Introduction: Foreign body piercing orbital floor and entering maxillary antrum is a rare scenario, and has to be managed in a meticulous fashion to avoid further complications.Transnasal endoscopic surgery is one of the methods for gaining access to both orbit as well as the maxillary antrum through a single approach.Case description: We report a case of a 40-year-old female with history of assault to the right eye using a pen.There was a J-shaped sutured wound present over medial aspect of the right eye with upper eyelid edema and a swelling medial to the right medial canthus.Computed tomography scan showed the presence of well-defined cylindrical structure measuring 46 × 9 mm noted in extraconal compartment inferomedial to right eyeball penetrating to floor of the orbit and reaching till posterior wall of right maxillary sinus.Patient was managed using transnasal endoscopic approach under general anesthesia.The postoperative period was uneventful, with complete resolution of complaints.Conclusion: A detailed history with relevant radiological imaging plays an important role in diagnosis of orbito-maxillary foreign bodies (FB) and also for planning the management.Approach to these FB varies based on their composition, size, and location.Therefore, proper surgical planning is important and will result in a good outcome with minimal complications.
Cerebrospinal fluid (CSF) rhinorrhea is due to communication between the subarachnoid space and the sinonasal cavity.Cerebrospinal fluid rhinorrhea is treated with immense care to avoid serious complications which can cause high mortality.Various techniques are available for CSF rhinorrhea in which the endoscopic endonasal approach is used widely as it has less morbidity.Treating CSF rhinorrhea in far lateral frontal sinus leaks is a challenging task endoscopically, which can be done with orbital transposition.We report a series of 3 cases of lateral frontal sinus CSF rhinorrhea and they are successfully treated by endoscopic endonasal with orbital transposition.
Incidence of primary sinonasal tuberculosis (TB) is only 1.8% of all cases of tuberculosis and among them the involvement of ethmoidal sinuses is very rare.The most common clinical presentation of sinonasal TB is that of persisting rhinosinusitis, resistant to usual treatment.We report a case of primary tuberculosis of the ethmoids and the orbit which presented with symptoms mimicking Tolosa Hunt syndrome (THS).Through this case we wish to highlight this rare clinical presentation of paranasal sinus tuberculosis and the subsequent management of this patient.
Aim:To study the clinical course, investigatory findings, and the need for timely diagnosis of extranodal natural killer/T-cell lymphoma, nasal type (ENKTL-NT) and to understand the diagnostic difficulties and treatment options.Background: Extranodal natural killer/T-cell lymphoma, also known as "Stewart's Granuloma, " is a rare non-Hodgkin's lymphoma originating in the nasal cavity.It mostly arises from the malignant transformation of cytotoxic T cells.It is characterized by aggressive and rapidly progressing necrotic lesions involving the mid face, principally the nose and palate.It is a diagnosis made by the exclusion of other infective and granulomatous mid-facial lesions.Case description: A 35-year-old male presented with bilateral nasal obstruction for 20 days, left cheek swelling for 2 days, associated with progressive left-eye swelling and nasal regurgitation of fluids.Local examination showed extensive nasal crusting, and septal and palatal perforation.No clinical improvement was seen with empirical antibiotics and antifungals.Immunohistochemistry (IHC) was positive for cluster of differentiation (CD) 3 and 56, which led to a diagnosis of ENKTL-NT, and chemotherapy was started.However, he succumbed to coronavirus disease-2019 (COVID-19) disease during the course of treatment.Conclusion: Extranodal natural killer/T-cell lymphoma, nasal type is an aggressive form of non-Hodgkin's lymphoma with a clinical picture masquerading as acute invasive fungal sinusitis, mid-face granulomatous lesions, etc.This leads to delayed diagnosis, which in turn affects morbidity and mortality.Therefore, a timely and precise diagnosis with aggressive treatment is a must.Clinical significance: Extranodal natural killer/T-cell lymphoma, nasal type, is rare with rapid and aggressive local tissue necrosis and progression.Its refractory behavior to our initial treatment regimens raised suspicions.In the current challenging times, trying to decrease misdiagnosis is of paramount importance.Through this case report, we aim to alert fellow practitioners to keep this entity in the differential diagnosis of such an aggressive clinical picture with a short history.
Aim/background: In rhinoplasties, splints are frequently employed to stabilize the nasal bone structure after osteotomies.The most popular splinting techniques used are Plaster of Paris (POP), thermoplastic splints, and aluminum splints.These splints also help to approximate the skin flap to the underlying bone and reduce hematoma formation.The objective of our study is to assess and compare the conformability and adhesion properties of fiberglass splints vs POP splint materials in the context of rhinoplasty.Materials and methods: About 1,000 patients undergoing cosmetic rhinoplasty were randomized into two groups.Group I, POP splint was placed, and group II patients managed fiberglass thermoplastic material.Conclusion: Fiberglass splint material is far simpler to use, more beneficial and takes lesser time to prepare overall than the widely used POP splinting material.Clinical significance: Due to the benefits of fiberglass splint material, the surgeon may be able to avoid long recovery times and obtain the ideal postoperative look.
Sinonasal malignancies are relatively an uncommon entity and squamous cell carcinoma is the commonest malignancy.Tumor mainly arises from the mucosa of nasal cavity or maxillary sinus.Primary tumor from the frontal and sphenoid sinuses are very rare.Patients often present with advanced disease, as the initial symptoms of tumor, such as nasal block, nasal bleeding, and nasal discharge mimic those of common nasal pathology such as rhinitis/sinusitis.The ideal treatment for sinonasal malignancy is surgery, followed by postoperative radiotherapy.Traditionally, such tumors were treated with open surgical excision or combined craniofacial resection in the case of skull base involvement.Now in the era of minimally invasive surgery, more and more such tumors are diagnosed early and operated on via a transnasal endoscopic approach.This article will serve as a guide for surgeons planning to operate upon such tumors endoscopically.
Xanthomas are localized lipid deposits in organs that may manifest as papules, plaques, or nodules on skin.There are many variants of xanthomas, and tuberous xanthoma is one of the xanthomas.They are very rare in head and neck region and xanthoma of the nose has been reported only once before.Xanthomas elsewhere are excised mainly for diagnostic purpose, whereas our patient wanted excision for better cosmetic appearance of the nose.We are presenting this case for its rarity and for concerns in management with review of literature.Facial xanthoma management requires excision for diagnosis and cosmesis.However, management of underlying lipid disorder is also very essential.
Background:The diseases of sinuses are commonly seen in all age groups.Currently, endoscopic sinus surgery (ESS) is commonly performed as a daycare procedure.The anesthetic technique should also be selected on this basis.Keeping these considerations in view, ESS has been performed under total intravenous anesthesia (TIVA) using or monitored anesthesia care (MAC). Materials and methods:This prospective randomized open-level study was conducted in 40 ASA I-II adult patients of either sex, undergoing elective ESS.All the patients were divided into two groups according to the randomized table: Group A: TIVA and group B: local anesthesia and conscious sedation.In group B, patients who did not tolerate the procedure were converted to the TIVA group.Results: The duration of surgical procedure was 69.00 ± 9.63 minutes in group A patients and 55.00 ± 10.34 minutes in group B patients.This result was statistically significant.But in group A, 55% of patients had a score of 2, and 45% had a score of 3. In group B, 90% had a score of 2 and 10% had a score of 3.This was statistically significant (p < 0.05). Conclusion:The time taken for ESS is reduced, the surgical field is better despite of higher mean blood pressure done with MAC care in comparison to TIVA.However, this needs the cooperative patient.
ABSTRACT Aim and objective The present report describes an atypical presentation of a lacrimal gland mass in a young male patient. Symptomatology favored a benign mass that was proven to be malignant on histopathology. Background Adenoid cystic carcinoma is the most common epithelial malignancy of the lacrimal gland. The usual presentation of adenoid cystic carcinoma is in either sex at about an average 40 years of age with range from 6 to 79 years. The patient usually complains of a superotemporal orbital mass with rapid progression usually within a year. Uncommonly, these masses may present with longer history as is described in present case report. Case description A 17-year-old male patient of Indian origin presented with a mass in the superotemporal part of the right orbit for the last 5 years and 6 months. A firm and smooth orbital mass, approximately 20 mm × 15 mm, was present in superotemporal orbit that was nontender and nonpulsatile. A clinical diagnosis of lacrimal gland pleomorphic adenoma was strongly suggested by the clinical as well as radiological features. The orbital mass was excised en bloc by a right transseptal anterior orbitotomy. Histopathological examination of the excised mass revealed features characteristic of lacrimal gland adenoid cystic carcinoma. Conclusion Lacrimal gland adenoid cystic carcinoma can simulate pleomorphic adenoma and can present with history over 5 years. Hence, it should always be kept as a clinical possibility in patients with the painless superotemporal orbital mass and early excision of such orbital masses for appropriate diagnosis and management is vital. Clinical significance The duration of 5½ years at presentation in well-localized lacrimal gland adenoid cystic carcinoma is the longest period ever reported. The present article recommends keeping the differential diagnosis of adenoid cystic carcinoma in all patients with the clinically benign superotemporal orbital mass. How to cite this article Gupta P, Kaur S, Zadeng Z, et al. An Unusual Lacrimal Gland Mass. Clin Rhinol An Int J 2019;12(2 and 3):49–51.
Background: Mucormycosis is a group of invasive infections caused by filamentous fungi of the Mucoraceae family.Most commonly seen in immunocompromised individuals.Sinonasal mucormycosis is a rare infection, difficult to treat, and can also be fatal. Aims and objectives:To highlight the importance of early detection of disease, early initiation of antifungal therapy, surgical debridement, and adequate management of immunosuppressive conditions.Materials and methods: In this prospective study, 46 cases of sinonasal mucormycosis with different courses of illness and comorbidities who presented to the ENT OPD at Bengaluru Medical College and Research Institute from July 2015 to June 2018 were included.They were subjected to a common standardized treatment protocol and outcomes were assessed and discussed.Results: Most of the patients in our study were in the 4th decade of life.Diabetes mellitus was seen in 94% of our patients.Imaging studies were non-specific with features suggestive of sinusitis.Nasal endoscopy helps in arriving at a provisional diagnosis and knowing the extent of the lesion.Biopsy of tissue showing fungal hyphae with invasion is confirmatory.In our study, 22 (47.8%)patients expired during the time period.Among the expired patients, only 7 had got combined modality treatment and 20 patients presented after 6 months of the onset of symptoms.In patients with strict glycemic control, no recurrences were seen. Conclusion:The key to manage mucormycosis is early detection and initiation of antifungal treatment.In any immunocompromised patient presenting with features of sinusitis, mucormycosis has to be ruled out.Liposomal amphotericin B therapy has better compliance.Endoscopic debridement is of vital importance for excellent local control.Control of glycemic status boosts the body's immune process and reduces the chance of recurrence.
ABSTRACT The present study is an observational case series study of 50 cases of patients in the age group of 5–15 years for a period of 2 years. The age range was chosen, where issue of tonsillar and adenoid hypertrophy is very common. The objective of this case series is to establish that adenoidectomy is not a requirement while performing adenotonsillectomy unless and until the patient suffers from genuine adenoid hypertrophy symptoms. How to cite this article: Vinayak ES. Role of Adenoidectomy in Adenotonsillectomy: An Observational Study. Clin Rhinol An Int J 2019;12(2 and 3):45–48.
Aim and objective: To describe the evaluation and management of multiple cases of unilateral proptosis due to various sinonasal pathologies.Materials and methods: Patients presenting to ENT OPD with unilateral proptosis were evaluated, diagnosed, and treated in this prospective study done over 2 years.All cases underwent complete otorhinolaryngological and ophthalmic examination apart from the endoscopic and radiological examination.Proptosis was measured by Hertel's exophthalmometry and readings above 21 mm or a difference of more than 3 mm between the two eyes were taken as positive.The cases were managed with appropriate surgery along with required medical management.Results: Twelve cases were observed over 2 years.The mean age of patients was 48.08 ± 13.02 years.Male:female ratio was 5:1.The most common cause was maxillary carcinoma with an orbital extension (four cases).Surgery was a mainstay of treatment in all patients, along with required medical treatment. Conclusion:A good work up and with surgical management resulted in good recovery of the patients with only one mortality.Sinonasal infections accounted for 25% of cases, benign neoplasms and tumor-like conditions 33%, and the rest 42% were constituted by malignant conditions.Clinical significance: Assessment of proptosis in otorhinolaryngology is of paramount importance as it can be an early and/or only manifestation of nasal or paranasal sinus pathology.Although the incidence of proptosis in everyday ENT practice is exceedingly low, the knowledge of the important causes helps in clinching the correct diagnosis and timely management.
Aim and objective: A rare presentation of intractable massive recurrent epistaxis diagnosed and managed.Background: Traumatic intracranial pesudoaneurysm is a rare complication of blunt trauma.Intracranial internal carotid artery pseudoaneurysm may rupture leading to delayed onset, massive, recurrent epistaxis, which requires an emergency intervention.Case description: Here, we present a case of recurrent massive intractable epistaxis due to a sphenoidal prolapse of supraclinoid part of right internal carotid artery, presenting as a pseudoaneurysm, secondary to a post-traumatic fracture dehiscence of roof of sphenoid, diagnosed with the help of a computed tomography angiography.The patient was treated successfully with a primary endovascular coiling. Conclusion:Intractable epistaxis due to a post-traumatic pseudoaneurysm is quite rare and can be fatal and hence need to be considered in the differential diagnosis of massive recurrent uncontrollable epistaxis and treated at the earliest.Clinical significance: The reach of presentations of such rare cases should be broadened as these are difficult to be diagnosed and managed.Inadequate and untimely diagnosis and management of such cases can cost the life of the patients.
ABSTRACTIntroductionNasal 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 methodsIt 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.ResultsIn 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).ConclusionNasal 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.How to cite this articleSingh J, Bhardwaj B, Singh T. Relative Incidence of Nasal Masses: A Tertiary Care Hospital Experience. Clin Rhinol An Int J 2019;12(1):16–20.
bstrAct 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.
OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis. MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly. RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064). CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.
ABSTRACT 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. How to cite this article Yeung W, Judd O. Reviving a Lost Art: Hot-water Irrigation Treatment for Intractable Epistaxis. Clin Rhinol An Int J 2019;12(1):1–2.
Ab s t r Ac t 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.
Even routine diagnoses, such as septal deviation, which most people do not think need imaging, require careful examination because rare diagnoses such as lipoma may occur in the nose. Careful examination and imaging lead to the best treatment.
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.
