(a) To study the variations in the superior attachment of uncinate process. (b) Incidence of pneumatization of uncinate process was also studied.

A total 200 sides of 100 CT scans of paranasal sinuses coronal section were studied for variations in the superior insertion of uncinate process using Landsberg and Friedman classification. Incidence of pneumatization of uncinate process was also studied.

In our study out of 200 sides, type 6 attachment was commonest (41%) followed by types 1 and 2. Pneumatization of the uncinate was seen in very small percentage of cases.

Lateral insertion of uncinate (lamina papyracea + aggar nassi) is the commonest variant followed by the insertion into the skulbase. Pneumatization of uncinate is rare.

Though the inferior attachment of the uncinate is almost constant the superior attachment has several variations, the knowledge of which is very important for the endoscopic surgeon to avoid intraoperative complications.

Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J 2016;9(2):59-61.

Sharma VK, Sharma R, Mehrotra A, Iqbal Z, Nigam K. A Retrospective Study of Bony Erosion Patterns in Cases of Fungal Rhinosinusitis. Clin Rhinol An Int J 2016;9(2):62-64.

The correlation between middle ear pathology due to Eustachian tube dysfunction and nasal allergy has been a topic of debate since long. Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions and Eustachian tube dysfunction. AIMS- The aim of this study was to evaluate the relationship between Eustachian tube dysfunction and nasal allergy and to evaluate the efficacy of oral steroids and intranasal steroidal spray on Eustachian tube dysfunction.

The patients were diagnosed according to the diagnostic criteria of allergic rhinitis. A total of 50 patients having moderate/severe symptoms who had not taken any treatment for allergic rhinitis in the past 6 weeks with deranged middle ear function were included in the study. Group I patients were given Prednisolone, 30 mg once daily for 10 days in tapering dose along with intranasal steroid spray for 6 weeks. Group II patients were given only intranasal steroid spray for 6 weeks. Impedance audiometry was repeated at the end of 6 weeks and results were statistically analyzed.

This study demonstrated the outcome of systemic steroids and intranasal steroidal spray in the treatment of middle ear dysfunction. In our study impedance audiometry was done at the start of study and showed type B tympanogram in 36% ears in group I and 21% in group II and type C tympanogram in 60% in group I and 50% in group II. Impedance audiometry was repeated at 10 days of treatment and showed reversal to type A curve in 26% of ears in group I and 14% of ears in group II. Impedance audiometry at the end of treatment demonstrated reversal to type A tympanogram in 64% of ears in group I and 48 % of ears in group II.

Sharma S, Srivastava A, Sharma CM. Middle Ear Dysfunction: Connection to Allergic Rhinitis. Clin Rhinol An Int J 2016;9(2):65-67.

This study compares the nasal mucociliary clearance time of patients with chronic sinusitis (pre- and postoperatively) and smokers, with controls, attending the ear, nose, and throat outpatient department at Southern Railway Headquarters Hospital, Perambur, Chennai.

Saccharin granule was used to study mucociliary clearance as it is safe, easy, fast, and reliable. A total of 32 patients in each group were studied. In chronic rhinosinusitis patients, the test was done preoperatively and 4 weeks postoperatively.

The average mucociliary clearance time pre- and post-operatively in chronic rhinosinusitis patients was 29.54 ± 28.68 and 12.17 ± 5.84 respectively. Cigarette smokers had a longer mucociliary clearance time (27.63 ± 21.11) compared with beedi smokers (24.04 ± 24.93). Controls had the fastest mucociliary clearance rate of 9.67 ± 4.62 among the study subjects.

Surgery for chronic rhinosinusitis improves both the overall symptoms of chronic rhinosinusitis and the protective functions of the nose and paranasal sinuses. Smokers had an impaired clearance rate compared with normals. As age advances, the mucociliary clearance rate becomes slower.

Vamanshankar H, Kumar SC, Preetham AP, Feshan M. Mucociliary Function: Its Variations with Disease. Clin Rhinol An Int J 2016;9(2):68-73.

Allergic rhinitis (AR) is a global health problem that significantly alters patients’ social life and affects learning at school and work productivity.

A total of 150 patients suggestive of a history of AR were included in this study. The patients underwent a thorough history, clinical examination, diagnostic nasal endoscopic evaluation, and radiological imaging.

Out of 150 patients, 65% were male, whereas 35% were female ranging from age 14 to 70 years; 30% of both male and female were between 21 and 25 years; and 85% belonged to urban area, whereas 15% were rural inhabitants. The most significant complaints of patients were mainly paroxysmal sneezing, nasal obstruction, and watery nasal discharge. In the present study, 21% of patients had first-degree relatives with a complaint of AR; 72% of male patients and 75% of female patients had swollen turbinate; 59% of male patients and 62% of female patients had pale edematous nasal mucosa; 68% of male patients and 56% of female patients had granular pharyngitis; and 25% of male patients and 40% of female patients had complications of AR.

Allergic rhinitis is a disease of youth that affects mostly people in the age group of 21 to 25 years, and it is paroxysmal sneezing that concerns most of the patients and brings them to hospital. About 60% of the patients have a history of contact with the AR patients.

Allergic rhinitis involves nearly 600 million people all over the world. Our study suggests three cardinal signs of AR, viz., swollen turbinate, pale and edematous nasal mucosa, and granular pharyngitis. This study also signifies female preponderance for complications of AR.

Agarwal VK, Goyal M, Bist SS. Study of Predisposing Factor, Clinical Profile, and Complications of Allergic Rhinitis. Clin Rhinol An Int J 2016;9(2):74-76.

Nasal and paranasal sinus disease can cause Eustachian tube (ET) dysfunction leading to middle ear (ME) hypoventilation. Persistent ME hypoventilation can result in ME conditions like retraction of tympanic membrane, otitis media with effusion, and chronic ME disease.

Aim of this study was to evaluate the ET function in cases of sinonasal polyposis. Evaluation was done by doing tympanometry.

This was a hospital-based prospective study consisting of 42 patients (84 ears) of nasal polyposis, of which 27 patients had antrochoanal (AC) polyp and 15 patients had ethmoidal polypi. After thorough history and detail clinical examination, tympanometry was done in all patients 1 day prior to surgery and 4 to 6 weeks after surgery.

Preoperatively in 30 ears (15 patients) of ethmoidal polypi had normal tympanogram (A type) in 40% ears and abnormal tympanogram (B and C) in 60% ears. Postoperatively 80% had A tympanograms and 20% had abnormal tympanogram. There was significant improvement on removal of polypi (p = 0.004). Preoperatively 54 ears (27 patients) of AC polyp had normal tympanogram (type A) in 55.56% ears and abnormal tympanogram (B and C) in 44.44% ears. Postoperatively normal tympanogram was seen in 81.48% and abnormal tympanogram in 18.52% ears, so there was significant improvement after functional endoscopic sinus surgery (p = 0.007).

Eustachian tube dysfunction was present preoperatively in 60 and 44.44% in ethmoidal and AC polypi respectively, while in postoperative period dysfunction was 20 and 18.52%. So function improves on removal of polyp.

Mane SB, Dasgupta KS. Sinonasal Polyposis and Its Effect on Eustachian Tube Function. Clin Rhinol An Int J 2016;9(2):77-80.

Hyaluronidase belongs to a family of enzymes that degrades hyaluronic acid, which is a constituent of the extracellular matrix. The property of hyaluronidase to help relieve tissue adhesions has found implications in epidural neuroplasty, failed back surgery syndrome, abdominal adhesions, and in prevention of formation of adhesions postoperatively in laparoscopic ventral hernia repair. There is no previous study supporting the role of hyaluronidase in relieving the adhesions around the orbital masses and aiding in their delivery. This article intends to discuss the utility of hyaluronidase in orbital mass excision by relieving adhesions around the mass.

The purpose of this article is to describe the successful use of hyaluronidase intraoperatively for excision of orbital cavernous hemangioma. This patient had an orbital cavernous hemangioma of 8 years’ duration.

This report describes a patient who presented with unilateral proptosis of long-standing duration and visual diminution of 6 months’ duration. Radiological imaging showed presence of intraconal cavernous hemangioma in the right orbit. The patient underwent transconjunctival orbitotomy for orbital mass excision. Intraoperatively, 5 mL of injection hyaluronidase 300 IU/mL diluted in balanced salt solution was injected around the mass for adhesiolysis using a 25-gauge cannula.

The intraoperative use of hyaluronidase helped in relieving the adhesions around the mass and helped in its easy delivery without undue manipulation.

Hyaluronidase is helpful in adhesiolysis around the orbital masses and promotes their easy delivery. This helps in early recovery and decreased postoperative tissue edema. This is first such report implicating the role of hyaluronidase in orbital mass excision.

Gupta P, Gupta S, Poredi A, Zadeng Z. Role of Hyaluronidase in Orbital Mass Excision. Clin Rhinol An Int J 2016;9(2):81-83.

Salwa A. Sinonasal Inverted Papilloma: Evaluating the Effectiveness of Prediction of the Site of Attachment based on Computed Tomography Scans. Clin Rhinol An Int J 2016;9(2):84-86.

Soni A, Duggal A. Idiopathic Cerebrospinal Fluid Oculorrhea: An Unusual Case Report. Clin Rhinol An Int J 2016;9(2):87-89.

Jana T, Sengupta M, Das S, Saha AK, Saha S. An Unusual ENT Presentation of Retinoblastoma: A Diagnostic Dilemma. Clin Rhinol An Int J 2016;9(2):90-93.

Maffucci syndrome is a congenital nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. Less than 200 cases of Maffucci syndrome have been published in the English literature. These lesions most commonly occur in the limb bones, especially in the hands and feet. Rarely, patients of Maffucci syndrome may present with mesodermal dysplasia involving head and neck region with nasal septum enchondromas reported only in two cases till now.

To report a rare case of nasal enchondroma in a patient of Maffucci syndrome.

A 15-year-old girl diagnosed with Maffucci syndrome 2 years back was referred to our ENT department with symptoms of left-sided nasal obstruction and epiphora. On thorough clinical examination and proper investigation, she was diagnosed to have nasal enchondroma. She successfully underwent endonasal endoscopic resection of nasal enchondroma.

Maffucci syndrome is a rare entity characterized by multiple enchondromas and hemangiomas, especially in the extremities. A manifestation in the head and neck region is rare and cartilaginous tumors of nasal septum are even rarer; however, differential of nasal cartilaginous tumors should be borne in mind in patients with underlying mesodermal dysplastic disorders like Maffucci syndrome.

Patients of Maffucci syndrome with enchondromas are at high risk of undergoing malignant transformation, especially chondrosarcomas. These patients need vigilant and close follow-up. Despite their rarity, chondromas should be taken into consideration in the differential diagnosis of nasal tumors, especially those arising from the nasal septum.

Bansal S, Sharma A, Dabholkar JP. Maffucci Syndrome with Nasal Enchondroma: A Rare Entity. Clin Rhinol An Int J 2016;9(2):94-97.

Gupta R, Nabh V, Nahar U, Gupta AK. Mucormycosis Maxilla: Behavior of Disease in an Immunocompetent Young Male Patient. Clin Rhinol An Int J 2016;9(2):98-101.

Varshney S, Malhotra M, Kaur N, Gairola P. Lacrimal Gland Abscess leading to Frontal Bone Chronic Osteomyelitis: A Rare Case Report. Clin Rhinol An Int J 2016;9(2):102-104.

Mundi DK, Bhagat S, Singh M, Gill K. Fibrous Dysplasia of Ethmoid. Clin Rhinol An Int J 2016;9(2): 105-107.