Diagnosis of the pathophysiology of chronic mucosal diseases of allergic rhinitis, asthma and otitis media as seen by an otolaryngologist

Otolaryngologists, like Pediatricians, often see patients with chronic rhino-sinusitis and draining ears. Surgeons can offer various procedures, from simple tympanostomy tubes to advanced sinus and turbinate operations, in which significant portions of bone and mucosa are removed. The rates of reinfection are often reduced [1] but failures occur.

A Study on the Efficacy of Saline Nasal Irrigation in Chronic Rhinosinusitis

BACKGROUND The objective of this study was to test as to whether daily saline nasal irrigation improved sinus symptoms in adult subjects with chronic rhino sinusitis, and also study the safety of saline irrigation, incidence of any complication and improvement in quality of life in these patients. METHODS This was a prospective observational study conducted between two groups of patients at Government TD Medical College, Alappuzha. Patients who satisfied the criteria for diagnosing chronic rhino sinusitis were included in the study. The first group was given saline nasal irrigation with oral drug therapy while the second group was put on oral drugs alone. Each subject was given a pretested, structured questionnaire. Along with socio-demographic information, the questionnaire also contained queries of quality of life measure, compliance of nasal irrigation and adverse effects following its use. RESULTS The pre-treatment scores and post treatment scores were analysed and the results were statistically significant with P values of < 0.001 in all. 77 % of the patients in the saline irrigation group were strictly using saline nasal irrigation which meant a satisfactory compliance and the improvement in post treatment scores was statistically highly significant with a P value of < 0.001. Also there was a statistically significant difference between the mean pre-test and post test scores of the two groups with P value of < 0.001 and t value of 51.942 using the paired t test. CONCLUSIONS Chronic rhinosinusitis has a major negative impact on the healthcare and economy of not only the patients but also of the society. Saline nasal irrigation is an effective yet easy method of therapy in alleviating the symptoms of chronic rhinosinusitis and improving the quality of life in these chronic sufferers. KEY WORDS Chronic Rhinosinusitis, Saline Nasal Irrigation, Quality of Life, Economic Burden

A COMPARATIVE STUDY OF LUND-MACKAY SCORING AND POSE SCORING IN CHRONIC RHINO-SINUSITIS PATIENTS.

INTRODUCTION: To compare preoperative Computed Tomography scan ndings of Para nasal sinuses using Lund-Mackay scoring and intra operative Functional endoscopic sinus surgery ndings in patients with Chronic Rhino-sinusitis using the POSE scoring and to correlate maximum scores obtained in Perioperative sinus endoscopy (POSE) scoring system and Lund-Mackay scoring system. MATERIALS AND METHODS:AProspective study was done for 1 year on 48 patients attending outpatient department of ENT, Sri Siddhartha Medical College aged between 18-60 years, who were clinically diagnosed to have Chronic Rhino-sinusitis, underwent pre-operative CT scan of nose and paranasal sinuses and thereafter FESS were enrolled for the study after obtaining the due consent. RESULTS: From our study group of 48 patients who underwent endoscopic sinus surgery for CRS, the minimum value of Lund-MacKay Scoring was 3 whereas the maximum was 18 (maximum obtainable is 24) with a mean value of 12.02 and standard deviation of 3.987. The minimum POSE Score obtained was 7 and the maximum POSE Score obtained was 37 (maximum obtainable being 40), with a mean value of 16.31 and standard deviation of 5.095. CONCLUSION: Pre operative CT scan combined with per operative endoscopy ndings has made the approach to Chronic rhinosinusitis more specic, rational and accurate. The results of our study highlights that CT scan is an important investigation tool to detect Chronic rhinosinusitis . CT scan has very much emerged as the gold standard in preoperative diagnosis and allows for accurate patient selection for FESS. In our study, POSE Scoring has shown a good correlation with Lund MacKay scoring system

Effect of endoscopic sinus surgery on general health related quality of life domains in chronic rhino sinusitis patients

<p class="abstract"><strong>Background:</strong> Chronic rhino sinusitis (CRS) is a common health problem affecting around 5-12% of the general population in a year. Treatment of CRS consist of medical and surgical management. Surgical management is considered when patient is not responding to maximal medical treatment or in case of complication. Sino nasal outcome test 22 (SNOT- 22) is considered as the most appropriate instrument in the evaluation of HRQOL impairment in CRS patients. This study evaluated general health related quality of life (QOL) domains of SNOT- 22 changes following endoscopic sinus surgery.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in 53 subjects who underwent endoscopic sinus surgery for chronic rhino sinusitis in Department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history including SNOT-22 questionnaire enquired. Clinical, radiological and endoscopic examinations were performed. This patient followed up after 1 week, 1month and 3 months. SNOT-22 scores were recorded at each visit; data compiled and analysed with help of SPSS.</p><p class="abstract"><strong>Results:</strong> The baseline SNOT-22 score for study population was 37.51. General health related quality of life domains was assessed separately. The score for psychological dysfunction and sleep dysfunction decreased from 10.72, 6.00 to 1.58 and 1.02 respectively at the end of 3 months.</p><p class="abstract"><strong>Conclusions: </strong>Chronic rhinosinusitis patients reported significant improvement in psychosocial dysfunction and sleep related symptoms after endoscopic sinus surgery. Chronic rhino sinusitis patient with anxiety and depressive disorders need special attention to improve health related quality of life (HRQOL).</p>

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

Objective: To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS. Methods: Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined. Results: Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%. Conclusion: Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients. doi: https://doi.org/10.12669/pjms.36.3.1661 How to cite this:Awan NU, Cheema KM, Naumeri F, Qamar S. Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1661 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The treatment of patients with chronic rhinosinusitis in the conditions of sanatorium and preventive measures

The objective of the research is to study of clinical and functional disorders of the nasal mucosa and paranasal sinuses of patients with chronic rhino sinusitis, as well as to make the choice of the optimal treatment method in a sanatorium using natural factors. A survey of 145 patients (94 men and 51 women) with chronic rhinosinusitis at the age of 18 to 65 years was conducted. Of these, male accounted for 64.8%, female – 35.2%. In patients with pathology of the paranasal sinuses, functional disorders of the nasal mucosa and paranasal sinuses were revealed. Particularly, violations of mucociliary clearance, acid-base balance of the nasal mucosa, and a decrease in nasal patency according to the data of active anterior rhinomanometry were defined. The use of natural factors as a treatment: inhalation of natural mineral water Maibalyk and mud applications on the paranasal sinus area significantly improved the course of way of chronic rhinosinusitis and led to normalization of the functional parameters of the nasal mucosa, in contrast to the comparison group (60 people). The comparison group did not use with Maibalyk natural water inhalations and mud applications from Lake Maybalyk, but used only ordinary alkaline inhalations.