nasal airway with nasal endoscopy at 1, 3 and 6 months, and compared with preoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Data is analyzed using percentage graph and tables. The comparisons of NOSE score at 1, 3- and 6-months interval showed the p value of 0.001 which was significant. Also comparison of two groups with NOSE score showed significant improvement in group B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study shows that hypertrophied turbinate need reduction along with septoplasty in cases of long standing nasal obstruction.&lt;/p&gt;

Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia

Introduction and ObjectivesChronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence. Patients and MethodsThe measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia. ResultsIn 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm. ConclusionsRecords of the entering examination must be considered before turbinoplasty under local anaesthesia.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty

IntroductionMechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. ObjectiveThis study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. MethodsThe research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients’ preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. ResultsThe mean preoperative NOSE scores were 10.3±4.2 in the RF group and 10.9±4.9 in the LAT group, and the mean six-month postoperative scores were 1.09±1.3 in the RF group and 1.2±1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p>0.05). ConclusionThe data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Clinicoradiological Comparative Study of Obstructive Osteomeatal Complexin Cases of Rhinosinusitis

Mosher said that intranasal ethmoidectomy is the most dangerous and terrifying. He said that in the mid-twentieth century. Endoscopy changed this view significantly. Since the commencement of medication, various endeavours have been made to light up and analyse within the different empty depressions situated inside the body.A hospital-based comparative and correlative study was undertaken with 50 patients. The research assessed the clinicoradiological comparison of obstructive ostiomeatal complex in cases of rhinosinusitis. Majority (28%) patients were 31-40 years in the age group. The 34.2±12.50 years was the mean age of patients.60% patients were males. The most common symptoms were nasal obstruction (80%) followed by headache (76%), nasal discharge (42%), postnasal discharge (40%), sneezing (28%) and epistaxis (20%). Osteomeatal complex and maxillary sinus were the most frequently affected regions seen in 88% of patients. The most common sign is purulent middle meatal discharge in 86% of patients. The next most common sign seen is deviated nasal septum in 46% of the patients. 62% of the patients in our study suffered from chronic rhinosinusitis. Out of 50 cases, 33 cases have septal deviation using DNE. Uncinate attachment to the skull base is seen in 18 (36%) cases each on the right, and 17 (34%) left side in both DNE and CT. In DNE 7 (14%) cases show middle turbinate hypertrophy on the right side.There was statistically significant correlation between Middle turbinate: concha bullosa and Maxillary sinus (r=0.621; p=0.0005), Pneumatiseduncinate and Anterior ethmoids (r=0.452; p=0.0001), Aggernasi and Frontal sinus (r=0.318; p=0.024) and Middle turbinate: paradoxical and Maxillary sinus (r=0.864; p=0.0001). The significance of variations is that they impair the normal drainage pathway, hinder endoscopic access to distal areas and increase the risk of endoscopic mishaps.

Postoperative pain with or without nasal splints after septoplasty and inferior turbinate reduction.

To determine the effect of intranasal Doyle splints on postoperative pain following septoplasty and inferior turbinate reduction (ITR). Changes in Nasal Obstruction Symptom Evaluation (NOSE) scores were also evaluated. A prospective cohort study conducted from January 2017 to January 2019. Patients were recruited if they experienced nasal obstruction due to septal deviation and inferior turbinate hypertrophy, and failed a one-month trial of intranasal corticosteroids. All patients underwent septoplasty with ITR, and either had Doyle splints or no splints placed. Patients were prescribed hydrocodone-acetaminophen 5-325mg and asked to keep a daily log of pain medication use and visual analog scale (VAS) scores. Pain logs and NOSE scores were compared between patients who had splints versus patients who had no splints placed after septoplasty and ITR over the first postoperative week. NOSE scores were also collected at every postoperative visit (1week, 1month, and 6months). Fifty-seven patients were enrolled (37 splints, 20 no-splints). The median postoperative pain VAS score was 3.0 (interquartile range [IQR] 2.0-5.0) for the splint group and 4.0 (IQR 2.0-5.0) for the no-splint group (P=0.906). The median postoperative pain medication requirement in morphine equivalents at the first postoperative visit was 5.4mg/day (IQR 2.0-13.3) for the splint group and 8.4mg/day (IQR 1.8-15.3) for the no-splint group (P=0.833). There were no statistically significant differences in postoperative pain VAS scores or pain medication use between the two groups. All patients experienced significant reductions in NOSE scores postoperatively.

The Anatomic Variations of the Nose and Paranasal Sinuses and Their Effect on Chronic Rhinosinusitis in Adult Patients.

To find out the anatomic variations of nose/paranasal sinuses and how they affect the sinuses in chronic rhinosinusitis (CRS). This observational cross-sectional study included adults with CRS, refractory to optimum medical management, planned for functional endoscopic sinus surgery (FESS). Pre-operative naso-endoscopy and computed tomography (CT) were utilized to estimate the extent of CRS, and to note the anatomic variations of the sinuses. The findings were corroborated within the practical scope of FESS. The anatomic variations were evaluated to establish how they affected the related sinus(es). Most of the 53 patients were young adults presenting with nasal obstruction (77%), discharge (76%) and headache (68%). On diagnostic naso-endoscopy, prominent agger bulge (83% of the nasal sides), prominent uncinate (18%), inferior turbinate hypertrophy (34%), concha bullosa (38%), mucopus and polyp in the middle meatus (51%, 19%; respectively), and gross septal deviation (55%) were noted. The spheno-ethmoid and frontal recesses were predominantly unremarkable. CT revealed inferior turbinate hypertrophy (38% of the nasal sides), agger (100%), and lateralized/collapsed uncinate (8%). Ethmoids and maxillary sinuses were diseased in 50% and 65% respectively, with blocked ostiomeatal complex in 32% and prominent bulla in 48%. Frontal and sphenoid sinuses were least involved (10%, 2%; respectively). Enlarged agger caused maxillary sinusitis (87%), whereas anterior ethmoiditis resulted from enlarged agger (100%), bulla (89%) and frontal cells (51%). Identification of the anatomic variations of the nose/paranasal sinuses through CT and naso-endoscopy (diagnostic, per-operative) is crucial to understand the pattern, extent and severity of the involvement of sinuses in CRS.

Intermittent hypoxia induces turbinate mucosal hypertrophy via upregulating the gene expression related to inflammation and EMT in rats.

Chronic intermittent hypoxia (IH) plays a pivotal role in the consequences of obstructive sleep apnea (OSA). It has been demonstrated that IH impairs nasomaxillary complex growth to reduce nasal airway cavity size in rodent models. Although turbinate dysfunction with inflammatory mucosal hypertrophy is related to OSA, the role of IH in turbinate hypertrophy with inflammation-driven fibrosis is unknown. Here, we aimed to clarify the pathogenesis of inflammatory mucosal hypertrophy and epithelial-mesenchymal transition (EMT) in the nasal turbinate under IH. Seven-week-old male Sprague-Dawley rats were exposed to IH (4% O2 to 21% O2 with 0% CO2) at a rate of 20 cycles/h. Hypertrophy of the turbinate mucosa occurred after 3 weeks, with the turbinate mucosa of the experimental group becoming significantly thicker than in the control group. Immunostaining showed that IH increased the expression of TGFβ and N-cadherin and decreased E-cadherin expression in the turbinate mucosa. Quantitative PCR analysis demonstrated that IH enhanced the expression of not only the inflammatory markers Tnf-a, Il-1b, and Nos2 but also the EMT markers Tgf-b1, Col1a1, and Postn. Collectively, these results suggest that IH induced turbinate hypertrophy via upregulation of gene expression related to inflammation and EMT in the nasal mucosa.

Acoustic analyses of snoring sounds using a smartphone in patients undergoing septoplasty and turbinoplasty.

Several studies have been performed using recently developed smartphone-based acoustic analysis techniques. We investigated the effects of septoplasty and turbinoplasty in patients with nasal septal deviation and turbinate hypertrophy accompanied by snoring by recording the sounds of snoring using a smartphone and performing acoustic analysis. A total of 15 male patients who underwent septoplasty with turbinoplasty for snoring and nasal obstruction were included in this prospective study. Preoperatively and 2months after surgery, their bed partners or caregivers were instructed to record the snoring sounds. The intensity (dB), formant frequencies (F1, F2, F3, and F4), spectrogram pattern, and visual analog scale (VAS) score were analyzed for each subject. Overall snoring sounds improved after surgery in 12/15 (80%) patients, and there was significant improvement in the intensity of snoring sounds after surgery (from 64.17 ± 12.18dB to 55.62 ± 9.11dB, p = 0.018). There was a significant difference in the F1 formant frequency before and after surgery (p = 0.031), but there were no significant differences in F2, F3, or F4. The change in F1 indicated that patients changed from mouth breathing to normal breathing. The degree of subjective snoring sounds improved significantly after surgery (VAS: from 5.40 ± 1.55 to 3.80 ± 1.26, p = 0.003). Our results confirm that snoring is reduced when nasal congestion is improved, and they demonstrate that smartphone-based acoustic analysis of snoring sounds can be useful for diagnosis.

The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult

Background: Obstructive Sleep Apnea Syndrome (OSAS) is one of sleep disorder characterised by repeated episodes of total obstruction in the upper airway system during sleep. The incidence of OSAS is estimated to be 1-10% of general population. OSAS can be affected by several risk factors. One of risk factor of OSAS is upper airway abnormalities. The study aims to find out the association between individual risk factor including septum deviation, nasal turbinate hypertrophy, tonsillar hypertrophy and mallampati score with the incidence of OSAS in young adults.Methods: Analytic observational research with case-control design was carried out on young adults aged 18-23 years in the city of Semarang during May - September 2018 grouped into OSAS and non-OSAS based on Polysomnography (PSG), then history and physical examination were performed. Statistical tests were using chi-square, Fisher's exact test, and logistic regression.Result: Total of 22 people were included in OSAS group and 22 were included in the control group. Bivariate analysis showed septum deviation (p= 0.005), tonsillar hypertrophy (p=0.015) and mallampati score (p&lt;0.001) significantly related to the incidence of OSAS, whereas nasal turbinate hypertrophy was not associated with OSAS incident. The results of multivariate analysis found that BMI had an OR value of 133 (95% CI 12.726 – 1390.002, p&lt;0.001) independently associated with the occurrence of OSAS in young adults.Conclusion: Septal deviation, tonsillar hypertrophy, mallampati score are the risk factors for OSAS in young adults.

Lasers in Rhinology-An Update.

A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.