Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study

Background In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. Methods 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. Results Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. Conclusions The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient’s comfort. To optimize it, however, further research is needed.

299 An Unusual Nasal Lump

A 70-year-old man received a few courses of various antibiotics for left dacrocystitis under the care of ophthalmologists. Despite the treatment, the lump was not improving. The patient, in the meantime, presented to his GP with recurrent left-sided epistaxis and it became apparent that he was also experiencing ipsilateral nasal blockage. He reported a 3-year history of left-sided tinnitus but no other red flag symptoms. He was subsequently referred as 2-Week-Wait to ENT and nasoendoscopy revealed complete blockage of the left nostril with the postnasal space fully obstructed by enlarged mucosal tissue and no palpable lymph nodes. CT showed an aggressive locally invasive sinonasal tumour and a necrotic posterior mediastinal lesion. MRI further defined the extent of invasion and revealed a significant level 2 lymph node. A gastroscopy and EUA nose were arranged to obtain histology to confirm the differential diagnosis of sinonasal SCC. This case highlights the importance of lateral thinking when presented with a refractory symptom, as a more sinister diagnosis can be detected earlier. It also reinforces the need for examination of surrounding anatomy that may influence the condition.

Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy

BackgroundTotal rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty.Case reportIn 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life.ConclusionUvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.

Carcinosarcoma of the nasopharynx: a case report

<p>Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (sarcomatous), and a mesenchymal component. Carcinosarcomas are characterized by a high recurrence rate, metastatic spread, and high morbidity and mortality. Carcinosarcoma can arise from any squamous epithelial lining but rare in the sino-nasal tract. We are presenting a case of a 19-year-old male with a 3-month history of recurrent epistaxis associated with nasal blockage, anosmia, and bilateral complete loss of vision over a few weeks. Carcinosarcoma of the sino-nasal tract is a rare entity and can mimic any sino-nasal malignancy. The optimal treatment of this disease is controversial and lacks a clear guideline, therefore challenging to the treating oncologists.<strong> </strong>Carcinosarcoma of the head and neck is a rare and aggressive tumor. It poses diagnostic and treatment challenges.</p>

Self-Reported Symptom Study of COVID-19 Chemosensory Dysfunction in Malaysia

Alterations in the three chemosensory modalities – smell, taste, and chemesthesis – have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June to 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains. Study Registration: NMRR-20-934-54803 and NCT04390165

CLINICAL STUDY ON SHIREESHADI AVAPEEDANA NASYA IN THE MANAGEMENT OF SURYAVARTHA (FRONTAL SINUSITIS)

Nasya karma is considered a prime treatment modality in all types of Shiroroga (Headache) and also in Suryavar- tha (Frontal Sinusitis). Suryavartha (Frontal Sinusitis) is one of the 11 types of Shiroroga. It is one of the com- mon clinical conditions found in day to day general as well as Shalakya (ENT) practice. It presents with headache as one of its cardinal features and its occurrence is found in both genders and in all age groups. Objective: To study the efficacy of Shireeshadi Avapeedana Nasya in the management of Suryavartha (Frontal Sinusitis). Ma- terial methods: Twenty patients of Suryavartha (Frontal Sinusitis) were diagnosed and registered for the clinical study irrespective of sex, socio-economic status, and religion. The study was divided into two groups - Group A and Group B. Group – A patients were treated with Shireeshadi Avapeedana Nasya for 7 days and Group – B patients were treated by Nasya with milk for 7 days. Observation and result: Among 20 patients of Suryavartha / frontal sinusitis, 20 (100%) of patients had headache, 11 (55%) had nasal blockage, 05 (25%) had nasal dis- charge, 08 (40%) had foul smell in their breath and 14 (70%) have variations from normal X-Ray. The severity of headache is significantly reduced after treatment in both Groups A and B (92.95% and 73.07%) respectively. Conclusion: Administration of Shireeshadi Avapeeda Nasya showed statistically significant improvement in the management of Suryavartha (Frontal Sinusitis). Keywords: Suryavartha, Nasya, Shireeshadi Avapeedana Nasya, Frontal Sinusitis, Shigru, Mulaka, Ksheera.

Inferior turbinate reduction by use of Diode Laser. A study on surgical outcome, post-operative crusting, and bleeding

Objectives: To assess the efficacy of the technique regarding the surgical outcome, post-operative crusting, and bleeding. Design: Single Blind interventional type of study. Study Place and period: This study was conducted at, Chaudhary Muhammad Akram Teaching and Research Hospital Lahore from July 2018 to June 2019. Material and methods: The study included 100 patients and the results of technique in respect to surgical outcome, the safety of technique regarding post-operative complications like crusting in the postoperative period and epistaxis were analyzed. Results: A total of 100 patients were included for research. Their ages were between 10-40 years. It was concluded that almost all the patients had felt improvement in their nasal blockage and postnasal discharge. The sneezing and headache in these patients also have been improved. Ten patients presented with nose crusting and 4 patient presented with mild epistaxis. No acitve intervention was not required in any patient. Conclusion: It was concluded that reduction of inferior turbinate by Diode laser is an excellent, and safe option, regarding the surgical outcome, and complications faced by patients registered for turbinate surgery. Keywords: Turbinates reduction, Diode laser, epistaxis.

Self-Reported Symptom Study of COVID-19 Chemosensory Dysfunction in Malaysia

Alterations in the three chemosensory modalities – smell, taste, and chemesthesis – have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June to 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 may be widespread and more common than previously thought among Asians, and manifest as an early symptom of SARS-CoV-2 infection. This has important implications for our understanding of the infectivity of viral strains, diagnosis, and management of this pandemic. Study Registration: NMRR-20-934-54803 and NCT04390165

Adult nasal chondromesenchymal hamartoma: a rare and benign tumour with aggressive malignant transformation

Nasal chondromesenchymal hamartoma (NCMH) is an extremely rare benign tumour of the nasal cavity predominantly described in infants. We report a case involving a 48-year-old woman who had been diagnosed with NCMH a year earlier and now re-presented with a short history of progressive nasal blockage, recurrent epistaxis and orbital apex syndrome. Histopathology was suggestive of malignant transformation into sinonasal sarcoma. However, following multidisciplinary team (MDT) discussions, including second and third opinions from external departments, the histological diagnosis was revised to ‘NCMH with bizarre stromal cells’. Despite this, the lesion demonstrated malignant features of rapid, invasive growth and was treated with palliative radiotherapy. The patient later developed radiological evidence of lung and liver metastases with subsequent pulmonary emboli. Shortly after this, she passed away. This case is unique in its diagnostic challenge, with ambiguous histopathological findings, and highlights the importance of an MDT approach when managing complex sinonasal tumours.