COMPARISON OF MICRODEBRIDER - ASSISTED TURBINOPLASTY VERSUS ENDOSCOPIC PARTIAL TURBINECTOMY IN CASES OF INFERIOR TURBINATE HYPERTROPHY IN ALLERGIC RHINITIS PATIENTS

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020. Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting & synechie/adhesions. All the data was entered on SPSS-17 and analyzed. Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting & 3 synechie/adhesions in endoscopic partial turbinectomy group. Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy.

Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial

(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

A Review on Deviated Nasal Septum: Classification, Clinical Features and Management

The nasal septum separates the right and left part of the nasal cavity and columellar septum, membranous septum and septum proper are the parts of it. Deviation of nasal septum is a common case of nasal obstruction presented in a clinic. A lot of classifications have been developed to help ease the study of deviated nasal septum but none of them is used as a standard. Some of the classifications include the one given by Vidigal, Guyuron, Cerek, Mladina and Cottle’s. Apart from nasal obstruction other common clinical features involving deviated nasal septum are sinusitis especially in horizontal deviation type V. Pressure on lateral wall by spurs can also cause pressure headache. Due to increased air flow in the nasal cavity, dryness occurs causing epistaxis. Obstruction of nasal cavity causes mouth breathing in return either exaggerating or leading to obstructive sleep apnoea. Septal deviation also effects the choroidal thickness and choroidal blood supply. Histopathologically, lymphocytic infiltration and squamous metaplasia occurs in septal mucosa. These changes occur mostly due to change in the aerodynamic flow. There is decreased cilia movement and inferior turbinate hypertrophy. Thickness of inferior turbinate gains importance while septoplasty as, if thickened a lot, the inferior turbinate demands excision. The deviated nasal septum is associated with sinusitis, chronic suppurative otitis media and Eustachian tube dysfunction. Management involves sub mucus resection or septoplasty. Out of the two, septoplasty is preferred as it is a conservative surgery. Only symptomatic and cosmetically grossly disfigured cases require a surgical treatment while the asymptomatic cases are generally not indicated for surgery. This study tries to review the Classification, Clinical Features and Management of Deviated Nasal Septum.

Endoscopic Septoturbinoplasty among Patients Undergoing Surgery in the Department of Otolaryngology-Head and Neck of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Septoplasty without turbinoplasty is one of the main reasons for failure of procedure in case of deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty is the procedure of choice for complete treatment. The main objective is to find out the prevalence of endoscopic septoturbinoplasty among patients undergoing surgery in Department of Otolaryngology-Head and Neck of a tertiary care hospital. Methods: This was a descriptive cross-sectional study in Department of Otolaryngology-Head and Neck Surgery done over a period of 1 year duration from 1st August 2020 to 31st July 2021 among 1248 patients who underwent surgery in the department. Ethical Approval was taken from Institutional Review Committee of Kathmandu Medical College and Teaching Hospital (Reference number: 2207202004). A convenience sampling technique was used. Two different techniques, Microdebrider Assisted Turbinoplasty and Outfracture with Submucosal Diathermy were used in surgery. Nasal Obstruction and Symptom Evaluation Scale questionnaire was used pre and postoperatively for data collection. Data were analyzed in Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated, with frequency, percentage, mean and standard deviations. Results: Out of 1248 patients, about 92 (7.37%) patients (4.95-10.14 at 95% Confidence Interval) underwent septoturbinoplasty. The mean Nasal Obstruction and Symptom Evaluation Scale before surgery was 75.21±6.19. Conclusions: The prevalence of septoturbinoplasty in our study is similar to other studies done in similar settings. We found almost complete resolution of breathing problems following endoscopic septoturbinoplasty, hence improving quality of life.

Effects of Acute Alcohol Intake on Nasal Patency

Background Acute alcohol intake may influence nasal patency; however, there is lack of objective evidence. Objective The aim of this study was to evaluate the effects of acute alcohol intake on nasal patency employing both subjective and objective measures. Methods A total of 31 participants were classified into 2 groups of non-heavy drinkers (n = 17) and heavy drinkers (n = 14). Both groups consumed wine in 1 h and were assessed for subjective nasal symptoms and objective nasal patency, using rhinomanometry and acoustic rhinometry, at baseline and at 0.5, 2, and 6 h post-alcohol consumption. Results Alcohol consumption significantly increased nasal obstruction from baseline values in both heavy and non-heavy drinking groups. Total nasal volume (TNV) and the minimal cross-sectional area (MCA) were significantly decreased and nasal airway resistance (NAR) significantly increased from baseline values by 2 h post-alcohol consumption for both heavy and non-heavy drinking groups ( P < .05). Significant differences were found in TNV, MCA, and NAR between baseline and post-drinking in allergic rhinitis subjects; with no significant differences in MCA and NAR in subjects without allergic rhinitis. Pulse rate (PR) and temperature (T) were elevated, and blood pressure (BP) was decreased after alcohol consumption ( P < .05). Blood alcohol concentration (BAC) was not significantly correlated with nasal patency with regard to any subjective or objective measurement. Conclusion Acute alcohol consumption may impair nasal patency, independent of the amount consumed. Individuals with allergic rhinitis may be more prone to nasal obstruction after alcohol consumption than those without allergic rhinitis.

Sphenochoanal polyp

Sphenochoanal polyp are rare tumours arising from sphenoid sinus. The main presenting complain is gradually progressing nasal obstruction. Sphenochoanal polyp mimics antrochoanal polyp clinically. To differentiate it from antrochoanal polyp, diagnostic nasal endoscopy, computer tomography and magnetic resonance imaging of the paranasal sinuses are the investigation of choice. Functional endoscopic sinus surgery is the line of treatment.: A 33years old female presented with right nasal obstruction since 2 years. On Diagnostic nasal endoscopy polypoidal mass was seen partially obliterating the right nasal cavity not arising from middle meatus. CT scan showed polypoidal mass obliterating the nasal cavity, choana and Sphenoid sinus. It was completely excised by functional endoscopic surgery.We present this rare case to highlight the use of diagnostic nasal endoscopy and Computed Tomography in the diagnosis and treatment of Sphenochoanal polyps