Unilateral Sinonasal Disease Research Articles

PREVALENCE OF FUNGAL ISOLATES IN UNILATERAL SINONASAL DISEASE

Fungal sinusitis has been on a rising trend and poses a health burden. Our study aims to nd out the prevalence of fungal isolates in unilateral sinonasal disease and its association with diabetes mellitus. A prospective study was conducted for 2years from August 2017 to August 2019. 150 patients were selected for study based on history, Diagnostic nasal endoscopy and radiological ndings. Patients were subjected to Functional Endoscopic Sinus Surgery (FESS). Sample collected has been sent for fungal smear, fungal culture and Histopathological examination. 50 (33.3%) patients were diagnosed with fungal rhinosinusitis based on fungal smear positivity and histopathology showing fungal elements. 100 (66.7 %) patients were categorized as non-fungal rhinosinusitis. Among the cases of fungal rhinosinusitis, 28 patients (56% of fungal rhinosinusitis) were diagnosed as allergic fungal rhinosinusitis, 15 patients (30% of fungal rhinosinusitis) were diagnosed as acute invasive fungal rhinosinusitis and 7 patients (14 % of fungal rhinosinusitis) were categorized as a fungal ball. A strong association has been found between fungal sinusitis and diabetes mellitus.

Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes.

Introduction There is a noticeable increase in the incidence of acute invasive fungal sinusitis which coincides with the ongoing coronavirus pandemic. It is a potentially-lethal fungal infection, with the most common form being the rhino-orbito-cerebral presentation. Objectives The aim of the present study is to discuss the different epidemiological factors, risk factors, clinical presentations and outcomes of acute invasive fungal sinusitis which is noticeably related to the coronavirus disease 2019 (Covid-19) pandemic. Methods The present cross-sectional cohort study included 22 adult patients who presented with Covid-19-related acute invasive fungal sinusitis. The diagnosis of acute invasive fungal sinusitis was confirmed by histopathological biopsy. All data, including demographics, risk factors, clinical findings, different lines of treatment and their outcomes, were recorded and analyzed. Results All patients had diabetes mellitus (100%), and 17 (77.3%) had been submitted to systemic steroids. All patients (100%) had unilateral sinonasal disease. Proptosis was found in 15 patients (68.2%), ophthalmoplegia was observed in 12 patients (54.5%), and intracranial affection occurred in 10 patients (45.5%). A total of 20 patients (90.9%) received liposomal amphotericin B. Surgical debridement was performed in 18 patients (45.5%). Non-septated mycelia was present in 19 biopsies (86.4%), while 3 (13.6%)showed septated mycelia. Total improvement was achieved in 10 patients (45.5%), while the mortality rate was of 27.3% (6 out of 22 participants). Conclusion Diabetes mellitus is the most common preexisting medical condition associated with Covid-19-related acute invasive fungal sinusitis. Systemic corticosteroid therapy is considered a predisposing factor. It is necessary to raise the level of awareness to diagnose this condition, especially in patients with Covid-19 infection or those who have recently recovered from it.

Characterization and Outcome of Patients Presented with Unilateral Nasal Disease to ENT unit at Hillah, Iraq

Background: A common finding during daily otolaryngological practice is a patient with unilateral nasalsymptoms, nasal polyp or mass. The causes behind most cases of unilateral nasal disorder are inflammatoryin nature and responds well to medical intervention and rarely there is need for surgical management. Thepossibility of neoplastic nature is high when there is unilateral nasal complaint or pathology as neoplasticconditions during their early stages may mimic inflammatory pathologies.Aim of the Study: The aim of the current study was to highlight the causes of unilateral nasal disease, theirmost frequent mode of presentation, management strategies and outcome in a sample of Iraqi patients.Patients and Method: The current prospective study included 96 patients, 42 males and 54 females, withsigns and symptoms suggestive of unilateral nasal disease. The study was carried out at Hillah GeneralTeaching Hospital, Babel province, mid-Euphrates region of Iraq and the work with this study has extendedfrom January 2014 to August 2019. All enrolled patients were subjected to routine ENT examination andoffice flexible endoscopy. Patients were managed by functional endoscopic sinus surgery for purpose ofexcisional or incisional biopsy.Results: The current study included 96 patients with a mean age of 49.09± 7.43 years and an age range of 39 to67 years. There were 42 males and 54 females. The results of complete evaluation have shown the followingpathologies at the end of the study: nasal polyposis (31, 32.3%), chronic rhinosinusitis without polyp (16,16.7%), antrochoanal polyp (14, 14.6%), inverted papilloma (11, 11.5%), frontoethmoidal mucocele (7,7.3%), concha bullosa (4, 4.2%), squamous cell carcinoma (3, 3.1%), rhinolith (2, 2.1%), fibrous dysplasia(2, 2.1%), adenocarcinoma (2, 2.1%), malignant melanoma (1, 1.0%), cavernous hemangioma (1, 1.0%),pyocele in concha bullosa (1, 1.0%) and non Hodgkin’s (1, 1.0%). Therefore, in the current study, nasalpolyposis was the commonest cause of unilateral sinonasal disease followed by chronic rhinosinusitiswithout polyp, antrochoanal polyp and inverted papilloma. The rate of malignant neoplasms was low.Conclusion: Differentiating the neoplastic nature form non-neoplastic nature of unilateral nasal pathologyis the most critical management step and in the current study, nasal polyposis was the commonest causeof unilateral sinonasal disease followed by chronic rhinosinusitis without polyp, antrochoanal polyp andinverted papilloma. The rate of neoplastic malignant conditions was low.

Unilateral sinonasal disease regarding clinical, radiological and pathological features

Background and objective: Patient with unilateral nasal pathology is common in clinical practice. A careful history followed by complete otolaryngology examination is mandatory and diagnostic nasal endoscopy by either flexible or by using endoscope. This study aimed to assess patients presented with the unilateral sinonasal disease, regarding clinical features, CT scan findings, and histopathological results. Methods: A prospective study was completed on 90 patients with unilateral sinonasal disease. The study was conducted at the Otolaryngology Department, Rizgary Teaching Hospital, Erbil city, Iraq, from February 2017 to July 2018. Regarding the pathological result, patients were categorized into two main groups of inflammatory and neoplastic. A biopsy was taken for histopathological confirmation from the patients with nasal mass either under local or under general anesthesia. The patients had been assessed clinically and radiologically. Results: Chronic rhinosinusitis was found to be the commonest cause of unilateral sinonasal disease followed by antrochoanal Polyp, benign tumor, fungal sinusitis and then malignant tumor in that order. Male gender and right side were predominant. The purulent nasal discharge was the commonest symptom under inflammatory conditions, while nasal bleeding, dental and orbital complained were the main symptoms in neoplastic diseases. Calcifications were noted on CT scan, mainly in patients with fungal sinusitis. Bony erosion and destruction were detected in the malignant tumor. Conclusion: Chronic rhinosinusitis was the most common cause of unilateral nasal and paranasal disease. Comprehensive evaluations of patient age, presenting symptoms, naso- endoscopic examination, and CT finding help in the diagnosis of unilateral sinus disease. However, histopathological confirmation remains the gold standard for final diagnosis.

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease

ObjectivesUnilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. Material and methodsWe conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. ResultsOf the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund–Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001). ConclusionA sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen.

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease

ObjectivesUnilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. Material and methodsWe conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. ResultsOf the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund–Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001). ConclusionA sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen.

Unilateral versus bilateral sinonasal disease: Considerations in differential diagnosis and workup.

Imaging findings play an important role in the workup and diagnosis of sinonasal disease. Unilateral versus bilateral involvement is a key finding that can differentiate between various diagnoses. Our objective is to characterize presenting symptoms, imaging findings, and most common diagnoses associated with unilateral versus bilateral sinonasal disease. Patients who underwent surgical intervention for sinonasal disease at Emory University between May 2015 and December 2016 were included in the study. Information including demographic variables, comorbidities, presenting symptoms, imaging findings, and pathologic diagnosis was collected for each patient. Unilateral versus bilateral disease was determined by preoperative computer tomography and magnetic resonance imaging, and correlated to surgical and pathologic findings. Data was analyzed using quantitative methodologies and descriptive statistics. The study cohort consisted of 250 patients presenting for primary sinonasal surgery, including 110 patients with unilateral disease and 140 patients with bilateral disease. The most common diagnosis for patients with bilateral disease was chronic rhinosinusitis with nasal polyps (46%) followed by chronic rhinosinusitis without polyps (26%). For patients with unilateral disease the most common diagnoses were chronic rhinosinusitis without nasal polyps (21%), malignancy (19%), benign neoplasm (15%), and allergic fungal sinusitis (10%). There was a statistically significant association between unilateral sinonasal disease and the final diagnosis of benign neoplasm (OR = 7.8, P < .01) and malignancy (OR = 8, P < .01). Patients with unilateral sinus disease on initial imaging are less likely chronic rhinosinusitis compared to patients with bilateral disease. This should be taken into consideration in the workup and management of patients with unilateral sinus disease. 3 Laryngoscope, 130:E116-E121, 2020.

Unilateral sinonasal disease in 376 adult patients: a retrospective study

To investigate the clinical and pathological features of patients with unilateral sinonasal disease (USD). A retrospective analysis was completed on 376 adult patients with USD from January 2015 to December 2016. Their presenting symptoms, nasal endoscope, CT scanning, and pathology were analyzed respectively. Among the 267 (71.01%) patients with inflammatory disease, there were 4 pathological types. And there were 8 pathological types in 60 (15.96%) patients with benign tumor. Of the 49 patients with malignant tumor, there were 15 pathological types which included squamous carcinoma, malignant melanoma, and lymphoma, as well as myoepithelial carcinoma and Mesodermal mesoderm. The onset age of inflammation group was younger than that of benign (P<0.05) or malignant tumor groups (P<0.05). The misdiagnosis rate was 8.33% in benign tumor (5/60), and 10.20% in malignant tumor (5/49). Nasal polyps was the most common misdiagnosis in the groups of benign and malignant tumor. The pathology of adult patients with USD is complicated, and no specific clinical feature was found for distinguishing between benign and malignant lesions. The tumor took a quite proportion in adult patients with USD. Therefore, careful consideration should be taken before diagnosing patients with USD in order to reduce misdiagnosis rate.

Clinical analysis of 92 cases of unilateral sinonasal diseases

Objective:To investigate the etiology of unilateral sinonasal disease and clinical features. Method:The clinic data of 92 patients with unilateral sinonasal diseases were analyzed. Result:42 cases of chronic sinusitis (31 cases of nasal polyps), 17 cases of nasal inverted papilloma, 9 cases of sinus fungal disease, 6 cases of odontogenic maxillary sinusitis, 3 cases of maxillary choanal polyp, 4 cases of nasal blood vessels tumor, 3 cases of sinus osteoma, 6 cases of sinus cyst, 2 cases of sinonasal malignancies. Conclusion:Among unilateral sinonasal diseases, chronic sinusitis, nasal polyps are very common, but there are still more than half of the other pathological changes, the most common one is the nasal inverted papilloma. Therefore, more attention should be paid to the preoperative differential diagnosis.

Unilateral Sinonasal Disease: analysis of the clinical, radiological and pathological features

Unilateral Sinonasal Disease: analysis of the clinical, radiological and pathological features

Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases

Background/Purpose. To elucidate the clinical characteristics of patients with unilateral sinonasal diseases in Taiwan. Methods. A descriptive analysis of the clinical manifestations, and the clinical pathology, microbiology, and radiography results in 54 patients with computed tomography (CT)-documented unilateral sinonasal opacification who underwent endoscopic sinus surgery from August 2004 to July 2005. The severity of opacification was based on the Lund-Mackay scoring system. Results. Nasal obstruction, rhinorrhea, and postnasal drip were the most commonly observed clinical presentations. The presence of extranasal symptoms, such as facial numbness and visual complications, was suggestive of fungal sinusitis or neoplasm. More than 60% of the patients had chronic rhinosinusitis with or without polyposis. Staphylococcus was the most common pathogen (56%) encountered, and 22% of patients had fungal sinusitis caused by Aspergillus. Bacteriology revealed the existence of resistance to first-line antibiotics. There was a significant correlation between nasal septal deviation and ipsilateral sinusitis (p＜0.05). The average Lund-Mackay grading score was 6.4±2.0. Conclusion. The most common postoperative diagnosis of unilateral sinonasal diseases was chronic rhinosinusitis. Nasal septal deviation was an important factor for ipsilateral sinusitis. Staphylococcus was the most common pathogen causing unilateral sinonasal disease. A notable degree of resistance to first-line antibiotics was observed.

Unilateral sinonasal disease without bone destruction. Differential diagnosis using diagnostic imaging and endonasal endoscopic biopsy.

To evaluate the diagnostic algorithms leading to minimal-access surgery in unilateral sinonasal disease without evidence of bone destruction. In selected patients, we assigned qualitative preoperative diagnoses by performing computed tomography (CT), magnetic resonance imaging (MRI), and endonasal endoscopic biopsy and prospectively analyzed the results for 3 years, from 1992 to 1995. Of 278 untreated patients who complained of nasal and sinus-related symptoms and underwent CT examinations, 130 were found to have unilateral sinonasal abnormalities without detectable changes in the bone structure. Accurate preoperative diagnoses were made using CT in 75% of the patients with chronic sinusitis with or without nasal polyps and 85% of the patients with mucoceles. In the remaining patients, preoperative diagnoses for both diseases were made using MRI. All fungal and vascular diseases were accurately diagnosed using MRI alone. Although neither CT nor MRI were useful in the qualitative diagnosis of neoplasm, the presence of neoplastic conditions, except papilloma, was indicated by MRI. Using endonasal endoscopy, biopsy was an accurate diagnostic tool, with minimal tissue damage, in 88% of the neoplasms. In differentiating untreated unilateral sinonasal disease without evidence of bone destruction, we conclude that CT is the first modality of diagnostic imaging and MRI is more sensitive than CT in identifying fungal disease and angiofibroma. Furthermore, MRI is helpful when neoplasm is indicated, but it is not an accurate diagnostic tool. The endonasal endoscopic approach for obtaining pathologic specimens is a qualitative diagnostic tool in the diagnosis of sinonasal neoplasm.