EFFICACY OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY(FESS) IN TREATMENT OF POST NASAL DRIP (PND) AS AN ANCILLARY PROCEDURE: A COMPARATIVE STUDY

Objective: To assess efficacy of functional endoscopic sinus surgery (FESS) in treatment of postnasal drip (PND) as an ancillary procedure to Septoplasty with Turbinoplasty. Study Design: Quasi experimental study. Methodology: Sample size was n-200, Patients were placed in two groups Group A (n-126) had septoplasty with turbineplasty. Group B (n-74) included patients with Septoplasty and Turbinoplasty combined with functional endoscopic sinus surgery. Post operative results regarding postnasal drip were compared amongst the Two groups. Results: Data was analysed in SPSS-17, Septoplasty along with turbinectomy was performed in n-126 patients (group A). And septoplasty, turbinectomy along with functional endoscopic sinus surgery was performed in n-74 patients (group B). Post nasal drip was significantly reduced in group B at 3 months follow up (p<0.046). More significant difference was noted at 6 months follow up (p<0.003). Conclusion: Patients having Chronic rhinosinusitis with postnasal drip as predominant symptom, should undergo functional endoscopic sinus surgery as an ancillary procedure to conventional nasal surgery.

Descriptive Statistical Analysis Report on the Results of Questionnaire and Observations on Patients With Physiological Halitosis Who Visited the KUMC Halitosis Clinic- A Retrospective Study

Background: We initiated to prepare the basic data that could help us to understand the characteristics of patients with physiological halitosis symptoms in Korea and aid in explaining the causes of these symptoms. Methods: We collected questionnaire and dietary analysis results from the data of 246 adult patients diagnosed with physiological halitosis symptoms, collected the data from the patients’ salivary measurements and the analysis data of patients’ tongue and throat management status. Using the SPSS (IBM SPSS™, Ver. 22.0) program, we performed a frequency analysis, calculating the correlation coefficient Phi with an independence test.Results: The mean age and one standard deviation of 246 patients with physiological halitosis was 41.85±11.63 years. The proportion of women, the proportion of patients who replaced breakfast with fast food or skipped breakfast, with beverage drinking habits such as coffee, tea, or carbonated drink, with irregular or insufficient consumption of water, who recognized their own oral malodor, suffering anxiety or stress over oral malodor, with an introverted personality, with insufficient unstimulated salivation volume, with incorrect tongue management, and with PND (Postnasal drip) or PTC (Posterior Tongue Coating) were all statistically analyzed to be significant (p < 0.05). As a result of the correlation analysis, the Phi values of the seven pairs of the bivariate variables were from 0.137 to 0.196, and the Phi values of the five pairs of the bivariate variables - the Phi value between the breakfast pattern variable and the regular diet variable, the Phi value between the stimulating menu variable and the drinking variable, the Phi value between the unstimulated saliva variable and the stimulated saliva variable, the Phi value between the unstimulated saliva variable and the sedimentation ratio of saliva variable, and the Phi value between the stimulated saliva variable and the sedimentation ratio of saliva variable - were from 0.203 to 0.394 (p < 0.05). Conclusion: We could suggest the 10 potential common risk factors related to physiological halitosis symptom, and the five pairs of variables with Phi values ranging from 0.20 to 0.40 could be judged to have a moderate correlation.

Flexible Nasal Endoscopic Procedures in Family Medicine: Indications and Effectiveness

Background and Objectives: Most literature about flexible nasolaryngoscopy comes from specialty clinics, making it unclear if these indications can be effectively managed without referral. This study evaluated effectiveness of diagnosis and management of upper airway complaints, utilizing flexible nasal endoscopic procedures, in a family medicine center. Methods: We performed retrospective chart review for all patients who had nasal endoscopy, nasopharyngoscopy, and nasolaryngoscopy performed at the University of Florida Family Medicine Center over 3 years (n=89) with 5 additional years of follow up. We used descriptive statistics to evaluate indications, diagnoses, effectiveness of management by family medicine, and referral rate. Results: The most common primary indications were hoarseness (n=33, 37%), chronic cough (n=20, 22%), nasal obstruction (n=9, 10%), and unilateral ear dysfunction (n=6, 7%). The most common primary diagnoses found were allergic rhinitis/postnasal drip (n=41, 46%), laryngopharyngeal reflux (LPR)/gastroesophageal reflux disease (GERD; n=24, 27%), masses concerning for malignancy (n=4, 4.5%), true vocal cord (TVC) polyp (n=3, 3%), TVC nodules (n=3, 3%), and epistaxis (n=3, 3%). Of the four concerning masses, two were confirmed cancers (2%). In addition, there was one case (1%) of erythroleukoplakia with dysplasia of the TVC. Most patients had documented improvement with family medicine management (n=57, 64%) and another six (7%) had follow up without documentation of status and no need for referral. Thus, a total of 71% (n=64) did not require referral and 20% (n=18) needed specialist referral. Conclusions: Flexible nasal endoscopic procedures are effective in the care of patients in a family medicine residency center and can be safely performed and taught to residents.

COMPARATIVE CLINICAL STUDY OF SHUNTHYAADI SNEHA YOGA NASYA OVER KSHAVATHU ROGA W.S.R. TO ALLERGIC RHINITIS BASED ON SNEHA MEDIA

Shunthyaadi Sneha Yoga which is a Sneha Kalpana developed with Ghrita and Taila Paka method containing ingredients which are Kshavathu hara and indicated specifically in Kshavathu Roga. In Ayurveda, Kshavathu is a symptom of many diseases and at the same time a separate disease entity. The literal meaning of Kshavathu is sneezing and is the main symptom of Allergic Rhinitis and both share similar etiological factors. Allergic rhinitis is an atopic disease characterised by symptoms of nasal congestion, clear rhinorrhea, sneezing, postnasal drip, and nasal pruritis. It is an inflammatory disorder of the nasal mucosa induced by allergen exposure triggering IgE- mediated inflammation. Around 20–30 % of the Indian population suffers from allergic rhinitis and that 15 % develop asthma. In the present study, an attempt has been made to compare the efficacy of Shunthyaadi Taila Nasya and Shunthyaadi Ghrita Nasya designed in two groups comprising fifteen patients each and analysed with parametric and non-parametric tests. Both the groups showed remarkable results in the management of Kshavathu. Keywords: Kshavathu, Shunthyaadi Sneha Yoga, Shunthyaadi Taila, Shunthyaadi Ghrita, Nasya,

Temperature-Controlled Radiofrequency Neurolysis for the Treatment of Rhinitis

Background Chronic rhinitis is a prevalent condition with a significant impact on quality of life. Posterior nasal nerve and vidian neurectomy are surgical options for treating the symptoms of chronic rhinitis but are invasive procedures. Objective To determine the outcomes of patients diagnosed with refractory chronic rhinitis and treated with temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area in a minimally invasive procedure. Methods A prospective, single-arm multicenter study with follow-up through 52 weeks. Eligible adult patients had chronic rhinitis symptoms of at least 6 months duration with inadequate response to at least 4 weeks usage of intranasal steroids and an overall 12-h reflective total nasal symptom score (rTNSS) ≥ 6 with subscores 2 to 3 for rhinorrhea, 1 to 3 for nasal congestion, and 0 to 3 for each of nasal itching and sneezing. Temperature-controlled radiofrequency energy was delivered to the nasal cavity mucosa overlying the posterior nasal nerve region with a novel single-use, disposable, handheld device. Results A total of 50 patients were treated (42.0% male; mean age 57.9 ± 11.9 years), and 47 completed the study through 52 weeks. Mean rTNSS significantly improved from 8.5 (95% CI 8.0, 9.0) at baseline to 3.6 (95% CI 3.0, 4.3) at 52 weeks ( P < .001), a 57.6% improvement. Similar trends in improvement were noted for rTNSS subscores (rhinorrhea, nasal congestion, itching, sneezing), postnasal drip scores, and chronic cough scores. Subgroup analysis demonstrated the treatment was effective regardless of rhinitis classification (allergic or nonallergic). No serious adverse events with a relationship to the device/procedure occurred. Conclusions Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area for the treatment of chronic rhinitis is safe and resulted in a durable improvement in the symptoms of chronic rhinitis through a 52-week follow-up. Data suggest that this novel device could be considered a minimally invasive option in the otolaryngologist's armamentarium for the treatment of chronic rhinitis.

An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

Background Aspiration pneumonitis is an inflammatory disease of the lungs which is difficult to diagnose accurately. Large-volume aspiration of oropharyngeal or gastric contents is essential for the development of aspiration pneumonitis. The role of cerebrospinal fluid (CSF) rhinorrhea is often underestimated as a rare etiological factor for aspiration in the diagnosis process of aspiration pneumonitis. Case presentation We present a case of a patient with 4 weeks of right-sided watery rhinorrhea accompanied by intermittent postnasal drip and dry cough as the main symptoms. Combined with clinical symptoms, imaging examination of the sinuses, and laboratory examination of nasal secretions, she was initially diagnosed as spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, and intraoperative endoscopic findings and postoperative pathology also confirmed this diagnosis. Her chest computed tomography showed multiple flocculent ground glass density shadows in both lungs on admission. The patient underwent endoscopic resection of meningoencephalocele and repair of skull base defect after she was ruled out of viral pneumonitis. Symptoms of rhinorrhea and dry cough disappeared, and pneumonitis was improved 1 week after surgery and cured 2 months after surgery. Persistent CSF rhinorrhea caused by spontaneous sphenoid sinus meningoencephalocele was eventually found to be a major etiology for aspiration pneumonitis although the absence of typical symptoms and well-defined risk factors for aspiration, such as dysphagia, impaired cough reflex and reflux diseases. Conclusions We report a rare case of aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, which can bring more attention and understanding to the uncommon etiology for aspiration, so as to make more accurate diagnosis of the disease and early surgical treatment.

Potential Therapeutic Effect of Continuous Positive Airway Pressure on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients

To investigate the potential therapeutic effect of continuous positive airway pressure (CPAP) treatment on laryngopharyngeal reflux in obstructive sleep apnea (OSA) patients, we performed a retrospective analysis of data prospectively collected from patients who underwent CPAP therapy after being diagnosed with moderate to severe OSA between January 2019 and May 2020. Subjects were asked to complete the reflux symptom index (RSI) questionnaire before and after CPAP. Additionally, a laryngoscopic examination was performed to evaluate objective endoscopic findings and determine reflux finding score (RFS). A total of 46 patients were included in the analysis. Overall, significant decreases in mean RSI score (10.85 ± 6.40 vs. 8.80 ± 7.99, p < 0.001) and RFS (7.41 ± 3.32 vs. 4.65 ± 2.12, p < 0.001) were observed after CPAP treatment. Within subdomains of the RSI, throat clearing, postnasal drip, breathing difficulty, troublesome cough, and foreign body sensation were significantly improved by CPAP treatment. All subdomains of RFS, with the exception of posterior commissure hypertrophy and granuloma, showed significant differences after CPAP treatment. There were no differences between subgroups according to body mass index or severity of OSA. CPAP treatment in OSA potentially reduces laryngeal reflux symptoms and improves laryngeal examination findings.

Prolonged High Dose Esomeprazole for the Treatment of Chronic Cough in an Israeli Adult Population – An Open Label Study

Background Chronic cough is considered to be part of the gastroesophageal reflux disease (GERD) spectrum. However, the response rate to standard dose proton pump inhibitors (PPI's) is poor. Our aim was to evaluate the response rate of chronic cough to an extended course of high dose PPI's and to identify predictors of treatment response. Methods This prospective study included adult nonsmoking patients with chronic cough, normal spirometry, normal upper endoscopy and with no evidence of postnasal drip (PND). Treatment consisted of high dose PPI's (esomeprazole, 40mg b.i.d.) for 4 months. Primary end point was the reduction of the Reflux Symptoms Index (RSI), Leicester Cough Questionnaire (LCQ) and the Reflux Findings Score (RFS) by more than 50% at 4 months from baseline. Results Forty-one patients (39% female; mean age 55.9 ± 15.19 years) were enrolled, most of them with mean cough duration of more than 1 year. The primary end point was achieved in 39% of patients. Predictors of response included higher educational level (p = 0.035), hyperemia of the arytenoids and the postcricoid area (p = 0.026), and hoarseness (p < 0.01). No difference was found in the frequency of heartburn and regurgitation between responders and nonresponders. More complaints of difficulty in swallowing were reported by nonresponders (p < 0.01). Conclusion A therapeutic benefit of high dose PPI's for chronic cough cannot be dismissed, especially in patients with hoarseness, and arytenoid or postcricoid hyperemia. Prolonged high dose therapy may be warranted.

Health Concerns of Textile Workers & Associated Community

Background: Workers in the textile industry risk developing various respiratory and pulmonary diseases due to exposure to cotton dust. The particles from the cotton lint are inhaled by the workers and results in the breathing problems including asthma, shortness of breath, cough and tightness in the chest. The poor health of labor contributes to the low productivity of the labor and in serious cases loss of jobs leading to the poverty. Methods: This study explores the health profiles of the textile workers and associated community and contrast them against the health profile of the control group to factor out any confounding factors. The study is conducted on cotton industry in Kasur, Pakistan. We interviewed 207 workers, 226 people from associated community (living in vicinities of weaving units) and 188 people for control group (from areas far away from weaving units and people are not associated with weaving industry) based on stratified random sampling technique. We employed descriptive methods and logistic regression to explore the association between respiratory diseases and weaving workers. Results: Overall, prevalence of postnasal drip, byssinosis, asthma, and chronic bronchitis were 47%, 35%, 20%, and 10% respectively among the workers. These percentages are significantly higher than the control group. Among workers, 43% & 21% feel difficulty in hearing against noisy background and at low volume respectively. Due to bad light arrangements at workstations, 21% & 31% workers are suffering from myopia and hyperopia respectively. Proportions of the workers suffering from continuous headache, skin infection, depression, and low back pain are 28%, 29%, 27% and 44% respectively. Conclusion: Better environment at workstations, use of protective gears and education are the factors which reduce the risk of associated diseases among workers.