Postoperative Complications of Conventional Polypectomy Versus Endoscopic Sinus Surgery

Objective: To compare the postoperative complications of conventional polypectomy versus Endoscopic sinus surgery. Study Design: This is cross sectional study. Setting: Study carried out at E.N.T department, Tertiary care hospital from April 2019 - March 2020. Materials & Methods: 52 out of which 32 were male and 20 were female. Benign nasal polyps within 14 yrs to 80 years from emergency and out- patient department both were included in our study. Only recurrent and neoplastic lesions were not inclusive of this study. Postoperatively the patient was prescribed with oral antibiotics, nasal decongestants and nasal douche with normal saline, followed by local steroids after 1.5 months. The post operative evaluation (both endoscopic and clinical) was done at 2 weeks, 6 weeks and 3 months post operatively and data was recorded. Statistical package for social sciences (SPSS) software version 20.0. Results: A total of 52 patients were recruited for the study with age ranging from 18 to 40 years. The mean age was 24.65± SD 4.12. There were 32 (61.53%) males and 20 (38.46%) female patients. Two weeks were observed postoperative complications. The intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 8(30.76%) Versus ESS 5(19.23%)), crusting (SIP 10(38.46%) Versus ESS 6(23.07%)), Synechiae formation (SIP 3(11.53%) Versus ESS 1(3.84%)), recurrence 0% were observed. At upto 6th weeks observed the intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 5(19.23%) Versus ESS 2(7.69%)), crusting (SIP 6(23.07%) Versus ESS 2(7.69%)), Synechiae formation (SIP 2(7.69%) Versus ESS 1(3.84%)), recurrence 0% were observed. Three months were observed the intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 1(3.84%) Versus ESS 0%), crusting (SIP 0% Versus ESS 0%), Synechiae formation (SIP 4(15.38%) Versus ESS 3(11.53%)), recurrence 3(11.53%) were observed only in simple intranasal polypectomy group. While the intraorbital and intracranial complications were not observed. Conclusion: We would like to conclude our study in favor of ESS to be superior to other intranasal polypectomy procedures in terms of post operative complications.

Acute nasal dryness in COVID-19

One of the entry routes of SARS-CoV-2 is the nasal epithelium. Although mounting evidence suggests the presence of olfactory dysfunction, and even anosmia, in patients with COVID-19, it is not clear whether these patients also suffer from other “nasal” symptoms that may influence their olfaction. A group of 35 patients with COVID-19 (and a control group matched in gender and age) were surveyed about the presence of a variety of nasal symptoms that may be associated to drastic perturbations experienced in the nasal cavity (e.g., “excessive dryness” and/or a continual sensation of having had a “nasal douche”). We used a cross-sectional, retrospective survey, targeted at the general population by means of non-quoted, non-random, snowball sampling. Symptoms were assessed with absence/presence responses. The possible association between two continuously distributed latent variables from categorical variables was estimated by means of polychoric correlations. More than 68% of the patients reported at least one “nasal” symptom. The clinical group also experienced “a strange sensation in the nose” and having excessive nasal dryness significantly more often than the control group. Fifty-two percent of the patients (but only 3% of the control group) reported a constant sensation of having had a strong nasal douche. Nasal symptoms predominantly co-occurred with anosmia/hyposmia, and ageusia/hypogeusia, appeared principally before or during the other symptoms of COVID-19, and lasted for twelve days, in average. The presence of these nasal symptoms, and their early occurrence, could potentially facilitate early diagnosis of COVID-19 and initial social distancing efforts.

Nasal Delivery Devices: A Comparative Study on Cadaver Model

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities.

Sinus Penetration of Saline Solution Irrigation and Atomizer in a Cadaveric Polyp and Allergic Fungal Sinusitis Model

Allergic fungal sinusitis (AFS) is a stubborn disease requiring surgical and medical management. Delivery of topical medication is paramount in these patients, but the most difficult to accomplish. We investigated heavy irrigation (nasal douche) and atomized medication delivery potential in a cadaveric sinus model of polypoid AFS disease. Three disease models were created: a control that involved unoperated sinuses and no simulated disease; an unoperated AFS with type II polyposis mode; and an operated model with recurrent allergic fungal sinusitis with type II polyposis. The maxillary sinus showed the best irrigation and overall the heavy irrigator was more efficient than the atomizer.

Recurrent Acute Rhinosinusitis: A Single Blind Clinical Study of N-Acetylcysteine vs Ambroxol Associated to Corticosteroid Therapy

The aim of rhinosinusitis treatment is to restore sinusal eutrophism and to normalize ventilation and mucociliary transport. Frequently the improvement of sinusal physiological conditions is associated with a reduction of infections and pulmonary symptoms. The treatment of these diseases often requires the combination of medical and surgical strategies. In particular, the aim of the medical therapy is multiple: to treat the infection (with antibiotics), to reduce the mucosal swelling (with corticosteroids) and to improve mucus drainage (with mucolytics or muco-regulators). The use of atomized nasal douche, as a washing of the nasal fossas, is chosen because of its local action minimizing systemic adverse effects. The surgical treatment is secondary to medical failure, and it is focused on clearing the sinusal ostia in the sphenoethmoidal recess and the osteomeatal complex. In case of recurrent sinonasal diseases the importance of the surgical operation is represented by the fact that the medical treatment better reaches the target in the sinusal space. This study is focused on the primary medical treatment of acute recurrent rhinosinusitis. The patients who immediately needed surgical treatment were excluded from the study (because of the presence of an anatomical obstruction of the osteomeatal complex and/or the sphenoethmoidal recess, hence non-susceptible to improvement by medical therapy alone), and these patients were immediately addressed to undergo a CT scan examination in order to be involved in a future surgical programme. The medical treatment for those forms which do not require antibiotics (i.e. when infections are not involved), is based on the use of topical corticosteroids. While there are controversies on the real efficacy of adding mucolytic agents to the steroids, they are commonly prescribed in clinical practice, with the rationale of reducing viscosity and improving clearance of mucus in order to help the restoration of the physiological sinus conditions. The primary aim of the medical treatment is to reduce the number of acute episodes and thus to increase the time between the exacerbations, allowing a good quality of life without necessitating surgical procedure.