Background: Fungus ball is an extramucosal fungal proliferation which completely fills one or more paranasal sinuses. Localization in the nasal cavity is extremely rare and can be confusing with rhinolithiasis. Case presentation: A 39-year-old female patient was referred to the ENT department for a left nasal obstruction that was associated with homolateral anterior rhinorrhoea. The diagnosis was an isolated fungal ball of the nasal cavity. Conclusions: The location of the fungus ball in the nasal cavity is rare and should prompt discussion of other calcified masses in the nasal cavity.
Telementoring shows promise as a supportive tool to enhance confidence and comfort in endoscopic sinus surgery training. This study’s remote guidance model demonstrates the potential of a scalable, low-barrier solution to expand access to expert mentor- ship in surgical education, particularly in resource-limited or geographically remote settings.
Within primary ciliary dyskinesia, there are different ultrastructural and motility phenotypes. Inspection for cilia motility with conventional light microscopy should not be used to exclude diagnosis. Tools such as nitric oxide, genetics, electron microscopy, and clinical history should be used.
Background: The self-administered odour questionnaire (SAOQ), consisting of 20 odours familiar to Japanese people, is proposed as a scoring system for the quantitative evaluation of sense of smell. We examined the correlations between the SAOQ and the standard olfactory test covered by insurance in Japan and evaluated the usefulness of the SAOQ in patients with olfactory dysfunction (OD). Methodology: Data from 3048 patients undergoing treatment for OD between June 2005 and September 2021 were retrospectively analysed. The causative diseases of OD were identified. Correlations between the SAOQ score and olfactory detection and recognition thresholds (DT and RT) were investigated using olfaction tests. The characteristics of each itemised odour of the SAOQ for each causative disease were analysed. Results: Causative diseases of OD were: chronic rhinosinusitis (43%), post-viral (25%), post-traumatic (6%), central nervous system dysfunction (2%), peripheral nervous system dysfunction (2%), congenital (1%), psychogenic (1%), or idiopathic (20%). The SAOQ score correlated with DT and RT in both the pre- and post-treatment stages. The median SAOQ scores significantly declined with RT severity. Analysis of the itemised odour scores of the SAOQ showed that ‘strawberry’ was the most declined-odour, while ‘perfume’ was the most preserved-odour. Conclusions: The SAOQ is a useful scoring interview system for evaluating sense of smell.
In January 2020, 14 medical staff members engaged in endona- sal endoscopic pituitary surgery at a hospital in Wuhan, China, were infected with a novel infection, coronavirus disease 2019 (COVID-19) (1). Since the nasal mucosa is a potential source of COVID-19 infection (2), close attention has been paid to infection control in rhinologic surgery during the COVID-19 pandemic (3). There are also many reports from other countries on COVID-19 infection among otolaryngologists, and these reports suggest that the risk of COVID-19 transmission is particularly high in rhinologic surgery (4,5). On the other hand, Sanmark et al. showed that the observed aerosol exposure during rhinologic surgery is lower or similar to exposures during coughing (6).
Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.
Background: Acute bacterial rhinosinusitis is a common condition often affecting children with inflammation of the mucous membrane in one or more nasal sinuses. Isolated sphenoid sinus infections can exhibit atypical or no symptoms before potentially severe suppurative complications develop. Awareness of early signs of complications is crucial to avoid delays in referral, diagnosis, and treatment. We present the first detailed report of a child with sphenoid sinus empyema with the symptoms intermittent unilateral esotropia and limb and gait ataxia. This case emphasizes the need to recognise atypical presentations, aiding early diagnosis and treatment to prevent severe, possibly life-threatening complications. Case presentation: A 7-year-old girl, previously healthy, presented with a months-long decline in health marked by general malaise, significant weight loss, and recurrent upper respiratory infections. Despite multiple primary care visits no antibiotics were prescribed because infection parameters were found to be normal. Subsequently, the emergence of intermittent double vision prompted referral to the pediatric emergency department. Examination revealed a wide-based gait, ataxic finger-nose-finger and knee-heel tests, and intermittent esotropia of the left eye. Neurological examination was otherwise unremarkable. Imaging of the cerebrum was performed on the suspicion of intracranial pathology and found isolated empyema within the left sphenoid sinus. Endoscopic sinus surgery and antibiotic treatment led to a full recovery within a month. The accommodative esotropia, likely triggered by the infection, was identified, and successfully treated with spectacles. Conclusion: This case recognises isolated empyema in the sphenoid sinus as a potential cause of intermittent esotropia and limb and gait ataxia. It serves as a reminder for clinicians to be vigilant for early signs of suppurative complications to commence prompt diagnosis and treatment to prevent delayed recognition and severe complications. It advocates the inclusion of images of the sphenoid sinus to accompany the conventional scans of the cerebrum, as patients risk referral on the suspicion of intracranial pathology on the basis of neurological symptoms.
Background: Establishing effective treatment algorithms for chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging, particularly concerning biologic therapies' discontinuation rates. Limited real-world data exist on the persistence of dupilumab, a biologic used in CRSwNP. We conducted a large-scale claims-based analysis to compare dupilumab discontinuation rates. Methodology: Utilizing the IBM MarketScan® Research Database, we identified CRS patients treated with dupilumab from July 2019 to December 2021. We assessed drug discontinuation rates, comorbidities, demographics, and surgical history using Kaplan-Meier curves and Cox proportional hazards models. Results: Of 1718 CRS patients on dupilumab, median age at initiation was 45 years, with 44% male. Dupilumab persistence varied by comorbidity, with patients with comorbid asthma exhibiting the longest median usage (652 days). Statistically significant differences in drug persistence were observed among comorbid conditions (p<0.001). Younger patients (<50 years) had higher discontinuation rates (p<0.001). Conclusions: Our study reveals that many CRS patients without comorbidities discontinue dupilumab within the first year, with a median duration of 366 days. Age and comorbidities significantly influence dupilumab persistence. These findings aid clinicians in counseling CRS patients and underscore the need for further research to optimize treatment strategies.
BACKGROUND: Studies on the long-term prevalence of smell and taste impairment concerned with severe disease in the acute phase of COVID-19 are limited. The aim of our study was to assess and compare psychophysical testing and self-reported smell and taste disturbances and recovery between three patient groups suffering from critical, severe, or mild COVID-19 in a follow-up at six-months after the acute phase. METHODOLOGY: The prospective controlled study of 227 participants comprised 72 intensive-care-unit-treated (ICU-treated), 53 pulmonology- or infectious-diseases-ward-treated (WARD-treated), and 48 home-isolated patients (HOME) with preceding COVID-19, and 54 individuals with no history of COVID-19 (CONTROL). All participants visited a follow-up clinic for a sense-of-smell screening and underwent Magnetic Resonance Imaging (MRI) of the brain, olfactory bulbs and sinonasal area at six months after acute disease. Before the follow-up visit, the participants received a questionnaire concerning smell and taste function. We sent a supplementary questionnaire including questions about phantosmia and parosmia and taste recovery at a median of 502.5 days after the acute phase. RESULTS: We found no statistically significant differences between the groups in the incidence of smell and taste dysfunction, recovery, or the occurrence of parosmia or phantosmia. There were no statistically significant differences in semi-objective smell performance across the different study groups and controls. The olfactory bulb volume was normal in all patients and controls. Mucosal thickening in paranasal sinuses was rare. CONCLUSIONS: We found no difference in a six-month follow-up in the subjective or semi-objective senses of smell and taste between three severity groups of COVID-19 and controls.
BACKGROUND: The assessment of qualitative olfactory symptoms is characterised by heterogeneous and unstandardised tools. To improve the means of capturing symptoms and subsequent treatment and care, this study aimed to develop a novel questionnaire, the parosmia, phantosmia, and anosmia test (PARPHAIT). METHODS: PARPHAIT was distributed to 165 participants with qualitative olfactory symptoms mainly due to COVID-19. The content was evaluated in participants with olfactory dysfunction, and an exploratory factor analysis (EFA) and internal consistency assessment was performed to assess underlying constructs and their reliability. RESULTS: PARPHAIT was scored as suitable, although suggestions for improvement were made. The EFA suggested a four-factor model with 34 items, all having factor loadings over 0.63. The factors had good to excellent reliability. CONCLUSIONS: This study aimed to develop a novel questionnaire, PARPHAIT, and evaluate its content and factor structure. The content and format were satisfactory, but had potential for improvement. EFA resulted in a four-factor, 34-item model with good to excellent internal consistency. PARPHAIT is only just developed and will need to be validated in different populations and confirmed with respect to its factor structure. However, PARPHAIT bears potential of being a robust, comprehensive - yet symptom-specific -, and standardised tool of capturing olfactory dysfunction.
Background: This study aims to assess anatomical variations in the frontal sinus and its drainage pathway within the Nepalese population. Methodology: This cross-sectional analytical study was conducted at the Department of ENT-HNS and Radiology, Maharajgunj Medical Campus in Nepal. Digital Imaging and Communications in Medicine (DICOM) computed tomography files of patients were analyzed over a year to assess pneumatization variations, frontal sinus size, presence of intersinus septa, olfactory fossa depth, frontal recess cells, and anterior ethmoidal artery position. Imaging files with obscuring disease processes or obtained in different positions, hindering frontal sinus or recess visibility, were excluded. Data analysis employed SPSS version 25, using descriptive statistics (median, range, interquartile range), Chi-squared tests, and Cramer’s V. Results: Among total sinuses analyzed, 7% exhibited unpneumatized frontal sinuses (3.3% bilaterally, 6.7% unilaterally). Median dimensions for right and left frontal sinuses were 10.2 x 11.15 x 11.7 mm and 10.2 x 11.1 x 11.6 mm, respectively. Predominant fin- dings included mixed upper uncinate process attachments, Type II olfactory fossa, agger nasi as the commonest anteriorly based cells, and supra bulla cells as the prevalent posteriorly based cells. Conclusion: Investigation of frontal sinus anatomy in the Nepalese population revealed distinct features. While generally well- developed, these sinuses exhibited relatively smaller dimensions compared to other ethnic groups. Consistent with prior studies, agger nasi and supra bulla cells were the most prevalent anteriorly and posteriorly based cells, respectively.
Objective: Clinical remission after immunotherapy for allergic rhinitis is based on an increase in Interleukin-10 (IL-10) production, a regulatory cytokine. We focused on the effect of the oral microbiome on sublingual immunotherapy and investigated the IL-10 production from human monocytic cell line (THP-1 cell) stimulated by one of the commensal gram-negative Prevotella species. Methods: We measured IL-10 production in THP-1 cells stimulated by P. melaninogenica, one of the major bacteria in the Prevotella genus. Lipopolysaccharides (LPS) from Escherichia coli (E. coli) were used to confirm the validity of the experiments. Polymyxin B sulfate salt (PMB), an antibiotic that interacts with LPS, was added to counteract the effect of LPS and P. melaninogenica. Results: P. melaninogenica induced IL-10 production in THP-1 cells (P < 0.01). The IL-10 production in THP-1 cells stimulated with P. melaninogenica was substantially increased when combined with PMB (P < 0.01), whereas IL-10 induced by E. coli LPS was decre- ased when combined with PMB. Conclusion: The IL-10 production in THP-1 cells was induced by P. melaninogenica and was increased when combined with PMB. Further investigations into the mechanisms of IL-10 production induced by Prevotella are needed.
Background: The purpose of this study was to evaluate whether office-based endoscopic sinus surgery (ESS) is as safe as tradi- tional outpatient surgery and whether there are differences in the operation results, patient recovery data, or complication and revision surgery rates. Methods: The study involved 164 subjects and data was collected retrospectively from Seinäjoki Central Hospital patient records. The office-based group included 92 patients who had undergone ESS under local anaesthesia in an office-based setting between April 2014 and December 2017, and the outpatient group 72 patients who had done so in an outpatient setting between January 2010 and December 2014. Patients were divided into two groups based on presence (wNPs, n=57) or absence (sNPs, n=107) of nasal polyps. Results: We found statistically significant differences in intraoperative medication in terms of amounts of drugs administrated. Sick leave was on average 2.1 days longer in the outpatient sNPs group and 2.4 days longer in the outpatient wNPs group than in the respective office groups. There were no statistically significant differences between methods in terms of complications. Revision rates for sNPs were 5.6% and 13.9% for the office and outpatient groups, respectively, and for wNPs 4.8% and 19.4%, respectively. Conclusion: Office-based ESS with careful patient selection seems safe, effective, and well tolerated by patients. Office-based intervention may lead to shorter sick leave durations and can reduce the overall use of sedative drugs during the operation.
BACKGROUND: We have previously shown that an adjusted magnetic resonance imaging (MRI) protocol could be used as an alternative for assessing most bony paranasal and vital structures. Here, we aimed to determine the feasibility of using this protocol during endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Three experienced rhinologists used an adjusted MRI scan to plan and perform ESS. They were blinded to the CT images and observed them only postoperatively. They also completed a detailed questionnaire about their experience. RESULTS: Forty-three patients with CRS (60.5% with polyps and 39.5% without polyps) were included in the study. MRI navigation was used in 58.3% and 33.3% of surgeries performed by surgeon #1 and #2, respectively. The median Lund-Mackay score was 12 (interquartile range 2-24). None of the surgeons switched entirely to using CT scans during the procedure; No intra or postoperative complications were observed. Two surgeons reported that it was convenient to work with the MRI scans to visualize all nasal sinuses, but the third surgeon found MRI scans convenient for visualizing the frontal sinus. MRI convenience was considered superior to CT in 7 cases (16.3%), the same as CT in 29 cases (67.4%), and inferior to CT in 7 cases (16.3%). All three surgeons agreed that using MRI scans intraoperatively for ESS is safe and comparable to using CT scans. CONCLUSION: MRI is a well-suited modality for planning and performing ESS. Rhinologists would be able to rely on it in specific and highly selected indications.
A middle-aged lady was referred to the Otolaryngology department for consideration of an endoscopic biopsy of a mass located in the right orbital apex. She had initially presented to the eye clinic with complaints of right proptosis and worsening vision. Upon examination, her right eye showed no perception of light, an amaurotic right pupil, and limited extraocular movement in all directions of gaze. Hertel's ophthalmometer revealed proptosis, and there was a loss of corneal sensation. Magnetic resonance imaging (MRI) of the orbits revealed an enhancing mass in the right orbital apex, extending into the cavernous sinus. She subsequently underwent an endoscopic trans-sphenoidal biopsy of the lesion. Histopathological analysis confirmed the pre- sence of squamous cell carcinoma (SCC). Further systemic evaluation did not reveal any other primary site or metastasis. Conside- ring the unresectable nature of the tumor and her poor candidacy for chemotherapy and radiotherapy, the patient was managed with best supportive care.
BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.
Background: Allergic rhinitis, rhinosinusitis, and upper respiratory tract infections, including the common cold, are caused by inflammation of nasal cavity areas. A key symptom is nasal congestion, which can be relieved with nasal spray medications. A key goal in developing a nasal spray medication delivery device for the relief of nasal congestion is delivering a fine mist to the inflamed areas while providing user comfort and convenience. Methodology: Using a Koken nasal cast model, we studied the deposition patterns of 2 xylometazoline and 1 oxymetazoline for- mulations with 2 different nasal pumps, the currently marketed Freepod and the investigational laterally actuated device. Effects of nasal tip orientation and breathing were investigated. Additionally, the degree of xylometazoline and oxymetazoline dripping down the back of the cast was assessed. Results: The largest coverage overall was observed with the xylometazoline formulation with the laterally actuated pump and without breath simulation. The laterally actuated pump used at a 30° angle resulted in deposition to the inferior, middle, and superior turbinates of the nasal cast, with less variability than the Freepod. Drippage at the back of the cast was observed with the Freepod device but not with the laterally actuated device. Conclusions: Using a nasal cast model, the laterally actuated pump used at a 30° angle produced a full mist covering areas inflamed with the common cold, allergic rhinitis, and rhinosinusitis with no dripping at the back of the cast, an improvement compared with the Freepod pump. In vivo studies are needed to confirm nasal cast results.
Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant orphan disease, leading to malformations of blood vessels. Regarding the pandemic, both, the course of COVID-19 infection and the response to the vaccination and its pos- sible side effects, such as increased bleeding episodes, are still poorly investigated. Methodology: Retrospective single-center cohort study at the Department of Otolaryngology / Head & neck Surgery (University Hospital of Zurich, Switzerland) between February 14th and March 21th 2022. Among the 32 eligible adult patients with HHT, we collected patient- and disease-specific characteristics. The course of a COVID-19 infection including severity of the disease and symptoms were noted. We assessed changes in the Hereditary Hemorrhagic Telangiectasia Epistaxis Severity Score (HHT-ESS) before and after vaccination. Results: Out of the 32 patients, 5 patients suffered a COVID-19 infection, thereby mainly experiencing loss of taste and smell and cough. No significant change of the HHT-ESS before and after vaccination was observed. The median HHT-ESS before and after the vaccination was 4.06. Conclusions: There was no significant change in bleeding severity (HHT-ESS) before and after COVID-19 vaccination. Based on these findings, the vaccination for HHT patients does not seem to worsen the further course of the disease. The overall symptoms, risks and complications after Sars-CoV-2 vaccination and infection seem to be comparable to the general population.
BACKGROUND: Most endoscopic sinus surgeons instruct their patients to avoid certain activities during the postoperative period. Due to the scarcity of empirical data on this issue, most instructions are based on surgeons’ personal insights. In this study we evaluated if restrictions for performing specific activities have a consensus among endoscopic sinus surgeons. METHODOLOGY: A nationwide survey was conducted among experienced Israeli endoscopic sinus surgeons. Participants were asked to note the optimal postoperative time restrictions of 25 different activities. RESULTS: The response rate was 30/36 (83%). Surgeons’ responses regarding time restrictions of specific activities postoperatively showed high variance. The greatest variance was noted for using a hair dryer, light physical activities, nose blowing, driving a car, having sexual intercourse, eating/drinking hot food or beverages, taking hot showers and drinking alcohol. CONCLUSIONS: The time restrictions given by endoscopic sinus surgeons for specific activities postoperatively vary greatly among them. The study findings call upon rhinology boards to establish consensus-based guidelines for postoperative management after endoscopic sinus surgery.
INTRODUCTION: The olfactory cleft is a region of significant importance within the nasal cavity, given the heightened focus on olfactory disorders in recent years. It is considered a 3-dimensional space that starts at the most anterior olfactory filament and ends just anteriorly to the sphenoid sinus. This study aimed to outline the profile of the olfactory cleft as an anatomical area of extreme relevance in the diagnosis of diseases of the nose, paranasal sinuses and olfactory disorders. The aim to establish parameters of radiological normality for the olfactory cleft enables us to recognize and differentiate nasal disorders by identifying the widening or narrowing of the olfactory cleft during the preoperative assessment, thus facilitating the planning of the optimal treatment. This supports a theory about the evolution and development of the nose (Evo Devo Theory) that shows the olfactory nose (ethmoid and olfactory cleft) represents the seat of most diseases of the nose and paranasal sinuses. MATERIALS AND METHODS: 700 random CT scans of the nose and sinuses have been studied. A homogeneous group of CT scans of patients without paranasal sinus diseases were included in this study, seeking to define a reference anatomical measure as a criterion for tomographic normality. Measurements of the olfactory cleft were taken in the lateral-lateral direction between the middle concha and the septum on each side of the nose cavity at three specific anatomical points in the anterior skull base in the anteroposterior direction, corresponding to the beginning, middle and end of the olfactory cleft. For data analysis, exploratory statistical techniques have been used that allowed a better visualization of the general characteristics of the data. The appropriate statstical analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: According to the statistical analysis performed, the reference values that were found evaluating and studying the three points were: at the first point - First Olfactory Neuron Point (FONP) – was 1.3 to 2.1 mm, at the second point - Middle Point (MP) was 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point (SERP) was 1.1 to 1.8 mm. The average in the first point was 1.78 mm, while in the second and third points were 1.41 and 1.48 mm, respectively. CONCLUSION: It is concluded that the tomographic olfactory cleft reference values are respectively: at the first point – First Olfactory Neuron Point- 1.3 to 2.1 mm, at the second point - Middle Point - 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point -1.1 to 1.8 mm.
