Introduction: Epistaxis is a common presentation in ear, nose, and throat (ENT). Given its substantial healthcare burden and associated morbidity, much work has been done to ascertain optimal management. Established treatment modalities include cautery and intranasal packing. Here, we describe our experience of the long forgotten yet efficacious and cost-effective technique of hot-water irrigation in patients with epistaxis.
Materials and methods: Hot water is flushed briskly into the nasal cavity of an actively bleeding patient. Irrigation is continued until the water running out of the nose is clear.
Results: Intractable epistaxis has been successfully managed in two patients with elevated bleeding risk. Patient A presented with incidental thrombocytopenia. Patient B presented having been anticoagulated with low-molecular weight heparin (LMWH) for deep vein thrombosis (DVT). Active epistaxis ceased with hot-water irrigation, and both patients were discharged with no further readmissions.
Discussion: We recommend that the lost art of hot-water irrigation is an additional safe and useful tool to combat the common presentation of epistaxis.
Aim: To study the role of drug-induced sleep endoscopy (DISE) and Muller\'s maneuver in diagnosing obstructive sleep apnea (OSA).
Materials and methods: This was a comparative study done on 30 patients above the age of 18 years with OSA. All the study subjects underwent Muller\'s maneuver and DISE. In both endoscopic procedures, the degree and type of airway collapse noted at the retropalatal and retrolingual levels.
Result: Our study revealed similar findings with regard to type and degree of airway collapse at the retropalatal and retrolingual levels with both Muller\'s maneuver and DISE.
Conclusion: The type and degree of upper airway collapse at the retropalatal and retrolingual levels in DISE were similar to that of Muller\'s maneuver in severe OSA. Hence, DISE is not necessarily a diagnostic tool in case of severe OSA.
Nihar R Mishra,
Bijan K Nayak
How to cite this article:
Kuravi N, Swaminathan P, Nagaraju K, Mishra NR, Nayak BK. Sensitization Patterns in Immunoglobulin E-mediated Allergic Diseases by Skin Prick Testing Using Standardized Allergens: A Study from Tertiary Care Allergy Center. Clin Rhinol An Int J 2019; 12 (1):6-15.
Aim and objective: To assess the sensitization patterns using standardized allergens in immunoglobulin E (IgE)-mediated allergic diseases by skin prick testing.
Materials and methods: This observational study was conducted in Chennai over a period of 1 year. Six hundred and three patients aged ≥6 months of either gender with predefined inclusion and exclusion criteria were enrolled after taking written informed consent. Analysis of sensitization patterns with different standardized allergen extracts and their association with age groups were performed with SPSS v 25.0 (IBM, New York, USA).
Results: Out of 603 cases, male were predominant (M:F = 1.8:1), with mean age of study population was 16.5 (13.2) years. There was no significant difference in polysensitization rates between under and above 18 years of age (p > 0.05). Out of 50 standardized allergens tested, the 5 most commonly sensitized were Blomia tropicalis (66.4%), D. pteronyssinus (63.6%), D. farinae (63.0%), American cockroach (54.1%), and Acarus siro (48.8%). There was a statistically significant difference observed in the odds of sensitization between <18 years and >18 years of age groups for the following antigens—grass pollens, weed pollens, tree pollens, molds, animal epithelia, and insects (p < 0.05). However, no such association was found among mites and food (p > 0.05).
Conclusion: Majority of patients were polysensitized, with a high sensitization rate to house dust mite (HDM), predominantly B. tropicalis. There was also a higher rate of sensitizations to grass pollens than previous studies.
Clinical significance: Our study shows higher sensitization rates to HDMs, especially B. tropicalis, storage mites, and grass pollens. Standardized allergen extract use might improve the accuracy of sensitization patterns in the community.
Introduction: Nasal masses are an intriguing arena for a rhinologist. With diagnostic advancement from anterior rhinoscopy to three-dimensional endoscopic view at a blazing speed in rhinology, it has become easier to diagnose a nasal mass. Early detection is a key for better management. Incidence of an entity varies over time because of the ever-changing environmental scenario and availability of advanced diagnostics. Incidence of nasal masses is still of importance because the pathophysiology of the nasal masses is still under research. This study will bring into notice of a rhinologist the relative incidence of various nasal masses highlighting the areas of concern and hence bringing our focus to a better management.
Materials and methods: It is a prospective study with a sample size of 200. All the modern diagnostic facilities were used, including a computed tomography scan can and nasal endoscopy, to reach a presumptive diagnosis of various nasal masses, and histopathology was done to establish the final diagnosis.
Results: In the present study, 62% were males (124) while 38% were females (76). Majority of the patients were in age-group of 21–40 years (42.5%, n = 85), followed by 40% (n = 80) in the age-group 41–60 years, and 14.5% (n = 29) in 10–20-year age-group. Around 6 (3%) cases were in less than 10 years of age-group. Out of 200 cases, 160 cases were non-neoplastic masses. Out of 40 neoplastic masses, 24 were benign and 16 were malignant. The most common mass was nasal polyps (144 of 200).
Conclusion: Nasal polyps are still the most common nasal masses. Improvement in diagnostic modality mandates a more active research to understand their molecular biology for better management.
Malignant tumors of sinonasal tract are rare, representing only 3% of head and neck cancers. Sinonasal undifferentiated carcinoma (SNUC) is a rare entity recently described by Frierson et al. in 1986. Many clinical and pathological aspects of this disease remain misunderstood. We report the case of 52-year-old male suffering from a rapidly fatal SNUC of the right nasal cavity. We tried to focus on the clinical and histological presentations of the disease, and we discussed the different possible treatment modalities, which are still guided by small retrospective studies. SNUC is a rare entity. Its management is challenging due to its local aggressive behavior and high propensity to metastasis. There is no evidence that aggressive therapy offers better survival. A better comprehension of the disease is necessary.
Rajiv R Sanji,
Reshma S Abey,
Aniruddha Tekkatte Jagannatha
Aim: To present an unusual clinical opportunity with invasive fungal sinusitis.
Background: Mucormycosis is a rare opportunistic zygomycotic fungal infection occuring mainly in immunocompromised patients. Rhinocerebral mucormycosis is the most common form of the disease.
Case description: Here we present a rare case of intracranial mucormycosis in an immunocompetent patient. The patient presented with left nasal block and recurrent nasal discharge. Nasal endoscopy showed multiple pale polyps. Magnetic resonance imaging findings showed left frontal, ethmoidal, and sphenoid sinusitis with leptomeningeal enhancement.
Management: A dual endonasal–transcranial approach was used by a neurosurgeon and ENT surgeon for the complete clearance of the disease. The histopathological examination was reported as mucormycosis, and the patient was started on inj liposomal amphotericin B. Patient was followed up postoperatively by serial nasal endoscopy and imaging as required.
Conclusion: Mucormycosis in an immunocompetent patient with polyps and dural erosion is a rare entity and hence requires complete removal of the disease process and reconstruction of the dura followed by the inj liposomal Amphotericin B. The patient needs regular clinicradiological follow-up to detect recurrence.
Clinical significance: Awareness of unusual manifestations and complications of paranasal sinus fungal disease is essential.
How to cite this article:
Pérez-Carbonell T, Ferrer-Baixauli F, Pla-Gil I, Segarra-Cortés P, Marco-Algarra J. Epidermoid Septal Carcinoma, A Rare and Singular Tumor: Case Report and Review. Clin Rhinol An Int J 2019; 12 (1):27-30.
Aim: To describe our casuistic and the way we manage these tumors with their differential behavior.
Background: Septal epidermoid carcinoma is a rare tumor that accounts for only 9% of tumors of the nasal fossa. This tumor presents histological, clinical, and prognostic characteristics that differentiate it from other nasal cavity tumors, mainly its anterior location that leads to an early diagnosis in incipient stages.
Case description: We present a series of six patients diagnosed with nasal squamous cell carcinoma as well as the clinic referred by the patients to the diagnosis, the associated risk factors, and their clinical and therapeutic approach.
Conclusion: The majority of cases (4/6) corresponded to early stages I and II, while the rest were classified as stage IV. In all cases, surgical treatment was performed using different approaches according to location and stage and completing treatment with radiotherapy in five of the six patients. After an average of 40 months of follow-up, all the patients were free of disease.
Clinical significance: This paper tries to explain many points of controversy in the management of the tumors of the most anterior areas of the nasal fossa and its differential characteristics with respect to the rest of the tumors in this area.
Andrea LC Carobbio,
Valerio G Vellone,
Frank RM Canevari,
How to cite this article:
Carobbio AL, Sollini G, Mazzola F, Iandelli A, Vellone VG, Canevari FR, Peretti G. Nasal Septum Warthin\'s Tumor: A Unique Case Report and Review of the Literature. Clin Rhinol An Int J 2019; 12 (1):31-34.
Warthin\'s tumor (WT) is the second most common benign salivary gland neoplasm following pleomorphic adenoma, accounting for approximately 5 to 15% of all salivary gland tumors. Extraparotid localizations of WT are only rarely described in ectopic salivary tissues. Salivary tumor findings are generally uncommon in the nasal cavity and usually correspond to malignant forms. Herein, we present the only case of nasal WT reported in the literature to our knowledge. A 56-year-old woman with a mild and intermittent right epistaxis lasting 1 year came to our attention reporting/referring slowly growing mass in the right nasal vestibule from 6 months. Personal history showed 40 years of smoking habit. Management and Outcome: Endoscopic evaluation, T1- and T2-weighted magnetic resonance imaging sequences, and subsequent surgical removal with diode laser under general anesthesia were performed. The final histopathological diagnosis was margin-free nasal localization of WT. A PubMed research was performed with the following terms: [(adenolymphoma OR lymphomatous cystadenoma OR cystadenolymphoma OR papillary cystadenoma lymphomatosum OR Warthin) AND (nasal OR sinonasal OR nasal septum)], as long as a cross-linked references research from the articles found. No eligible articles were identified. The existence of extraparotid WT (EPWT) is believed to be a consequence of late encapsulation of the parotid gland during embryologic development with the intermingling of salivary and lymphoid tissues. Other authors have suggested that the lymphocytic component is the result of an immunological reaction to epithelial component proliferation. Nasal tumors are rare and extremely variable. Among salivary neoplasms in the nasal and paranasal sinuses district, pleomorphic adenoma cases were reported, but no nasal WT can be found described in the literature. Despite the unicity of this finding, sharing the diagnostic and therapeutic details of this case was considered to be potentially useful.
Aim: To diagnose a rare case of lipoma in nasal septum that causes nasal obstruction.
Background: Lipoma is one of the most common neoplasms in adults. Although lipoma of upper back, arms, upper thigh, buttock, and shoulders are common, lipoma of the nasal cavity, paranasal sinuses, or midface are rare due to lack of normal adipose tissue. Here, we present a 22-year-old man with lipoma on upper part of his nasal septum.
Case description: A 22-year-old man presented to our hospital with the chief complaint of nasal obstruction. On physical examination, he had significant septal deviation with obvious nasal deformity. Computed tomography without contrast revealed unusual septal thickness, and subsequent magnetic resonance imaging showed an amorphous heterogeneous fat content mass. The mass was excised using submucoperichondrial approach with no complication. No recurrence was seen after 6 months, and while nasal airway opened considerably, the apparent nasal deviation was alleviated to some degree.
Conclusion: Lipoma of the nasal septum is a rare presentation. While this mass may present itself as a common septal deviation, we should keep in mind rare causes of nasal obstruction other than deflected cartilages.
Clinical significance: Lipoma of nasal septum is not common in the midface, and it is hard to find and rare in nasal cavity due to scarce amount of fatty tissue that presents with nasal obstruction.
Clinicopathological Conference Report
Paresh J Khavdu,
Alpesh D Fefar,
Yash D Lavana
Aim: To present a typical case of frontal and ethmoidal osteoma and its management.
Methodology/case description: A 45-year-old female presented with a complaint of swelling over the right supraorbital region medially associated with right-sided headache and decreased vision in the right eye. She was diagnosed with right frontoethmoidal osteoma (dense bony lesion of 49 × 34 × 26 mm in both right frontal sinus and anterior ethmoid sinus. Defect in the superomedial orbital wall with intraorbital protrusion on right side) on CT PNS, which was then managed by bilateral endonasal sinus surgery with septoplasty with right frontoethmoidal osteoma excision—combined (endoscopic and external) approach with fascia lata grafting (inner table of frontal bone was dehiscent). No intraoperative or postoperative complications were seen.
Results: No complications or recurrence were seen at 1 year follow-up. Complete resolution of symptoms was achieved.
Conclusion: Osteoma of paranasal sinuses is amenable to surgery with excellent results and no recurrence.