Morphological Changes in Nasal Mucosa in Patients with Sarcoidosis.

Objectives: The purpose of this study was the evaluation of any alterations in the microvascular network of the nasal mucosa in patients with pulmonary sarcoidosis and the investigation of potential correlations with olfactory acuity and serum levels of angiotensin-converting enzyme (sACE). Design: Patients’ nasal mucosa was examined with contact endoscopy (CE). A novel classification scheme for the microvascular pattern at the anterior septal mucosa (Little’s area) was introduced and implemented. Olfaction was tested using sniffin’sticks. Fifteen healthy subjects served as controls. Participants: 15 patients with pulmonary sarcoidosis and sinonasal symptoms. Main outcome measures: Microvascular pattern at the anterior septal mucosa (Little’s area). Olfaction tested using sniffin’sticks. Setting: Tertiary referral medical centre. Results: The nasal microvascular network was disrupted under CE in most (14/15) patients, while in one patient no microvascular net could be detected. Moreover, hyposmia was documented in four patients and complete anosmia in one patient. In healthy subjects, a very strong correlation between vascular pattern of the mucosa and olfactory test results was found (r=0.93). Conclusions: Contact endoscopy findings show promise and should be further tested, to evaluate their validity as a surrogate marker of mucosal nasal inflammation in sarcoidosis patients with sinonasal symptoms. Vascular patterns of nasal mucosa and olfaction seem to be strong correlated.

Epistaxis in children: a clinical study

<p class="abstract"><strong>Background:</strong> Epistaxis is a common condition among children. Most cases are due to vascular fragility in the nasal vestibule aggravated by digital trauma. Epistaxis is rare below 2 years. 30% of children of all children between 0-5 years, 56% aged between 6-10 years, 64% of those aged between 11-15 years have had at least 1 episode of epistaxis in their lifetime.</p><p class="abstract"><strong>Methods:</strong> A retrospective analysis was done on 56 patients of nasal bleed, at Institute of child health and Hospital for children / Madras Medical College, Chennai, between June 2015 - June 2016. The records of children were analysed. All the patients under went blood investigation. The statistical analysis was done for the age group. </p><p class="abstract"><strong>Results:</strong> There were 56 cases of nasal bleed enrolled in our study, out of which 35 were boys and 21 girls. The most common age group was between 6-10 years accounting for 27 cases. In laterality of nasal bleed right side was common. The most common site in nostril noted was from little’s area of nasal septum in 27 cases. The most common cause was idiopathic in 15 cases. Most of the cases were managed conservatively.</p><p class="abstract"><strong>Conclusions:</strong> Epistaxis is a common clinical condition among the paediatric age group. In all cases, ENT examination should be done to rule out nasal pathology or foreign body in nasal cavity and haematology workup is necessary. Majority of nasal bleed stops with digital pressure.</p>

Use of potassium titanyl phosphate (KTP) laser Dermastat in the treatment of recurrent anterior epistaxis – a new technique

Objective:To evaluate the short- to medium-term effectiveness of potassium titanyl phosphate (KTP) laser Dermastat in patients with recurrent anterior epistaxis.Method:Fifty-eight patients presenting with recurrent anterior epistaxis were treated using potassium titanyl phosphate laser Dermastat. Those with recurrent epistaxis arising from prominent vessels in Little's area, and/or those for whom treatment with silver nitrate cautery failed, were included. The main outcome measure was resolution of epistaxis at two months.Results:Fifty-eight patients were treated; 27 were under 18 years old. Thirty patients had prominent vessels. Thirty-one patients had undergone previous cautery treatment. Thirty-eight patients had treatment to the left side, 19 to the right and 1 to both. At two months, 74 per cent reported resolution of epistaxis with no complications. This increased to 78 per cent at further follow up.Conclusion:Our technique is a successful, safe treatment for recurrent anterior epistaxis in an otherwise treatment-resistant group. A single procedure is effective. The handpiece and tip are reusable and sterilisable, resulting in cost-effectiveness.

Ectopic Intranasal Tooth: An Unusual Cause of Epistaxis in a Child

Nasal bleeding is a common disorder in children that is frequently caused by irritation in the Kiesselbach plexus (also known as Little's area). Other common underlying causes include local inflammatory diseases of the nose, infections, vascular malformations, and trauma. We report here a rare case of an ectopic tooth in the nasal cavity as the cause of recurrent epistaxis in a 3.5-year-old child. The clinical presentation, investigations, and management are discussed.

Use of trans-septal mattress suture of Little's area for anterior epistaxis

Background:In some cases of epistaxis, anterior packing and/or electrocoagulation are not sufficient and suturing is needed. However, standard suturing techniques are sometimes ineffective. This paper reports the use of a new kind of trans-septal mattress suture, based on regional vascular anatomy, in this clinical context.Methods:Four adult patients with haemorrhage in Little's area underwent standard suturing, but bleeding persisted. These patients were successfully treated with trans-septal mattress suturing, using four punctures around the haemorrhage site.Results:No relapses or complications were observed over a six-month follow-up period.Conclusion:In cases of persistent bleeding from Little's area, suturing should surround the bleeding area. The described suturing method is simple, efficacious and cheap.

A Model of Airflow in the Nasal Cavities: Implications for Nasal Air Conditioning and Epistaxis

Background A friction force is generated when moving air contacts the nasal walls, referred to as wall shear stress. This interaction facilitates heat and mass transfer between the mucosa and air, i.e., air-conditioning. The objective of this research was to study the distribution of wall shear stress within the nasal cavity to identify areas that contribute significantly to air-conditioning within the nasal cavity. Methods Three-dimensional computational models of the nasal airways of five healthy subjects (three male and two female subjects) were constructed from nasal CT scans. Numerical simulations of nasal airflow were conducted using the commercial computational fluid dynamics code Fluent 6 (Ansys, Inc., Canonsburg, PA). Wall shear stress was derived from the numerical simulation. Air-conditioning was simulated to confirm the relationship with wall shear stress. Results Nasal airflow simulations predicted high wall shear stress along the anterior aspect of the inferior turbinate, the anteroinferior aspect of the middle turbinate, and within Little's area. Conclusion The airflow simulations indicate that the inferior and middle turbinates and Little's area on the anterior nasal septum contribute significantly to nasal air-conditioning. The concentration of wall shear stress within Little's area indicates a desiccating and potentially traumatic effect of inhaled air that may explain the predilection for spontaneous epistaxis at this site.

Suturing of Little's area of the nasal septum for epistaxis

Background:Epistaxis is a common condition presenting to emergency and ENT clinics. Most epistaxis bleeding originates from Little's area of the nasal septum. Some cases of refractory epistaxis cannot be resolved with packing or electrocoagulation.Method:The suturing technique applied is widely used in surgery. When faced with pulsatile, recurrent bleeding from Little's area of the nasal septum, all rhinologists should possess the skills to be able to suture the bleeding site, especially after failure of local cautery or packing.Case report:The authors have successfully treated four difficult cases of nasal bleeding from Little's area by suturing.Conclusion:This technique could eliminate the discomfort and complications of nasal packing. To the best of our knowledge, this report probably represents the first published case series of suturing of Little's area to treat recurrent nasal bleeding. More cases need to be treated in this way to enable further evaluation of the technique.

Demonstration of the Nasal Septal Branches of the Sphenopalatine Artery by Use of a New Intravascular Injection Method

We injected a new injection material into the external carotid artery using a new method, which led to the successful demonstration of the nasal septal branches of the sphenopalatine artery in human cadavers. The result shows the trunk of the artery divided into three main branches, the upper two of which run toward Little's area. We believe that the knowledge of septal branches, shown in a photograph, is very useful, not only for nasal treatment, but also for anatomic demonstration to students.