Clinical Rhinology

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2020 | January-April | Volume 13 | Issue 1

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Original Article

R Anil Kumar, Deepthi Padmanabhan, Shreya Dodeja

Peak Nasal Inspiratory Flow: A Diagnostic Tool to Determine the Need for Septoplasty

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:4] [Pages No:1 - 4]

   DOI: 10.5005/jp-journals-10013-1375  |  Open Access |  How to cite  | 


The nose is a major contributing factor for nasal resistance. The nasal airway is responsible for approximately 50% of the total airway resistance. The most common metrics used to assess nasal breathing are subjective, which can lead to inaccurate and inconsistent results. Hence, objective tests are used which give a more accurate and reliable idea of the degree of nasal resistance. Materials and methods: A cross-sectional study on 100 patients with symptomatic DNS was conducted at Sri Venkateshwara ENT Institute attached to Bangalore Medical College and Research Institute, Karnataka, India. This was a cross-sectional study conducted on 100 patients with symptomatic deviated nasal obstruction. The visual analog score (VAS) was used to clinically determine the severity of nasal obstruction and a peak nasal inspiratory flow (PNIF) meter was used to objectively test the severity of nasal obstruction. The Spearman linear correlation coefficient was used to analyze the correlation between VAS and PNIF, age and VAS, and age and PNIF of the subjects in the sample. Results: Of the 100 patients, 59 were male and 41 were female. The mean VAS was 6 and the mean PNIF was 149.7 L/minute. A positive correlation between VAS and PNIF for nasal obstruction (p = 0.032) was found but the same was not seen between age and PNIF and also between age and VAS. Conclusion: The PNIF meter is a viable, non-invasive, easy-to-handle, and cost-effective alternative for the evaluation of nasal patency. It has proved to be one more reliable tool to aid in the diagnosis as well as the follow-up of nasal, clinical, or surgical treatments.


Original Article

Hosalli Kumaraswamy Nagarathna, Tejaswini Honnegowda

Clinical Study of Rhinogenic Headache and Its Management in Adults

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:4] [Pages No:5 - 8]

   DOI: 10.5005/jp-journals-10013-1372  |  Open Access |  How to cite  | 


Introduction: Rhinogenic headache is the secondary headache caused by various sinus pathologies. Aim and objective: To study various etiologies of rhinogenic headache and outcome of its management. Materials and methods: This was a prospective study on 60 patients with rhinogenic headache, presenting to the ENT department of Akash Institute of Medical Sciences and Research Centre, Karnataka, India. All patients with rhinogenic headache underwent Diagnostic Nasal Endoscopy (DNE) and X-ray of the paranasal sinuses. High-resolution computed tomography paranasal sinuses were done in patients who were to be managed surgically. Patients were managed according to the etiology by a conservative or surgical method and followed up for 6 months to evaluate the treatment outcome. Results: All the patients were adults, predominantly males 58% and 41% were females. Fifty percent of patients were in the age group of 20–30 years. 38.3% of patients had deviated nasal septum as the cause of rhinogenic headache, while chronic rhinosinusitis 28.3%, acute rhinosinusitis 16.7%, nasal polyposis 10%, allergic rhinitis 3.3%, and concha bullosa 3.3%. Twenty percent of patients underwent conservative management while 80% underwent surgical management like septoplasty, inferior turbinoplasty, and functional endoscopic sinus surgery. 61.7% had complete relief from headache while 31.3% had significant relief from pain. Conclusion: Rhinogenic headache is an important etiology of secondary headache and significantly affects the quality of life. Diagnostic difficulties do exist and the otolaryngologist plays a pivotal role in instituting appropriate treatment. The relevant treatment of the underlying etiology provides a more effective outcome in a patient with rhinogenic headache.


Original Article

Anoop Muraleedhara Ghosh, Shobhit Gupta, Amarveer S Mehta

A Comparative Clinical Study between X-ray Nasopharynx and Nasal Endoscopy in the Diagnosis of Chronic Adenoiditis: Our Experience

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:6] [Pages No:9 - 14]

   DOI: 10.5005/jp-journals-10013-1373  |  Open Access |  How to cite  | 


Aims and objectives: In our study, we tried to analyze the utility of X-ray nasopharynx and nasal endoscopy in assessing the size of the adenoid tissue and thereby grading chronic adenoiditis. The grading of adenoids was correlated clinically with the severity of symptoms attributed to chronic adenoiditis. Materials and methods: Our study was an observational prospective study of 80 children with a diagnosis of chronic adenoiditis conducted in the Dept of ENT from January 2019 to 2020. The digital X-ray nasopharynx lateral view and nasal endoscopic results of all patients were analyzed, graded, and compared. Results: The most common age group was 5–7 years which included 34 children (42.5%). Mean adenoid–nasopharyngeal ratio for which otitis media with effusion (OME) was present was 0.72 which corresponds to X-ray grade II. It was also noticed that 71.4% X-ray grade III had OME and 65.8% of cases of endoscopic grade III adenoid had OME. Conclusion: X-ray nasopharynx was found to be a simple, less costly, practically easy option in a day-to-day practice in assessing the size of adenoid tissue; whereas nasal endoscopy is a more scientific approach providing three-dimensional views of the adenoids in the nasopharyngeal compartment. Lateral extensions of adenoids to eustachian tube orifices can be noticed in nasal endoscopy. Nasal endoscopy is considered the gold standard in diagnosing chronic adenoiditis. Reaching the correct diagnosis of chronic adenoiditis at the earliest is the main key in treatment to prevent complications and sequelae related to this clinical condition. Clinical significance: Both X-ray nasopharynx and nasal endoscopy are useful tools in the diagnosis of chronic adenoiditis. Grading of adenoids can be done in both techniques. While X-ray tomogram is a cheap and convenient method, nasal endoscopy is more scientific and accurate in giving a three-dimensional view of adenoids.



Anuragini Gupta, Sushmita Gupta, Deepika Chaudhary, Ashok K Gupta

Endoscopic Endonasal Management of Extraskeletal Sinonasal Ewing's Sarcoma

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:15 - 17]

   DOI: 10.5005/jp-journals-10013-1370  |  Open Access |  How to cite  | 


Ewing's sarcoma (ES) is a primary neoplasm of the skeletal system. Ewing's sarcoma of the head-and-neck region constitutes about 1–4% of extraskeletal Ewing's sarcoma (EES cases). Sinonasal EES is extremely rare and there is limited literature on this entity. Establishing the diagnosis requires a histopathological examination, immunohistochemistry, and a cytogenetic analysis along with a CT scan and MRI of the paranasal sinuses. They require multimodality treatment including surgical resection followed by chemotherapy and/or radiotherapy. We present a case report of a 31-year-old male patient presenting with a right-sided headache associated with nausea and vomiting, right nasal obstruction, a mass protruding from the right nostril and associated with occasional nasal bleed for 4 months with aggravation of symptoms since last 15 days along with proptosis of the right eye. On nasal examination, reddish-brown friable slough covered mass protruding from the right nostril bleeding on manipulation. Endoscopic endonasal excision biopsy revealed a round cell tumor-ES/primitive neuroectodermal tumor (PNET). The patient received radiotherapy and chemotherapy postoperatively and is on regular follow-up for 2 years and is disease-free.



Rajeshwary Aroor, Marina Saldanha, Sharik Mustafa, Thayyezhuth Devika

Symptoms of Ocular Myasthenia Gravis Masked by an Organic Lesion in Sphenoid Sinuses

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:18 - 20]

   DOI: 10.5005/jp-journals-10013-1369  |  Open Access |  How to cite  | 


Otolaryngologist tends to assume that the cranial nerve palsy is due to local causes, but it is important to overlook the symptoms to rule out other neurological causes too. Here, we present a 79-year-old elderly man, diabetic, who presented to our department with ophthalmoplegia along with contrast-enhanced computed tomography scan of nose and paranasal sinuses did in another hospital showing suspected mass lesion in bilateral sphenoid sinuses with the expansion of the sinus wall and erosion of the posteromedial wall of the right orbit. A provisional diagnosis of ophthalmoplegia secondary to pressure effect from the mass lesion in the sphenoid sinuses was considered. The patient underwent functional endoscopic sinus surgery (FESS) and fungal debris was removed from the sphenoid and ethmoid sinuses on both sides. Immediate postoperative period, he had improvement in ptosis. On subsequent follow-up, there was a worsening of his symptoms and neurological evaluation done. A repetitive nerve conduction study revealed abnormal decrement in the bilateral median and facial nerves. Blood serum levels showed elevated acetylcholine receptor antibody (10 nmol/L). Thus, a diagnosis of ocular myasthenia gravis was made. The patient was symptomatically better with neostigmine (60 mg) and ophthalmoplegia improved.



Muhammad Adam Shariff, Jeyasakthy Saniasiaya

Extensive Sinonasal Rhabdomyosarcoma in an Adult

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:21 - 23]

   DOI: 10.5005/jp-journals-10013-1368  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to highlight the importance of diagnosing sinonasal rhabdomyosarcoma (RMS) in an adult patient. Background: Rhabdomyosarcoma is a malignant tumor that originates from striated muscle. It is known to be the most common sarcoma in children. Occurrence among adults especially above 50 years of age is rare. Case description: Herein, we report on an adult patient who presented with a 1-month history of unilateral nasal obstruction and epiphora which turned out to be extensive sinonasal RMS extending intracranially. Conclusion: The patient was treated referred to the oncology unit for chemotherapy. Clinical significance: We would like to highlight that following the aggressive nature of sinonasal RMS, prompt management is undertaken to improve the survival rate.



Neeraj Kasliwal, Anirudh Kasliwal, Ashwath Kasliwal

Rhinosporidiosis: A Surgeon's Nightmare

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:24 - 26]

   DOI: 10.5005/jp-journals-10013-1371  |  Open Access |  How to cite  | 


Aim and objective: To assess the role of the coblation method in excision of nasal rhinosporidiosis. Background: Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi. The most common areas affected are nasal mucosa, ocular conjunctiva, and other mucosae with high chances of recurrence. Among these, the most common area affected is nasal mucosa. Case description: We present you a case of a 55-year-old man with recurrent nasal rhinosporidiosis, operated 6 times earlier, with recurrence every time within a span of 2–3 months. The patient was then operated on by coblation method and was followed up for 1 year, postoperatively. No recurrence was seen in any follow-up. Conclusion: Coblation technology is a novel and better technique for the excision of rhinosporidiosis with fewer chances of recurrence. Clinical significance: The use of coblation for the excision of rhinosporidiosis is a better technique than other methods as it causes less thermal damage to surrounding tissue and less bleeding, prevents spillage to adjacent mucosa, and therefore fewer chances of recurrence.



Shantanu Panja, Mehak Agarwal

Successful Management of a Complex Case of Recurrent Sphenoid Sinus Mucocele with Fungal Sinusitis and Optic Nerve Compression

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:27 - 29]

   DOI: 10.5005/jp-journals-10013-1366  |  Open Access |  How to cite  | 


Background: Mucoceles occur most commonly in frontal sinus and rarely in sphenoid sinus. The common presentations in sphenoid sinus mucoceles are deep-seated headache and visual disturbance. Case description: We present the case of a 58-year-old lady who came to us with headache, nose block, and reduced vision in the left eye since 2 years. She was diagnosed with an expansile lesion compressing the optic nerve. She underwent endoscopic drainage multiple times. The histopathological examination (HPE) was suggestive of aspergillus and she was treated with voriconazole. In spite of medical and surgical treatment, her symptoms were persistent. Eventually, she presented to our hospital with worsening of symptoms and deterioration of vision. Following MRI, we did drainage of mucocele with marsupialization. The clival bone was drilled out widening the entire face of sphenoid sinus. Fungal culture was suggestive of aspergillus and the patient was given voriconazole for 3 months. She has been on regular follow-up since then. Conclusion: In cases of recurrent sphenoid sinus mucoceles, complete marsupialization of the mucocele, drilling of bony barriers, adequate medical management, and diligent follow-up are necessary for the successful outcome. Clinical significance: Recurrent mucoceles of the sphenoid sinus represent a difficult entity to treat and are ridden with complications. Not only do they require aggressive surgical management but also meticulous postoperative medical management and repeated endoscopic follow-ups.



Divya Vaid, Deepika Vajpayee, Shilpa Rafeek, Dhirendra Suman, Lakshmi Vaid

Binder's Syndrome: A Rare Case Report

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:5] [Pages No:30 - 34]

   DOI: 10.5005/jp-journals-10013-1363  |  Open Access |  How to cite  | 


Background: Binder's syndrome or maxillonasal dysplasia is a rare developmental anomaly affecting the anterior maxillary region and nasal complex. Its causes are unclear and it is characterized by an extremely flat nose and retruded midface with a concave profile. Case description: We describe here a case of an 18-year-old male patient who presented with external nasal deformity since birth. On examination, the patient had classical features of the condition described by von Binder in 1962. Using costal cartilage graft, the nasal dorsum and the premaxilla were augmented by combined oral vestibular and external rhinoplasty approach. A brief review of the anomaly and the proposed treatment options in accordance with the age and the degree of malformation has been discussed. Conclusion: Satisfactory correction of the maxillonasal deformity, to achieve pleasing esthetics without functional limitations, is a challenge for surgeons. Clinical significance: This case report highlights the importance of correctly diagnosing patients suffering from Binder's syndrome (maxillonasal hypoplasia) and providing them with appropriate management. If clinicians miss this diagnosis, the desired surgical outcomes may not be achieved by rhinoplasty only without premaxillary augmentation.



Shilpa Chandrashekhar, Kumar Shankar De, Sandeep Shetty, Prakash Bhadravathi Ganesh

Differential Diagnosis for Sinonasal Tumors

[Year:2020] [Month:January-April] [Volume:13] [Number:1] [Pages:4] [Pages No:35 - 38]

   DOI: 10.5005/jp-journals-10013-1374  |  Open Access |  How to cite  | 


Aim and objective: To describe small round blue cell tumors (SRBCT) of the sinonasal cavity which are tumors that are likely to be misdiagnosed due to their presenting features that often mimic each other. Background: Small round blue cell tumors clinically tend to cause symptoms of nasal obstruction and epistaxis. They have overlapping histologic and immunophenotypic findings; hence, a proper workup is required to reach the proper diagnosis and for further management of each case. Case description: We present two cases of SRBCT, where the patients presented with a 1-month history of nasal obstruction and episodes of epistaxis, along with ophthalmologic symptoms in one of the cases. The patients were diagnosed with histopathology and immunohistochemistry and responded well to surgical treatment and chemoradiotherapy. Conclusion: Sinonasal masses with erosive potential can have a wide differential diagnosis. Small round blue cell tumors respond well to surgical debridement and combined chemoradiotherapy, which can effectively prevent tumor recurrence in many cases. Clinical significance: Early diagnosis and proper management of the tumors effectively improve the treatment outcome and lead to lowering of mortality and morbidity for the patient.


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