Comparative study of outcomes of conventional and endoscopic septoplasty

<p><strong>Background: </strong>Literature and other available research states lots of comparison between endoscopic and conventional septoplasty. The study helps conclude the merits and demerits of both techniques and compares the superiority of one method over the other on various aspects from surgeon’s and patient’s point of view. The objective of the study was to compare outcomes of conventional and endoscopic septoplasty.<strong></strong></p><p><strong>Methods: </strong>Study included 48 patients having symptomatic deviated nasal septum willing for surgery randomly divided into two groups of 24 each who underwent endoscopic septoplasty and conventional septoplasty. All the patients selected for study, were assessed for subjective and objective evaluation pre-operatively and post-operatively on 7^th day, 1 month and 3 months. The study was conducted at Surat Municipal Institute of Medical Education and Research (SMIMER), Surat.</p><p><strong>Results: </strong>There are technical advantages of using endoscope during septoplasty as it is definitely superior from surgeon’s point of view but there is no significant difference in terms of functional outcome, complications and post-operative hospital stay.</p><p><strong>Conclusions: </strong>There are technical advantages of using endoscope being superior in terms of illumination, preciseness and surgery, visualization of deeper parts of nasal cavity and resection of posterior deviation and spur especially in isolated septal spur and in achieving hemostasis. The study helps us conclude that endoscopic septoplasty has merits over conventional septoplasty on various aspects.</p>

A comparative study of synechiae formation in endoscopic septoplasty with and without intranasal splints

<p class="abstract"><strong>Background:</strong> Septoplasty is the treatment of choice for deviated nasal septum. Deviated nasal septum can be C shaped or S shaped leading to unilateral or bilateral nasal obstruction. Septal spur may also require surgery. Sometimes deviated nasal septum may block osteomeatal complex leading to chronic sinusitis. For the evaluation of nasal cavities preoperatively computed tomography (CT) paranasal sinuses and diagnostic nasal endoscopy is done. Diagnostic nasal endoscopy done after two weeks of surgery. The objective of the study is to compare the efficacy of intranasal splints in the prevention of nasal synechiae following septoplasty.</p><p class="abstract"><strong>Methods:</strong> 100 patients undergoing septoplasty under general anesthesia from March 2018 to March 2019 were enrolled. Patients with nasal septal deviation and aged between 18-50 years were included in the study. All surgeries were performed by consultant ear, nose and throat (ENT) surgeons under general or local anesthesia. Institutional ethical committee approval was obtained for the study. Informed consent was obtained from all patients. Patients with age under 18 years or over 50 years were excluded for the study. </p><p class="abstract"><strong>Results:</strong> Septoplasty with intranasal splints reduce the formation of synechiae in 48 patients.</p><p class="abstract"><strong>Conclusions:</strong> Usage of intranasal splints indicates a decrease in the postoperative formation of synechiae after septoplasty.</p>

Intranasal findings in unilateral primary acquired nasolacrimal duct obstruction

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common entity with associated different types of intranasal abnormalities. The pathogenesis of PANDO is unknown. The objective of the study was to describe the intranasal findings in cases of PANDO and find out any association of these findings to the disease. Methods: A comparative cross-sectional study was designed consisting of 50 cases of unilateral PANDO with epiphora and 50 normal volunteers with no history of epiphora. Nasal Evaluation was done with anterior rhinoscopy and nasal endoscopy. Data was tabulated and analyzed using SPSS version 21. Results: The mean age in the unilateral PANDO group was 33.6 years and 34.5 years in the normal volunteer’s group (P-0.84). Left sided dominance of PANDO was observed in 64% (32/50) cases. The odds of having Nasolacrimal duct (NLD) obstruction was1.6 times more among individuals having septal deviation versus no deviation (95% CI, 0.907–2.78). The laterality of septal deviation was corresponding to the side of NLD obstruction in 91% (31/34) cases. High located DNS was more common in the PANDO group which was significant (P-value 0.012). Turbinate hypertrophy, the presence of septal spur or rhinitis had no significant association with NLD obstruction. Conclusions: Deviated nasal septum (DNS), turbinate hypertrophy, septal spur and rhinitis were the associated intranasal findings in cases of unilateral PANDO. A significant association exists between DNS and PANDO, although a cause and effect relation require further probing.

Nasal Septal Spur Associated with Rhinogenic Contact Point Otalgia and Tinnitus

Rhinogenic contact point otalgia is a new term in medicine and it represents earache as a form of facial pain that is caused by intranasal mucosal contact points between the nasal septal spur or septal deviation and lateral nasal wall. It is a referred otalgia without any signs of inflammation. The author reports an unusual case of a 19-year-old male who complained of a 5-year history of right-sided otalgia and tinnitus. On physical exam, a big, right-sided nasal septal spur was seen in contact with the right lateral nasal wall. Other findings are unremarkable. Placement of anesthetic and vasoconstrictor solution provided relief of symptoms. After the exclusion of other causes of otalgia, and after surgical removal of septal spur, the patient experienced a significant relief of symptoms.

COMPARISON OF CARTILAGE TYPE IIIA AND IIIB TYMPANOPLASTY IN INDIAN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Objective: This prospective comparative study determined the efficacy of type III tympanoplasty using homologous septal spur cartilage in patients with chronic otitis medis (COM).Methods: We selected patients by random sampling. Complete otolaryngologica examination including otological examination, tuning fork tests, pure tone audiometry (PTA), and relevant investigations was done. Post-tympanoplasty residual air-bone gap (ABG) was graded. Type III tympanoplasty was done for all and followed up until month 6.Results: Of 50 patients, 70.0% were men. Mean age was 27.72±10.81 years, 24 and 26 patients underwent type IIIA and IIIB tympanoplasty, respectively. Pre-operative mean PTA and ABG was 50.08 dB and 38.27 dB, respectively. Pre-operative ABG of 31–60 dB was seen in 41 patients while nine had an ABG of 0–30 dB. Overall, pre- and post-operative PTA was 50.24 dB and 28.54 dB, respectively. Overall, pre- and post-operative ABG was 38.32 dB and 16.40 dB (III A 36.92 dB and 14.79 dB; III B 39.62 dB and 17.88 dB). Mean overall hearing gain postoperatively in PTA was 21.70 dB (type III A 22.33 dB, III B −21.115 dB). Overall, ABG closure was 23.53 dB (type III A 22.333 dB, III B −21.115 dB). None had failure (>30 dB). Good ABG of 10–20 dB was seen in 72% and 78% of patients at month 3 and 6, respectively.Conclusion: Significant post-operative hearing improvement was seen in both types of tympanoplasty using homologous cartilage graft for ossicular reconstruction. Type III A is better than type IIIB as the stapes superstructure is vital for hearing.

An Aetiopathological Study on Epistaxis in Adults and its Management

IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.