How to cite this article:
Murthy P, Madala S, Potluri R, Chodavarapu VD, Tripuraneni S. Clinical Study on Prognostic Indicators of Endonasal Dacryocystorhinostomy. Clin Rhinol An Int J 2017; 10 (3):103-106.
Aim: To assess various preoperative and peroperative clinical findings in endonasal dacryocystorhinostomy (DCR) as prognostic indicators of the surgical outcome.
Materials and methods: A prospective study of 25 cases of chronic dacryocystitis with epiphora. All the patients were divided into two groups based on the presence or absence of medial canthal swelling with regurgitation of mucopus on finger pressure over medial canthus. Other factors included duration of epiphora, associated nasal problems, condition of the bone, sac wall, and lumen of the sac during surgery.
Results: Out of 14 patients with medial canthal swelling (group I), all were successful on the table with free flow of saline, but one patient developed symptoms on 6 months follow-up and that was treated as failure. Out of 11 patients without medial canthal swelling, five were successful with free flow of saline on the table and six were unsuccessful because of tight or absent flow with regurgitation.
Conclusion: Presence of medial canthal swelling and regurgitation of mucopus on digital pressure over medial canthus is a good prognostic indicator for a favorable surgical outcome. In patients without medial canthal swelling, we need to rely on syringing or dacryocystogram. Early intervention gives good results.
Satveer S Jassal,
How to cite this article:
Bhargava A, Chandra M, Jassal SS, Ullah S, Khare V. A Comparative Study of Microbiology of Chronic Rhinosinusitis in Smokers and Nonsmokers. Clin Rhinol An Int J 2017; 10 (3):107-112.
Aim: Comparative study of microbiology of chronic rhinosinusitis (CRS) in smokers and nonsmokers.
Materials and methods: This study was carried out on 700 patients diagnosed with CRS attending the ear, nose, and throat outpatient department (OPD) at Era\'s Lucknow Medical College, Lucknow, India, between January 2015 and June 2016. These patients were divided into two groups (smokers and nonsmokers). All patients underwent diagnostic nasal endoscopy. Two samples were collected and antimicrobial sensitivity test was done. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0. Chi-squared test and independent samples t-test were used to compare the data. A p-value <0.05 indicated a statistically significant association.
Results: Of 700 patients included in the study, smokers constituted 333 (47.57%) patients and nonsmokers constituted 367 (52.43%) patients. Out of the 700 patients, bacterial isolates of 585 (83.57%) were found to be positive, of which aerobes were 485 (82.91%) and the rest 100 were anaerobes. After antimicrobial therapy, all the symptoms were higher in smokers as compared with nonsmokers. Proportion of improvement in nonsmokers (90.19%) was higher as compared with smokers.
Conclusion: Microbiology of CRS is highly influenced by smoking habit. On evaluating the treatment response in terms of repeat sampling after 3 months, we found that pathogen positivity rate was much higher in smokers as compared with nonsmokers, thus implying that smoking exposure in vivo does alter the efficacy of antibiotics.
How to cite this article:
Mehan R, Varghese L, Kurien R, Jeyaseelan V, Rupa V. Is Nasal Packing Essential after Functional Endoscopic Sinus Surgery? A Randomized, Controlled Trial. Clin Rhinol An Int J 2017; 10 (3):113-119.
Aim: To assess the need for nasal packing following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS).
Materials and methods: We used a prospective, singleblinded, intrapatient, randomized, controlled study design. Fifty patients undergoing bilateral FESS were randomized to have nasal packing on one side for a day and no packing on the other. Postoperative bleeding, nasal block, facial pain, and headache were monitored for 5 days. Improvement of symptoms and endoscopic and sino-nasal outcome test (SNOT)-22 scores at the 4th and 12th postoperative weeks were noted.
Results: Postoperative bleeding was significantly more in the no-packing side on the first postoperative day (p < 0.002) and, on the packed side, after pack removal on the second (p < 0.001) and third days (p = 0.003), with no difference thereafter. Three patients developed postoperative bleeding on the unpacked side necessitating packing in the recovery room. Nasal block (p < 0.001) and pain (p < 0.001) were worse on the packed side for the first 2 days. Both intention-to-treat and per-protocol analysis showed no significant difference between the two groups for all parameters.
Conclusion: Nasal packing following routine FESS is not required for most patients to prevent either postoperative bleeding or poor surgical outcome.
Clinical significance: Most ear–nose–throat (ENT) surgeons in India tend to pack the nose for at least 1 day postoperatively. The procedure of nasal packing and its removal may itself cause mucosal trauma, which may lead to delayed healing and increased risk of scarring and synechiae formation. By using hypotensive anesthesia, there is less intraoperative bleeding, and postoperative nasal packing can be avoided totally or minimized. Our study has shown that the results of packing and leaving the nose unpacked are comparable both in terms of early postoperative morbidity as well as late sequelae and quality-of-life.
Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive disease with fatal complications. The mortality rate of AIFRS ranges between 49 and 62%. The incidence of visual loss in AIFRS has been reported to be between 26 and 29%. A total of 5/16 patients in our study showed improvement in vision after treatment in 1 year follow-up while 11 patients showed no improvement in visual acuity. The AIFRS with visual loss is managed using systemic amphotericin B with a combination of surgical debridement.
Aim: To investigate the impact of chronic hypoxia due to congenital septal deviation on the blood count.
Materials and methods: The study was retrospective and included 213 patients of both sexes, 141 patients in the study group and 72 controls. The study group consisted of patients with congenital septal deviation. They were healthy and did not have additional obstructive sleep apnea syndrome (OSAS) and any other kind of disease nor were taking medications that could have an influence on the blood count. Patients were divided into groups according to their smoking, alcohol, and drug habits. Septal deviations were classified using Mladina classification. In testing blood count the count of red blood cells, hemoglobin, hematocrit, and number of platelets were considered.
Results: In the tested group, there were 63.83% of men and 36.17% of women. The median age was 32. The results of the blood count of the patients who were operated because of the marked septal deviation did not differ from the results of the blood count of the control group. There was no statistically significant difference even in one parameter: Red blood cells count, hemoglobin, hematocrit, and platelets count.
Conclusion: Nasal septal deviation, which is operated at the ear, nose, and throat (ENT) departments, is mostly a problem of quality-of-life. It affects patient\'s everyday living and disturbs him/her in doing their daily activities. However, serious consequences that affect the blood count and could have an impact on the patient\'s other systems could not been seen.
Clinical significance: This work is important because of the increasing number of studies that are being carried out, which are attempting to find a correlation between chronic hypoxia due to septal deviation and cardiovascular diseases. With this study, we wanted to show that, in simple cases of nasal septal deviation, there does not exist marked chronic hypoxia that could have an impact on the blood count, specifically in the number of platelets and red blood cells.
How to cite this article:
Siddapur GK, Siddapur KR. Study on Nasal Tip Projection of South Indian Population to derive Reference Values for Corrective Nasal Surgeries. Clin Rhinol An Int J 2017; 10 (3):128-131.
Aim: The present study was taken up with an objective to derive reference values in relation to nasal tip projection (NTP) of Tamil Nadu population.
Materials and methods: The present study was conducted with the approval of the Institutional Ethics Committee. A total of 118 medical students from Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India, participated in the study. Consenting students were included and individuals with noticeable facial disfigurement and with history of previous facial surgery were excluded. Goode method was used to analyze NTP.
Results: The present study reports NTP of 0.65 (0.66 in males and 0.64 in females) with standard deviation (SD) of 0.06 in South Indian population of Tamil Nadu region.
Conclusion: Nasal tip projection can be considered as a ratio that can be used while planning corrective nasal surgeries, and can be used in a simple and effective manner than other parameters like nasal angles and indices, and nasal morphology.
Clinical significance: The present study results will help surgeons avoid complications by anticipating the healing forces and take into account support mechanisms of the nasal tip when planning an optimal approach for esthetic nasal surgeries on patients, especially of our geographical area, and of the ethnic group that has been studied on. Also, surgeons from other parts of the world can use the present study results as reference while planning similar surgeries.
How to cite this article:
Kaur G, Dhingra R, Singh M. Assessment of Clinical Effectiveness of Various Drugs in the Patients of Allergic Rhinitis visiting Tertiary Care Hospital of Punjab, India. Clin Rhinol An Int J 2017; 10 (3):132-136.
Introduction: Allergic rhinitis is characterized by mild to severe upper respiratory symptoms, such as nasal congestion, rhinorrhea, sneezing, and itching. In this study, attempt is being made to evaluate the clinical efficacy of various drugs in allergic rhinitis and to compare clinical efficacy in individual symptom score of allergic rhinitis.
Materials and methods: Totally, 125 patients clinically diagnosed as suffering from allergic rhinitis were enrolled for the study. All the patients were randomly divided into five groups of 25 each. Patients were given tablet Montelukast 10 mg once a day (OD) in group I, tablet Levocetirizine 5 mg OD in group II, tablet Fexofenadine 180 mg OD in group III, tablet Desloratadine 5 mg OD in group IV, and tablet Chlorpheniramine maleate 4 mg three times a day (TDS) in group V. Each patient was followed up after 2 weeks and then after 4 and 6 weeks for the sneezing and nasal congestion/obstruction.
Results: At the 2nd week follow-up, Levocetirizine was significantly effective with 40% patients having zero (0) sneezing symptom score and with mean rank 45.54 as compared with other drugs. At fourth and 6th week follow-up, Montelukast was more effective with 48 and 56% patients having zero sneezing symptom score and having mean rank 54.60 and 51.78 as compared with other drugs. At 2nd week follow-up, Levocetirizine was significantly effective with 24% patients having zero symptom score; at 4th week follow-up, Montelukast was more effective with 44% patients having zero symptom score in nasal discharge; and at 6th week follow-up, Montelukast was more effective with 60% patients having zero symptom score.
Conclusion: Symptomatic improvement was seen in all the drug groups. It was observed that Levocetirizine was better at 2 weeks. Overall, at the end of 6 weeks of treatment, Montelukast group had maximum improvement followed by Levocetirizine, Fexofenadine, Desloratadine, and Chlorpheniramine respectively.
R Anil Kumar,
Hosaagrahara S Satish
How to cite this article:
Kumar RA, Thirugnanamani R, Dodeja S, Satish HS. Bacterial Profile and Antibiotic Sensitivity in Patients with Chronic Rhinosinusitis undergoing Functional Endoscopic Sinus Surgery: A Prospective Study. Clin Rhinol An Int J 2017; 10 (3):137-141.
Background: Chronic rhinosinusitis (CRS) is a prevalent disorder affecting up to 2% of the world population with a significant impact on the quality of life. Not only is it common, it is also the type of nasal disease with greater propensity for morbidity. The study was done to identify bacteria causing CRS and to obtain information regarding the antibiotic sensitivity of the organism.
Materials and methods: A prospective study was done on 109 patients with CRS, undergoing endoscopic sinus surgery. Swabs were obtained from the maxillary sinuses and sent for bacterial cultures and sensitivity tests.
Results: Hundred patients (91.7%) were positive for pathogenic organisms. Among them, Gram-positive cocci were seen in 77%, methicillin-sensitive Staphylococcus aureus was found in 49 patients and was the most common organism isolated. This was followed by methicillin-resistant S. aureus (MRSA) in 15 patients and coagulase-negative Staphylococcus (CoNS) in 13 patients. These organisms were most sensitive to Linezolid (96.1%) and least sensitive to Ampicillin and Clindamycin (54.4%). Gram-negative bacilli included Pseudomonas in 11 patients, Klebsiella in 5 patients, and Proteus, Enterobacter, and Fusobacterium one in each patient (3 patients). All the Gramnegative organisms were sensitive to Piperacillin-Tazobactam (100%) and showed 86.9% sensitivity to Amikacin, Imipenem, and Ceftazidime.
Conclusion: Our study showed there is rise in the number of methicillin-sensitive S. aureus (MSSA) cases compared to other studies. All organisms isolated in our study showed resistance to majority of the oral and parenteral antibiotics. We also observed an increase in the number of Gram-negative rods, mainly Pseudomonas aeruginosa, and Klebsiella spp., and hence, antibiotic prescription should be streamlined to minimize the chances of rising trend in antibiotic resistance.
Prashant H Patil,
Shailashree L Samaga,
Harshalatha S Mahajan,
Aim: To present a rare case of nasal dermoid cyst and its management in a 14-year-old boy. Background: Congenital midline nasal masses are rare, with an incidence estimated to be 1 in 20,000 to 1 in 40,000. Among these, nasal dermoid cyst is commonest. They arise from the lines of embryonic fusion. Various theories have been postulated in the development of nasal dermoid cyst, and prenasal theory by Pratt is the most accepted one. Case report: A 14-year-old boy presented with a gradually progressive midline swelling since birth, which was solitary, soft, nontransilluminant, present over the lower dorsum and tip region. Based on the history, clinical examination, and serial relevant investigations, diagnosis of a nasal dermoid cyst was made. Surgical strategy planned was dermoid cyst extirpation via an open rhinoplasty approach and augmentation of the defect with an autologous conchal cartilage graft. Conclusion: Nasal dermoid cyst is a rare congenital anomaly. Presence of intracranial extensions, sinus formation, and other differential diagnosis should be ruled out preoperatively. It demands early surgical intervention in order to avoid further distortion of the nose or atrophy of the bony or cartilaginous component as a result of pressure secondary to the growth of cyst and infection. Clinical significance: • This midline congenital cyst is cosmetically unacceptable. Hence, early surgical removal is mandatory. • Open rhinoplasty is the preferred surgery as it gives good esthetic results. It gives a scope for augmentation of the defect following the extirpation of the cyst. • Autologous conchal cartilage is the preferred graft as it provides sufficient quantity and esthetically pleasing contour.
Ehrlson de Sousa,
Epistaxis is one of the most common presentations in the ear, nose, and throat (ENT) department. Majority of causes are due to local pathology, while a few are caused due to systemic causes. Epistaxis secondary to ear pathology is virtually unheard of. We report a unique case of epistaxis secondary to middle ear pathology.
Aim: To present a rare case of extranasopharyngeal angiofibroma (ENA) in a female originating from uncinate process in nasal cavity.
Background: Nasopharyngeal angiofibroma is a rare vascular tumor affecting adolescent male. It is the most common benign tumor of nasopharynx. Angiofibroma located outside the nasopharyngeal area are extremely rare and, consequently, may be misdiagnosed. Unlike nasopharyngeal angiofibroma, symptoms of ENAs are nonspecific and depend on localization and extent of tumor. The occurrence of any nasopharyngeal angiofibroma in females is very rare. Also, ENA has been reported at various subsites in nasal cavity, but origin from uncinate process is not reported in world literature till date. So we are reporting this unique case.
Case description: A 40-year-old female presented with intermittent profuse bleeding diagnosed as ENA originating from uncinate process. Tumor is removed completely through lateral rhinotomy approach.
Conclusion: Extranasopharyngeal angiofibroma is a rare tumor but it should be kept in differential diagnosis of vascular tumor of nose and paranasal area. Surgical excision is the treatment of choice for angiofibroma of nose and paranasal sinuses.
Clinical significance: Extranasopharyngeal angiofibromas can originate from various subsites of nasal cavity including uncinate process. Patients affected are older, symptoms develop more quickly, and hypervascularity is less common.
Jyotirmay S Hegde,
Suhasini P Ravichandran,
Sunil K Saxena
Odontogenic keratocysts (OKCs) have an incidence of 5.4 to 17% of all odontogenic cysts. These OKCs are more common in the mandible, with cysts in the maxilla having incidence of 31.3% only. In the maxilla, they most commonly occur in the canine region. The rarity of this case presentation is in the fact that only 1% of maxillary OKCs will show involvement of maxillary sinus, which was seen in both our patients. Historically, OKCs have been treated by open approaches like Caldwell Luc. We present two of our cases that were treated by endoscopic endonasal approach with review of literature.
Aim: Headache with sinonasal polyps not responding to routine medical and surgical management is a real challenge to a rhinologist. Here we present a rare case of primary tuberculosis (TB) of frontal sinus presenting as intractable headache.
Background: Pulmonary TB is common in developing countries like India. With the advent of effective treatment, the incidence of otorhinolaryngological TB has come down significantly. Otorhinolaryngological TB constitutes <5% of all cases of extrapulmonary tuberculosis (EPTB). In ear, nose, and throat (ENT), TB of cervical lymph nodes is common in low socioeconomic groups. Most of the ENT TB is secondary to pulmonary infection. Tuberculosis of paranasal sinuses is a rare thing to occur and primary affection of it is still a rarity. Among paranasal sinuses, maxillary sinus is the most frequently involved sinus and is usually unilateral.
Case report: A 35-year-old, diabetic female presented with severe headache, forehead swelling, and nasal blockage. Nasal endoscopy revealed multiple nasal polyps with anterior table of frontal sinus eroded on computed tomography (CT) scan. The patient underwent endoscopic sinus surgery. Histopathological examination (HPE) of sinonasal tissue was suggestive of inflammatory polyps. Her headache persisted and nasal polyps recurred in less than 2 months. On second endoscopic surgery, Draf 2 was done. There was no improvement in headache; HPE suggested granulomatous disease; all other reports of TB were negative, so the patient was put on antituberculosis treatment (ATT). After 1 month of treatment, her headache was relieved, with no recurrence of polyps.
Conclusion: Primary TB of frontal sinus, though rare, can be the cause of headache, and high index of suspicion is the only way to treat it. Moreover, ATT is sufficient to treat and invasive procedures can be avoided.
Clinical significance: Tuberculosis of frontal sinus should be kept in mind in the era of human immunodeficiency virus (HIV) and immunocompromised patients.
Aim: To present a rare case of placental site trophoblastic tumor (PSTT) metastasis to nasal septum.
Study design: Case report.
Setting: A tertiary care referral hospital.
Case report: A 32-year-old lady multigravida presented with history of intermittent, spontaneous nasal bleeding for 3 days and who had underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for PSST.
Results: Complete excisional biopsy of the left nasal septal mass was performed and sent for the histopathological examination. Grossly, the mass was fleshy, reddish in color, and about 2 × 3 cm in size. Microscopically, there was infiltration of nasal mucosa with the intermediate type trophoblastic cells. After excision of left nasal septal mass, she underwent adjuvant chemoradiation of five cycles and she is in remission phase now.
Conclusion: Metastasis of PSST to nasal mucosa is very rare showing placental site trophoblastic cells within nasal mucosa. Though it is rare disease, we have to keep it in differential diagnosis of nasal bleeding.
Ashok K Gupta,
Tumors of plasma cell origin are termed as plasmacytomas. They can be primary or secondary. Primary tumors are invasive locally and do not metastatize. Involvement of the eye and orbit is very rare, and only few cases have been reported around the globe. We outline the case of a 48-year-old male, who presented with primary plasmacytoma of the maxilla and orbit, and how it was managed using the combined approach technique.