Adenoid hypertrophy is a common finding in children with antrochoanal polyp

Background Many nasal pathological findings have been described with antrochoanal polyp (ACP). We aimed in this study to assess the prevalence of adenoid hypertrophy among children presented with ACP and to evaluate the efficacy of concomitant adenoidectomy on the outcome of endoscopic removal of the lesion. Results Forty-three children with ACP were included in this study. Preoperative nasal endoscopy and computed tomography were performed for all patients. Endoscopic sinus surgery (ESS) with widening the maxillary ostium was used for removal of ACP in all patients. Associated nasal pathology was recorded and managed accordingly. The patients were followed up for at least 3 years postoperatively. Coexistent nasal pathology with ACP was detected in 39 patients (90.7%); adenoid hypertrophy was found to be the commonest concomitant lesion (83.7%). Adenoidectomy was performed during ESS for those who had adenoid hypertrophy. Postoperatively, no patients developed adenoid regrowth; however, recurrence of ACP was detected in five patients (11.6%). Conclusion Adenoid hypertrophy is a common pathological finding in children presented with ACP. Endoscopic removal of ACP with concomitant adenoidectomy is an effective procedure and has a favorable outcome.

1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab

Aim This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures. Method we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training. Results We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath. Conclusions Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.

Regeneration of ciliated epithelium of nasal cavity in normal conditions and after surgery

The problem of postoperative management of patients after surgical interventions on intranasal structures is still actual. Statistically the frequency of nasal pathology that required surgical correction is on rise. These facts stimulate to make an analysis of wound healing processes of nasal mucosa and triggers that influence on these processes. In this paper morphological and functional changes of nasal mucosa during different pathological conditions are observed. The wound healing is regulated on different levels and one of the most significant role some tissue and cells mediators are played. The effects of transforming growth factor beta (TGF-b) and matrix metalloproteinases (MMP) on nasal mucosa regeneration are shown based on literature search. Possibility of correction of these substances for better and faster restoring of nasal mucosa after intranasal surgery is discussed.

Unexpected nasal foreign body

Foreign body in the nose is a common complaint in the paediatric age group and the most prevalent site of foreign body insertion compared to the ear and throat. Typical presentation involves foul-smelling unilateral nasal discharge. However, some cases are asymptomatic with no witnesses, and only discovered by medical practitioners during routine examinations. The diagnosis in this scenario becomes more challenging when another nasal pathology is present. We describe the case of a 6-year-old girl with underlying extensive infantile haemangioma of the face, tongue, neck and chest, who came for a routine follow-up, without any nasal complaints. However, the examination revealed right nasal crusting with bluish discoloration and hypertrophy of the right inferior turbinate, which was initially thought of as extension of the patient’s haemangioma. A foreign body in the right nasal cavity was noted by the girl’s parent on the next day after nasal douching, and was successfully removed in the clinical setting.

Biofilms and inflammation in patients with chronic rhinosinusitis

Introduction. The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods. A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results. Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Conclusion. Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.

Effects of Trio and Pair Breeding of Mice on Environmental Parameters and Nasal Pathology and Their Implications for Cage Change Frequency

According to the Guide, cage change frequencies must be considered when cage density requirements are exceeded. We monitored ammonia, carbon dioxide, cage wetness, health status, and breeding parameters of trio and pair breeding cages containing CD1 mice in ventilated and static microisolation caging (4 cages per condition) daily for approximately 6 wk. Minimum cage change frequencies for each condition were determined on the basis of performance data. At 3 d after cage change, static trio and pair cages had average ammonia levels of 74 and 38 ppm. Ventilated cages remained below the 25ppm threshold reported to be potentially deleterious for mice until at least day 7 after cage change. By 7 d after cage change, ammonia levels had risen to an average of 100 ppm and 64 ppm in static trio and pair cages and to 34 ppm and 20 ppm in ventilated trio and pair cages, respectively. Ammonia levels in ventilated cages continued to rise slowly through day 14 after cage change. CO2 levels exceeded 5000 ppm in all groups at 2 d after cage change. Pair breeders in ventilated cages took the longest—10 to 14 d—to reach cage wetness threshold scores. On day 7, pups in trio static cages were noted to have decreased and squinted eyes, whereas in ventilated cages containing trios and pairs, these clinical signs were rare to absent. Histologically, there was an increasing incidence and severity of nasal lesions in weanlings with increasing housing density and decreasing ventilation, consistent with nasal epithelial toxicity. Given these parameters, we concluded that under the current husbandry conditions, it may be necessary to change breeders in static cages more frequently than every 7 d. Additional studies are necessary to evaluate the effects of more frequent cage changes on reproductive parameters, given that cage changing is stressful for mice and affects breeding results.

Association Between Nasal Obstruction Symptoms and Anxiety

Aim: The aim of this study was to determine the correlation between nasal function assessment and anxiety scales. Methods: A total of 120 patients with the complaint of nasal obstruction were classified as nasal septum deviation group (DNS) and no nasal pathology group (NON). A control group was formed of 57 healthy participants. Nasal obstruction severity was assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, nasal resistance level with rhinomanometry and anxiety levels with the Agoraphobic Cognitions Questionnaire (ACQ), and the Body Sensations Questionnaire (BSQ). Results: There was a statistically significant difference between both the DNS and the NON groups and control group in terms of NOSE scale, ACQ, and BSQ ( P < .001). The total nasal resistance values were higher in the DNS group compared to both the NON and control groups ( P < .001), although the difference between the NON group and control group was not statistically significant. Conclusion: The results of this study showed that patients with nasal breathing complaints, but no organic pathology, had the same level of nasal obstruction symptoms as patients with nasal septal deviations. Anxiety levels are elevated in patients with symptoms of nasal obstruction, even when there is lack of organic nasal pathology.

Intranasal proliferative fibro-osseous dysplasia in a domestic longhair cat

Case summary A 13-year-old female domestic longhair cat was presented for further investigation of chronic sneezing combined with a right-sided nasal discharge. A CT scan of the head revealed a locally invasive, aggressive right nasal mass radiographically consistent with a malignant neoplastic process. Histopathology on rhinoscopically guided biopsies revealed an unusual pathology consistent with fibro-osseous hyperplasia/dysplasia. Surgical treatment via a ventral rhinotomy and curettage was performed, and the diagnosis confirmed by repeat histopathology. The cat’s clinical signs significantly improved postoperatively. Relevance and novel information This case report describes an unusual feline nasal pathology. To our knowledge, there are no previous reports of a non-neoplastic, non-inflammatory expansile feline nasal tumour. Also described are the CT and histological appearance of the mass, and the difficulties encountered obtaining the definitive diagnosis. Information regarding the prognosis following surgical removal of proliferative fibro-osseous lesions in cats is poor, especially from the nasal cavity where clean margins may well be impossible to obtain. In this case, surgical resection improved clinical signs and the cat remains well at 15 months post-procedure.

Feline infectious peritonitis virus-associated rhinitis in a cat

Case summary This report describes a cat with initial respiratory signs prior to developing fulminant feline infectious peritonitis (FIP) after adoption from an animal shelter. Histologic examination of the tissues revealed typical lesions associated with FIP in the lung, liver, large intestine and small intestine. Histologic examination of the nasal cavity revealed pyogranulomatous rhinitis. Immunohistochemistry with monoclonal antibody FIPV3-70 targeting FIP antigen in macrophages confirmed FIP and molecular analysis identified a spike protein mutation (R793S) consistent with the presence of an FIP virus. Pathological changes, immunolabeling and molecular analysis provide evidence that respiratory infection by feline coronavirus is part of the spectrum of FIP-associated disease. Relevance and novel information This report highlights nasal pathology associated with FIP through a combination of histopathology, immunohistochemistry and molecular characterization of the virus. Our work supports a little-appreciated role of the respiratory tract in FIP.