A CT Scan Study Showing Prevalence of Haller Cells in Patients with Sinonasal Complaints

Background: Anterior ethmoid cells that extend into the maxillary sinus roof are known as Haller cells. They are commonly seen on the floor of the orbit. They may cause sinusitis symptoms by blocking the infundibulum, may get infected and also sometimes complicate the Functional Endoscopic Sinus Surgery (FESS). The present study was undertaken to determine the prevalence of Haller cells on CT scans in patients having sino-nasal complaints. Subjects and Methods : This was a descriptive observational study carried out on 150 patients who presented with various sino-nasal complaints and underwent a CT Scan in the Department of Radiodiagnosis, Bangur Institute of Neurosciences, Kolkata. Their CT scans were studied retrospectively for the presence of Haller cells. Radiological variations data were summarized by routine descriptive statistics namely counts and percentages for categorical variables. Fisher’s Exact Tests and were applied to calculate the ‘p’ value to find out any statistically significant difference between males and females. Results: Haller cells were found in 12% (18 cases) in the present study, 5.33% in males and 6.67% in females. ‘p’ value in this case was 0.616 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like Haller cells are quite common and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the Haller cells in Eastern India which will definitely help the FESS surgery and its outcomes.

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Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽

10.1186/s12893-021-01269-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Salma S. Al Sharhan ◽

Mohammed H. Al Bar ◽

Shahad Y. Assiri ◽

Assayl R. AlOtiabi ◽

Deemah M. Bin-Nooh ◽

...

Keyword(s):

Surgical Outcomes ◽

Endoscopic Sinus Surgery ◽

T Test ◽

Sinus Surgery ◽

Symptom Improvement ◽

P Value ◽

Psychological Dysfunction ◽

Significant Difference ◽

The Mean ◽

Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

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CT Scan Evaluation of Prevalence of Paradoxical Middle Turbinate In Adult Population of Bihar

Academia Anatomica International ◽

10.21276/aanat.2020.6.1.1 ◽

2020 ◽

Vol 6 (1) ◽

pp. 01-04

Author(s):

Raag Reeti ◽

Md Jawed Akhtar ◽

Avanish Kumar ◽

Binod Kumar ◽

Rajiv Ranjan Sinha

Keyword(s):

Convex Surface ◽

Adult Population ◽

Middle Turbinate ◽

Lateral Wall ◽

Anatomical Variations ◽

Sinus Surgery ◽

P Value ◽

Test Results ◽

Common Cause ◽

Exact Test

Introduction: Middle turbinate overlying the middle meatus is the most important anatomic area in the lateral wall of the nose. It is a thinsheet of bone which curves in different planes very similar to a dried leaf. Paradoxical Middle Turbinate (PMT) is the abnormal curvatureof middle turbinate, where the convex surface faces laterally instead of its usual medial curvature and may block the drainage pathway ofmiddle meatus. The present study aimed at observing the prevalence of the paradoxical middle turbinate in the adult population of Bihar. Subjects and Methods: This was a retrospective study being conducted on 150 patients who presented to the Department of Radiodiagnosis. Their CT scans were analysed for the presence of paradoxical middle turbinate. The results were analysed as percentage and ‘p’ value was calculated using Fischer’s Exact Test. Results: Prevalence of Paradoxical Middle Turbinate was observed in 28 cases i.e. 18.6% cases; 16 in males and 12 in females. ‘p’ value was 0.677 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like paradoxical middle turbinate are quite common cause of diseases involving paranasal sinuses and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the paradoxical middle turbinate which will definitely help the FESS surgery and its outcomes.

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TLR4 T399I Polymorphism and Endometriosis in a Cohort of Italian Women

Diagnostics ◽

10.3390/diagnostics10050255 ◽

2020 ◽

Vol 10 (5) ◽

pp. 255 ◽

Cited By ~ 2

Author(s):

Enrica Marchionni ◽

Maria Grazia Porpora ◽

Francesca Megiorni ◽

Ilaria Piacenti ◽

Agnese Giovannetti ◽

...

Keyword(s):

Molecular Mechanisms ◽

Categorical Variables ◽

P Value ◽

Genotype Distribution ◽

Exact Test ◽

Fisher's Exact Test ◽

Genotype Frequencies ◽

Significant Difference ◽

Fisher’S Exact Test ◽

Italian Women

Background: Endometriosis is a widespread multifactorial disease in which environmental, genetic, and epigenetic factors contribute to the phenotype. Single Nucleotide Polymorphisms (SNPs) in genes implicated in pivotal molecular mechanisms have been investigated as susceptible risk factors in distinct populations. Among these, Toll-like receptor 4 (TLR4) represents a good candidate due to its role in the immune/inflammatory response and endometriosis pathogenesis. Methods: The TRL4 gene T399I SNP (C/T transition, rs4986791) was investigated in 236 Italian endometriosis patients and 150 controls by using the PCR-RFLP method. One-tailed Fisher’s exact test was used to compare differences between categorical variables. T399I genotype distribution was evaluated for Hardy–Weinberg equilibrium in both groups using the Chi-squared test for given probabilities. Results: Fisher’s exact test comparing C and T allele frequencies showed a difference in the frequency of T alleles between patients and controls (OR = 1.96, 95% confidence interval 0.91–4.23; p-value = 0.0552). Genotype frequencies did not show any significant difference between patients and controls. The homozygous TT genotype was observed in 2% of endometriosis women and not in controls. Conclusions: Our results show that the TLR4 rs4986791 T variant may be considered a genetic risk factor for endometriosis in Italian women. More extensive studies in other populations are needed to confirm this result.

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ROLE OF SEPTOPLASTY AND FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN THE TREATMENT OF RHINOGENIC HEADACHE

UP STATE JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY ◽

10.36611/upjohns/volume9/issue1/2 ◽

2021 ◽

Vol VOLUME 9 (ISSUE 1) ◽

pp. 6-12

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

P Value ◽

Age Group ◽

Significant Difference ◽

Key Factor ◽

A Prospective Study

INTRODUCTION: Rhinogenic headaches are basically described as headache or facial pain caused by rhinological source. The presence of nasal symptoms & it’s temporal relationship with headache is the key factor that can guide the diagnosis and patient management. AIMS: This study aims to evaluate the efficacy of Septoplasty with Functional endoscopic sinus surgery (F.E.S.S) in the management of Rhinogenic headache. MATERIALS & METHODS: It was a Prospective study conducted in M.G.M Medical College & associated M.Y group of hospitals from March 2019 to March 2020. 64 patients of age group 18 years to 60 years having chronic rhinosinusitis with headache included in the study. After detailed history and thorough examination, nasal endoscopy and CT Paranasal sinus was done. Patients not responding to conservative management were selected for undergoing functional endoscopic sinus surgery. RESULTS: A total of 64 patients were included in the study,34 male & 30 female with the mean age group of 31.4 & 30.1 years respectively. Out of 64 patients,67% were completely free from headache,15% were significantly improved,7% had mild relief & 11% did not show any benefit in headache from surgery. Postoperatively, there was statistically significant difference was found patient’s symptomatology (i.e. p value =0.0165). CONCLUSION: To make the diagnosis both anatomical & infective factors needed to be considered. Correction of obvious anatomic abnormalities in carefully selected patients can significantly improve several important clinical outcomes from abolishing headache completely to decreasing its intensity and frequency of episodes. KEY-WORDS: Rhinogenic headaches, Septoplasty, Chronic rhinosinusitis, F.E.S.S, Nasal endoscopy

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Prevalence of sinonasal anatomical variations and their effect on chronic rhinosinusitis in Al-Ramadi teaching hospital, Ramadi city, Iraq

Muthanna Medical Journal ◽

10.52113/1/2410-4590/2021-35-39 ◽

2021 ◽

Vol 8 (1) ◽

pp. 35-39

Author(s):

Raid M. Al-Ani, ◽

Ghassan M. Khalaf

Keyword(s):

Chronic Rhinosinusitis ◽

Teaching Hospital ◽

Anatomical Variations ◽

Cross Sectional Study ◽

Ct Scans ◽

P Value ◽

Deviated Nasal Septum ◽

Cross Sectional ◽

Radiological Features ◽

Significant Difference

Anatomical variations (AVs) of the nose and paranasal sinuses (NPS) are quite common findings on CT scans. However, their effect on chronic rhinosinusitis (CRS) is still controversial. The objectives of this study is to estimate the prevalence of AVs of the NPS on CT scans and to assess the association between multiple versus single variant and CRS. A cross-sectional study was conducted in the Al-Ramadi Teaching Hospital during the period from January 1, 2018, to March 31, 2019. We reviewed the CT scans of the patients with suggestive symptoms and signs of CRS. Out of 203 CT scans, there were 153 (75.4%) scans associated with AVs of the NPS (group A). Seventy-eight with and 75 without radiological features of sinusitis. While group B (n=50 24.6%) were not detected any variants, 24 with and 26 without features of sinusitis. There was no statistically significant difference between the two groups (p-value>0.05). There were 11 AVs detected. The septal deviation of 63% was the commonest one. Most of the AVs of the NPS were multiple (2 or more) 99 (64.7%). Forty-nine (49.5%) of them were associated with features of sinusitis. There was a statistically significant difference (p-value <0.05) between those with multiple and those with single AVS concerning the radiological features of sinusitis. In conclusion; AVs of the sinonasal region were common findings on CT scans. A deviated nasal septum is the commonest AVs. Most of our patients contain more than 2 AVs, and they were more vulnerable to sinusitis.

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EXPERIENCE OF DOING ENDOSCOPIC SINUS SURGERY FOR CHRONIC MAXILLARY SINUSITIS WITHOUT PRE-OPERATIVE CT-SCAN IN A PERIPHERAL HOSPITAL

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v1i1.7924 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S534-38

Author(s):

Adnan Asghar ◽

Sohail Aslam ◽

Syed Muhammad Asad Shabbir Bukhari ◽

Umar Ijaz ◽

Shahid Iqbal ◽

...

Keyword(s):

Ct Scan ◽

Endoscopic Sinus Surgery ◽

Goodness Of Fit ◽

Maxillary Sinusitis ◽

Cross Sectional Study ◽

Sinus Surgery ◽

Military Hospital ◽

P Value ◽

Cross Sectional ◽

Chronic Maxillary Sinusitis

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans. Study Design: Cross sectional study. Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019. Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis. Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276). Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.

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Use of Computed Tomography (CT scan) for delineating anatomy and variation of frontal Sinus before Functional Endoscopic Sinus Surgery

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0903.13 ◽

2022 ◽

Vol 9 (3) ◽

pp. 54-57

Author(s):

Sajjad Ali Hashmi Syed ◽

Sadaf Tanveer Khan ◽

Jawwad Ali Hashmi Syed

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Anatomical Variations ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Medical College ◽

Orbital Roof

Abstract Introduction: For Functional Endoscopic Sinus Surgery (FESS), the surgeon needs an accurate depiction of the anatomy of paranasal sinuses and their variations. Computed tomography (CT Scan) fulfills this requirement by providing detailed anatomy, the anatomical variants, and the extent of the disease in and around the Para nasal sinuses. The aim of this study is to show the anatomy of the Frontal sinus as delineated by the computed tomography. Materials and Methods: STUDY DESIGN: Cross section Descriptive Study. Out of 337 patients above 12 years of age who were referred for computed tomography of paranasal sinuses in the Dept. of Radio- Diagnosis, Govt. Medical College and Hospital from December 2015 till October 2017, 200 adults(males and females) were randomly selected.Of the 200 subjects studied 37(18.5%) subjects had hypoplastic/ non or poorly pneumatised frontal sinuses of which 31 (15.5%) were bilateral and 6 (3%) were unilateral i.e. on right side. Observations and results: Intra frontal cell were seen in about 64 (32%) subjects of which 26 (13%) on right side, 24 (12%) were on left side and 14 (7%) were bilateral. Extension of pneumatisation into crista galli was seen in 16 (8%) subjects and into orbital roof was seen in 6 (3%) subjects. Conclusion: The findings in this study show that anatomical variations in the Para nasal sinuses and nasal cavity are common. Computed tomography is fundamental radiologic investigation for diagnosis of the Sino nasal lesions or pre and post-surgical assessment.

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CT scan vs nasal endoscopy findings in the diagnosis of chronic rhinosinusitis: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191741 ◽

2019 ◽

Vol 5 (3) ◽

pp. 739

Author(s):

Shruti Baruah ◽

Pratibha Vyas ◽

Arpit Srivastava

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Middle Turbinate ◽

Ct Imaging ◽

Ct Scans ◽

Nasal Endoscopy ◽

Common Finding ◽

Diagnostic Tools ◽

P Value ◽

Significant Difference

Background: Diagnostic nasal endoscopy and CT imaging are both widely used essential diagnostic tools for chronic rhinosinusitis (CRS). This study analyses their individual roles in the management of CRS as well as the degree of correlation between the two.Methods: A prospective observational comparative study was conducted in the Department of Otorhinolaryngology, Mahatma Gandhi Hospital, Jaipur from January, 2017 to June, 2018 on a sample size of 201 patients diagnosed with chronic rhinosinusitis, as per AAOHNS guidelines. DNE and CT PNS were done for all patients enrolled in the study, the findings of each were correlated and their individual sensitivity and specificity for each variable was calculated. Results: On Comparing CT findings with diagnostic nasal endoscopic findings, Polyps were seen in 91 patients’ CT scans as opposed to 124 on DNE. B/L Polyps on CT imaging vs bilateral ethmoidal polyps visualized during DNE revealed a highly significant “P” value; whereas for antrochoanal polyps or unilateral polyps there was no significant difference. Maxillary sinus involvement is the most commonly observed finding in CT scan of PNS in CRS while deviated nasal septum is the most common finding on a diagnostic nasal endoscopy, seen in 60.7%. For anatomical variants like concha bullosa and paradoxical middle turbinate, no significant difference was seen.Conclusions: CT scans and DNE are both key pre-operative diagnostic tools for patients of CRS and both are complementary to each other in detecting type and extent of pathology.

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Predictive value of disease severity on self-reported rating and quantitative measures of olfactory function outcomes after primary endoscopic sinus surgery. A prospective study

Rhinology Journal ◽

10.4193/rhino14.043 ◽

2014 ◽

Vol 52 (4) ◽

pp. 437-443

Author(s):

Friederike Minwegen ◽

Jan P. Thomas ◽

Manuel Bernal-Sprekelsen ◽

Stefan Dazert ◽

Amir Minovi

Keyword(s):

Quality Of Life ◽

Prospective Study ◽

Ct Scan ◽

Disease Severity ◽

Endoscopic Sinus Surgery ◽

Olfactory Function ◽

Sinus Surgery ◽

Ct Scans ◽

Life Questionnaire

Background: This prospective study investigates the influence of primary Endoscopic Sinus Surgery (ESS) in patients with chronic rhinosinusitis (CRS) on olfactory function and on the patients' quality of life. We assess the role of preoperative disease severity measured by computed tomography (CT) scan in predicting outcome. Methodology: Adults undergoing ESS were examined preoperatively (n=92) and five months postoperatively. Coronal CT scans were evaluated referencing the Lund Mackay (LM) system. On the basis of the LM score, the collective was divided into two groups. We performed the olfactory test "Sniffin' Sticks" and handed out the specific health-related quality of life questionnaire SNOT-20. Results: We could demonstrate that olfactory function of patients with strong opacification on CT scans improved by an average of 2.49 points more than olfactory function of patients with less severe disease. In terms of the self-reported rating of smell, the degree of amelioration differed significantly. Both groups showed an improvement in quality of life irrespective of severity of disease. Conclusion: Mean olfactory function of patients with a high degree of disease in CT scan improved more than that of patients with less opacification on CT scan. Patient's subjective perception of smell impairment was in line with these findings.

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Utility of Second-Look Endoscopy with Debridement After Pediatric Functional Endoscopic Sinus Surgery in Patients with Cystic Fibrosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420922865 ◽

2020 ◽

Vol 129 (12) ◽

pp. 1153-1162

Author(s):

Zachary M. Helmen ◽

Ryan E. Little ◽

Thomas Robey

Keyword(s):

Cystic Fibrosis ◽

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

P Value ◽

Second Look ◽

Significant Difference ◽

Pulmonary Exacerbations ◽

The Impact

Objectives: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED. Methods: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions. Results: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively ( P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively ( P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively). Conclusion: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.

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