Correlation between nasal endoscopy and computed tomography in a tertiary care hospital

Background: Chronic rhinosinusitis is associated with morbidity and affects the quality of life of the affected persons and increases their treatment costs. Diagnosis is mainly by nasal endoscopy or by computed tomography which is considered to be the gold standard.Methods: Nasal endoscopy was done for all the patients under local anaesthesia. All the patients also underwent computed tomography and paranasal sinuses and the findings were scored according to Lund Mackay scoring system. Results: The most common age group was 31-40 years and nasal discharge was the most common symptom seen in 82% of the patients. The paranasal sinuses that were involved were predominantly maxillary sinus in a total of 88% of the patients. 22% of the patients have sinusitis in the anterior ethmoid of the left nose and 20% on the right nose. Bilateral was seen in 22% of the cases. The sensitivity of nasal endoscopy over computed tomography was 95.6% while the specificity was 80%. The positive predictive value was 97.7% and the negative predictive value was 66.7%. The accuracy of the test was 94%.Conclusions: Nasal endoscopy is found to be as good as the computed tomography for the diagnosis of chronic rhinosinusitis and can be used on a regular basis for its detection among the patients. It not only lacks radiation but is also economically viable.

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Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195697 ◽

2019 ◽

Vol 6 (1) ◽

pp. 101

Author(s):

Falguni J. Parmar ◽

Avani D. Patel

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Care Center ◽

Tertiary Care ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Advantages And Disadvantages

Background: Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).Methods: A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included. Results: Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.Conclusions: Prolonged duration of rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.

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Prevalence of asthma and association with the allergic rhinitis among the patients attending a tertiary care hospital of district Varanasi: a cross sectional study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194302 ◽

2019 ◽

Vol 7 (10) ◽

pp. 3739

Author(s):

Raj Kamal Singh

Keyword(s):

Allergic Rhinitis ◽

Bronchial Asthma ◽

Tertiary Care ◽

Nasal Endoscopy ◽

Diagnostic Tools ◽

Nasal Discharge ◽

Common Symptom ◽

Care Hospital ◽

Age Group ◽

Cross Sectional

Background: The prevalence of Bronchial Asthma and Allergic Rhinitis is increasing not only in developing countries but also in developed as well. These two has been the subject of several epidemiological investigations and found an overlapping of symptoms between both diseases.Methods: Present study conducted on the patients attending the OPD of Department of TB and chest, Institute of Medical Sciences, Banaras Hindu University, Varanasi and confirmed diagnosis of asthma and allergic rhinitis were made using spirometry and nasal-endoscopy respectively.Results: 110 participants of age between 15 to more than 56 years were included attending the OPD of Department of TB and Chest with signs and symptoms related to the asthma. 32(29.09%) participants were age group of 15-25 years, 34(30.09%) of 26-35 years,18(16.36%) of 36-45 years and 15(14%) participants were from age group of 46-55years and rest 11(9%) were of 56years and above. common symptom was found nasal discharge 62(79.48%) participants followed by headache which was there in 59(75.64%) participants, excessive sneezing was found in 54(69.23%) participants and facial, postnasal discharge was found in 48(61.53%) of participants .Only 6(5.45%) participants had confirmed asthma. 6 asthmatic participants undergone the nasal endoscopy and out of 6(100%), 4(66.66%) had confirmed the diagnosis of allergic rhinitis but association was not found statistically significant.Conclusions: The prevalence of bronchial asthma was higher among the younger age group Due to the overlapping of the symptoms between asthma and allergic rhinitis confirmatory diagnostic tools should be used before starting the treatment.

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Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/642 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3541-3546

Author(s):

Jayaprakash Subramani ◽

Rajesh Prabhu ◽

Jagadeesapandian Palpandi

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Predictive Value ◽

Tamil Nadu ◽

Objective Assessment ◽

Tertiary Care ◽

Severity Index ◽

Apache Ii ◽

Care Hospital ◽

Male Predominance

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

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Nasomaxillary swellings: our experience at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210680 ◽

2021 ◽

Vol 7 (3) ◽

pp. 469

Author(s):

Mukesh Rawat ◽

Archana Lall ◽

Kavita Sachdeva

Keyword(s):

Tertiary Care Hospital ◽

Histopathological Examination ◽

Tertiary Care ◽

Final Diagnosis ◽

Inverted Papilloma ◽

Nasal Endoscopy ◽

Common Symptom ◽

Fungal Sinusitis ◽

Care Hospital ◽

Malignant Lesions

Background: A wide spectrum of lesions may present as nasomaxillary swellings ranges from benign to malignant lesions including fungal sinusitis and fibro vascular lesions example: JNA (Juvenile nasopharyngeal angiofibroma) and Inverted papilloma. Many Pathologies ranging from benign to malignant tumors may mimic a simple Nasomaxillary mass. It is diagnostic challenge to determine pathology behind it. A detailed clinical evaluation with nasal endoscopy and relevant pre-operative investigations including radiological imaging and histopathological examination is essential to reach up to final diagnosis. The aim of the study was to do clinicopathological evaluation of patients presenting with nasomaxillary swelling and correlation of clinical, radiological and Histopathological findings.Methods: This was a prospective observational study on 50 nasomaxillary swelling patients who are presented in the Department of ENT and Head and Neck Surgery of N.S.C.B. MCH Jabalpur, a tertiary care Hospital, between March 2018 to August 2019. A detailed history taking and clinical examination with nasal endoscopy and relevant preoperative investigations including CECT Nose and PNS and histopathological examination was done in all patients.Results: 50 Nasomaxillary swelling patients were selected for this study. 30 patients were male and 20 were females. Ages of patients were varied from 12 years to 72 years. 23 patients (46%) were malignant and 27 (54%) were benign. Histopathological examination results shows benign lesions like JNA (6 cases), fungal sinusitis (6 cases), dermoid cyst (1 case), inverted papilloma (3 cases), sebaceous cyst (1 case), jaw lesions (10 cases), (odontogenic like radicular/ infected cyst, dentigerous cyst, cystic ameloblastoma and non-odontogenic like fibrous dysplasia) and malignant lesions like SCC (squamous cell carcinoma) (12 cases), spindle cell sarcoma (2 cases), undifferentiated carcinoma (3 cases), adenocarcinoma (3 cases), adenoid cystic carcinoma (1 case), Invasive pleomorphic sarcoma (1 case) and malignant melanoma (1 case). SCC was most common lesion f/b JNA and fungal sinusitis. Well differentiated SCC was most common histological type (10 out of 12 cases of SCC). Most common symptom was nasal obstruction (66% cases) f/b epistaxis (52% cases) but epitasis was most common symptom among malignant and JNA cases. In 6 cases (3 JNA, 1 inverted papilloma, 1 malignancy and 1 radicular cyst) radiological diagnosis were not correlated with histological findings.Conclusions: Most our cases were malignant nasomaxillary lesions followed by fungal sinusitis and JNA. Most patients presented in advanced stage of disease so rapidly evaluation including nasal endoscopy should be done. CECT scan is essential to determine tumors extent and bony lesions. All patients should undergo hisotopatholigical examination. The final diagnosis should be made on the basis of clinical, radiological and histopathological findings.

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EVALUATION OF VARIATIONS IN SPHENOID SINUS PNEUMATIZATION USING MULTIDETECTOR COMPUTED TOMOGRAPHY IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL, VISAKHAPATNAM

10.36106/ijar/2408893 ◽

2021 ◽

pp. 62-65

Author(s):

Sonica Sharma ◽

Bhamidipaty Kanaka Durgaprasad ◽

Payala Vijayalakshmi

Keyword(s):

Computed Tomography ◽

Paranasal Sinuses ◽

Sphenoid Sinus ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ct Images ◽

Care Hospital ◽

Anterior Clinoid Process ◽

Anterior Extension ◽

Sphenoid Sinuses

BACKGROUND: The purpose of our study was to assess the prevalence of different patterns of pneumatization in the sphenoid sinuses as detected on the computed tomography (CT) images of paranasal sinuses of the patients presenting with various pathologies. This is a retrospective radiological study of CT im MATERIALS AND METHODS: ages of paranasal sinuses, done at Radio diagnosis department of a Tertiary care hospital. The study comprised CT images of 500 patients in the age range of 18-75years who were referred for CT scan of paranasal sinuses for various pathologies between the period of July 2018 and July 2019. All images of paranasal sinuses had been acquired following a standardized protocol in axial plane. Their reconstructed images in axial, coronal and sagittal planes were evaluated, using Osirix software, for the extent and different patterns of sphenoid sinus pneumatization. The Images of sphenoid sinuses were assessed for the posterior, lateral and anterior extension of their pneumatization The sphenoid sinuses pneumatization patterns in the RESULTS: descending order of prevalence were complete sellar (75.0%), incomplete sellar (22.6%), presellar (2.4%) and conchal (0%). The clival extensions was seen in 75% of patients and lateral extension sides in 49.1% patients. Lateral recesses as assessed on coronal images was seen in 49.1 % of cases with the prevalence in descending order being extension into pterygoid process 59.8 %, greater wing of sphenoid 9.2 %, full lateral 41% and lesser wing (anterior clinoid process) 19.3%. The pure forms were relatively less common and combined forms being more common. A preoperative review of the sphenoid anatomy should allow for safer endo

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Accessory maxillary sinus ostia in superior meatus: a retrospective study and its clinical application

10.22541/au.162007915.55476712/v1 ◽

2021 ◽

Author(s):

Hsiao-Wei Lu ◽

Pin-Zhir Chao ◽

Fei-Peng Lee ◽

Cheng-Jung Wu ◽

Hsing-Won Wang

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Maxillary Sinus ◽

Chronic Rhinosinusitis ◽

Paranasal Sinus ◽

Maxillary Sinusitis ◽

Tertiary Care ◽

Care Hospital ◽

Computed Tomography Scans ◽

Superior Meatus

Objectives: To investigate the incidence of accessory maxillary sinus ostia in superior meatus in patients with clinical and radiological signs of maxillary sinusitis and the association with the development of chronic rhinosinusitis. Design: Retrospective study Setting: Tertiary care hospital Participant: 159 patients examined with paranasal sinus computed tomography scans Main outcome measures: We retrospectively evaluated patients who visited the outpatient department at an academic medical facility between January and April 2020 with a clinical diagnosis of chronic rhinosinusitis. Paranasal sinus axial and coronal computed tomography scans were evaluated for accessory maxillary sinus ostia in superior meatus and confirmed by reconstructed three-dimensional simulation images. The demographic information and incidence of accessory ostia in superior meatus were assessed. The Lund–Mackay score was used to rate chronic rhinosinusitis severity. Analysis of variance was performed to correlate the severity of chronic rhinosinusitis with presenting accessory ostia in superior meatus. Results: Of 159 patients (81 males; 78 females), 41.5% had accessory maxillary sinus ostia in superior meatus. Of these, two-thirds were bilateral and one-third was unilateral. The severity of rhinosinusitis was not correlated with having accessory maxillary sinus ostia in superior meatus, but the presence of accessory ostia was significantly associated with less severe chronic rhinosinusitis (P < 0.001). Conclusions: Accessory maxillary sinus ostia in superior meatus are significantly associated with less severe chronic rhinosinusitis and most cases are bilateral.

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Diagnosing chronic rhinosinusitis: a comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213897 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1630

Author(s):

Dharmishtha H. Parmar ◽

Hiten R. Maniyar ◽

Hetna A. Patel

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Predictive Value ◽

Nasal Endoscopy ◽

P Value ◽

Computed Tomographic ◽

Heterogenous Group ◽

Operative Evaluation ◽

Accurate Procedure

Background: The term ‘rhinosinusitis’ refers to a heterogenous group of disorders characterized by inflammation of mucosa of the nose and paranasal sinuses. The National Institute of Allergy and Infectious Diseases (NIAID) have recently mentioned that 136 million people of India suffer from chronic rhino sinusitis.Methods: A total 50 patients with symptoms of rhinosinusitis were investigated with both diagnostic nasal endoscopy and CT scan paranasal sinuses and their findings were scored with particular scoring system and compared with each other. Results: Out of 50 patients, 90% patients were diagnosed on CT scan and 84% patients were diagnosed on nasal endoscopy. By considering CT scan as accurate procedure and correlating nasal endoscopy with CT scan, sensitivity was 88.88%, specificity was 60%, positive predictive value was 95.23%, negative predictive value was 37.5%, and p value was 0.004671, which was significant at p<0.05, indicates that CT paranasal sinuses is more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis.Conclusions: Both diagnostic nasal endoscopy and CT paranasal sinuses are important pre-operative evaluation tools in detecting pathology and both are complementary to each other. But CT paranasal sinuses are more convenient than endoscopy according to this study.

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Post-adenoidectomy quality of life in children with refractory chronic rhinosinusitis

The Journal of Laryngology & Otology ◽

10.1017/s002221511700113x ◽

2017 ◽

Vol 131 (9) ◽

pp. 773-778 ◽

Cited By ~ 5

Author(s):

V Bettadahalli ◽

A Chakravarti

Keyword(s):

Quality Of Life ◽

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Nasal Endoscopy ◽

First Line ◽

Interventional Study ◽

Maximal Medical Therapy

AbstractObjective:This study aimed to evaluate post-adenoidectomy quality of life in children with refractory chronic rhinosinusitis.Methods:A prospective interventional study of children aged 4–12 years with chronic refractory rhinosinusitis was conducted. A total of 60 children completed follow up. Nasal endoscopy and non-contrast computed tomography of the paranasal sinuses were performed, and both symptoms and their effects on patient quality of life pre- and post-adenoidectomy were evaluated.Results:The most frequent symptoms were nasal obstruction, cough, fever and fatigue, which were experienced by 100 per cent, 90 per cent, 85 per cent and 81.7 per cent of children, respectively. Nasal endoscopy showed oedema and discharge were present in all children. A statistically significant post-operative improvement in sinus and nasal quality of life was seen in 53 children (88.3 per cent).Conclusion:Adenoidectomy is a simple, first-line surgical procedure for managing paediatric chronic rhinosinusitis refractory to maximal medical therapy and leads to an improved quality of life.

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The Role of Diagnostic Nasal Endoscopy and a Computed Tomography Scan (Nose and PNS) in the Assessment of Chronic Rhinosinusitis: A Comparative Evaluation of the Two Techniques

Sinusitis ◽

10.3390/sinusitis5010007 ◽

2021 ◽

Vol 5 (1) ◽

pp. 59-66

Author(s):

Karthika Nathan ◽

Sudhir Kumar Majhi ◽

Rohit Bhardwaj ◽

Ankur Gupta ◽

Sabarirajan Ponnusamy ◽

...

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Diagnostic Tool ◽

Predictive Value ◽

Cost Effective ◽

Nasal Endoscopy ◽

Symptom Criteria ◽

Tomography Scan

Introduction: The objective components of chronic rhinosinusitis (CRS) diagnosis require confirmatory findings from either diagnostic nasal endoscopy (DNE) or a computed tomography (CT) scan. Chronic rhinosinusitis affects a significant population worldwide, imposing a huge toll on the human economy as well as on quality of life. Thus, it is particularly important to define a cost-effective and easily available diagnostic tool for it. Hence, we have conducted this study with the aim of assessing the effectiveness of DNE in comparison with CT for evaluating CRS. Material and Methods: Eighty participants fulfilling the diagnostic symptom criteria of CRS underwent CTs of their noses and paranasal sinuses (PNS) and DNE. Standard Lund–Mackay and Lund–Kennedy scores were awarded to all participants based on the CT and DNE. A comparative analysis was done. Results: DNE in comparison to CT had 92.31% sensitivity, 73.33% specificity, 93.75% positive predictive value, 68.75% negative predictive value, and 88.75% diagnostic accuracy. Conclusion: We suggest that nasal endoscopy be used as an early diagnostic tool in the clinical assessment of suspected CRS patients (based on the diagnostic symptom criteria). DNE helps to decrease the usage of CT, thereby decreasing cost and radiation exposure. Computed tomography may be added for patients having anatomical defects (affecting endoscopic visualization) or refractory disease, and where surgery has been planned.

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The management of appendicular abscesses in a Tunisian Tertiary Care Hospital

BMC Surgery ◽

10.1186/s12893-021-01424-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Atef Mejri ◽

Khaoula Arfaoui ◽

Mohamed Ali Mseddi ◽

Mohamed Ben Slima ◽

Sarra Saad ◽

...

Keyword(s):

Iliac Fossa ◽

Univariate Analysis ◽

Tertiary Care ◽

Case Series ◽

Laparoscopic Approach ◽

Ileocecal Resection ◽

Common Symptom ◽

Care Hospital ◽

Palpable Mass ◽

The Right

Abstract Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.

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