RISK FACTORS INVOLVED IN RECURRENCE OF CHRONIC RHINOSINUSITIS AFTER FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN KASHMIRI POPULATION.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases, which is defined as an inflammation of the nose and paranasal sinuses. Computed tomography (CT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery (FESS), which is, nowadays, regarded as the gold standard for treatment of CRS after a trial of medical treatment. Our aim in this study is to explore the risk factors and anatomical findings on CT scan of CRS patients who had recurrence after undergoing FESS in Government Medical College,Srinagar . METHODS: A retrospective chart review study was conducted in the department of otolaryngology head and neck surgery,GMC Srinagar, to assess the risk factors of patients with recurrent CRS after FESS. The study included all patients, who were adults 18 years of age and above of both genders that had FESS after a diagnosis of CRS between 2017 and 2019. RESULTS: The study identified 129 patients with CRS, of which 19 (14.79%) patients had recurrence after FESS. Various risk factors were taken into consideration such as age, gender, airway and inflammatory autoimmune diseases, smoking, type of sinusitis, and anatomical variations and findings on CT scan. However, only fungal type of sinusitis was found to be a significant risk factor of a recurrent CRS. Anatomical findings on CT scan postoperatively were mucosal thickening, nasal polyps, nasal septum deviation, and obliterated osteomeatal complex. CONCLUSION: CRS patients were assessed for various risk factors of recurrent CRS. The overall incidence of recurrent CRS was 14.79%. Fungal rhinosinusitis was found to be a significant risk factor. The most common anatomical findings on CT scan postoperatively were mucosal thickening in paranasal sinuses followed by nasal polyps.

A multicentric observational study of imaging findings in COVID-19-related rhino-orbito-cerebral mucormycosis: a new Pandora’s box

Background There is a sudden rise of fungal infection with corona virus disease. This is attributed to the immunomodulation by the disease and the drugs used, diabetes mellitus, steroid use, oxygen inhalation using dirty water, use of zinc and iron supplements, etc. Early diagnosis and prompt medical and surgical intervention is the mainstay of treatment. This can greatly reduce the high morbidity and mortality associated with this disease. The objective of the study is to describe the imaging findings of acute invasive rhino-orbito-cerebral mucormycosis (ROCM) in 25 patients with severe acute respiratory syndrome corona virus 2, from three different centers with proven mucormycosis. Special emphasis is placed on the signal enhancement patterns of sinonasal mucosa, the earliest and most common findings. Statistical analysis was performed using descriptive statistics. Results Computed tomography (CT) and magnetic resonance imaging (MRI) of 25 patients showed most commonly involved sinuses as maxillary and ethmoid sinuses (19, 76%) together. Sino-nasal mucosal thickening was the most common finding (24, 96%). Periantral infiltration (18, 72%) preceded before orbital (15, 60%), cerebral (5, 20%) and vascular (2, 8%) complications, with grossly intact bones. Sinus wall erosions were seen in only 2 patients (8%). Palatal (22%) and maxillary alveolar arch erosion (39%) were frequent findings. CT showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T1 and T2 iso- to hypointense mucosal thickening (62%) and intense (43%) and no (33%) contrast enhancement as the main finding. Conclusions Contrast enhanced MRI is better at demonstrating early mucosal abnormalities, turbinate necrosis, non-enhancing devitalized tissues, orbital apex involvement and intra-cerebral extension. Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses in premaxillary, retroantral fat, facial muscles, pterygopalatine fossa, temporal, infratemporal fossa and extraconal orbital fat along with typical patterns of sinonasal mucosal enhancement should raise the suspicion of acute invasive fungal etiology given the short duration of history and immunocompromised status. High incidence of periantral and orbital extension of the disease is suggestive of acute invasive form of fungal infection. Also the rapidly progressive inflammatory changes without much bone involvement should suggest the suspicion of ROCM. Bony, cerebral and vascular involvements are relatively late complications.

A Novel Cause of Bowel Obstruction in a Patient with Long-Standing Crohn’s Disease

Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A 70-year-old male with complicated Crohn’s disease presented with 3 days of nausea, emesis, constipation, and abdominal pain. Computed Tomography (CT) demonstrated mucosal thickening of the middescending colon, consistent with fibrosing stricture. Surgical excision revealed an unusual, 5 cm mass originating in the subserosa. Histopathology of the lesion was notable for a proliferation of cells with spindle and stellate-shaped nuclei and no appreciable mitotic figures, which extended into the muscularis and submucosa. Immunohistochemistry was STAT6 nuclear positive and cytoplasmic CD34 positive, diagnostic for solitary fibrous tumor (SFT). In this case, the SFT infiltrating into the muscularis propria and subserosa caused the stricture and bowel obstruction. This illustrates that while fibrosing strictures are usually the etiology of bowel obstruction in the setting of Crohn’s disease, other rare possible causes should be considered.

Computer Assisted Analysis of Oral Antifungal Therapy in Chronic Rhinosinusitis With Airway Mycosis: A Retrospective Cohort Analysis

BACKGROUND: Environmental fungi are etiologically related to chronic rhinosinusitis (CRS) with airway mycosis, but their infectious role remains uncertain in part because of potentially inadequate methods of disease quantitation. OBJECTIVE: To determine objective radiographic and symptomatic outcomes of oral antifungal therapy in adult patients with CRS and airway mycosis using computer assisted analysis. METHODS: We conducted a retrospective study of 65 patients with CRS and culture-proven airway mycosis in a single center referral-based academic practice, comparing paired sinus CT scans and symptom scores prior to and during chronic oral antifungal therapy using computer assisted analysis of sino-mucosal area (CAASMA). A comparator group received standard therapy without antifungals. RESULTS: Administration of antifungals was associated with significantly reduced sinus mucosal thickening as assessed by CAASMA (-6.85% absolute reduction, 95% CI -11.8283 to -1.8717, p<0.005), but not by Lund Mackay score. In contrast, standard care alone was linked by CAASMA to enhanced mucosal thickening (4.14% absolute increase, 95% CI -1.8066 to 10.0866, p<0.005). Thirty of the forty-one antifungal treated patients (73%) showed decreased sinus mucosal burdens while only 21 patients (43%) receiving standard therapy showed improved imaging (OR 11.65, 95% CI 3.2 to 42.2, P<0.05). Nineteen patients (50%) noted improved symptoms at time of follow up CT scan while only 8 patients (20%) on standard therapy improved (OR 6.21, 95% CI 1.7 to 22.7, P<0.05). CONCLUSION: These retrospective findings indicate that oral antifungals can reduce mucosal thickening and improve symptoms in CRS with airway mycosis. Randomized clinical trials are warranted to verify these findings.

Ileal duplication cyst with giant polypoidal gastric heterotropia:

Enteric duplication cysts (EDCs) are congenital malformations of the gastrointestinal tract. EDCs can present as tubular or spherical cystic lesions of the abdomen. The tubular variant of EDC arises as an outpouching from the bowel wall, whereas the spherical variant rarely shows bowel communication. EDCs are known to harbour heterotopic pancreatic parenchyma or gastric mucosa. We present a case of EDC of the ileum (tubular type) with heterotopic gastric mucosa in a 7-year-old child who came with malena and abdominal discomfort. CT revealed focal abnormal dilatation of the ileal loop with polypoidal mucosal thickening. Differential diagnosis of lymphoma, bowel polyps and Meckel’s diverticula with gastric heterotopia (GH) were considered. Subsequent surgery followed by histopathology revealed it to be EDC with GH. We discuss this case to familiarise radiologists with the atypical imaging features of EDC, to prevent misdiagnosis and initiate prompt treatment in appropriate clinical settings.

Association between periodontal status and degree of maxillary sinus mucosal thickening: a retrospective CBCT study

Background It is well known that periodontitis can stimulate thickening of the maxillary sinus mucosa, but the association between periodontitis status and the degree of maxillary sinus mucosal thickening (maxMT) has not been reported. The objectives of this study were to investigate the effect of periodontal status of maxillary molars on the degree of maxMT. Methods Retrospective analysis of cone-beam computed tomographic (CBCT) images of 203 periodontitis cases with maxMT. Parameters related to periodontitis in maxillary molars were measured and recorded on CBCT images. The dimension and length of the maxMT were also recorded. Multiple linear regression analysis was used to identify periodontal factors influencing the severity of maxMT, and multivariate logistic regression analysis was used to identify the odds ratio of these factors. Results The factors affecting the degree of maxMT were mainly the amount of alveolar bone loss (ABL) and the minimum residual alveolar bone height (miniRABH). Compared to mild ABL, severe and moderate ABL were more likely to display severe maxMT. And the lower the miniRABH, the more severe the maxMT. Conclusions The severity of periodontal status of maxillary molars can influence the degree of maxMT.

Sinus Radiological Findings in General Asymptomatic Populations: A Systematic Review of Incidental Mucosal Changes

Objective To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. Data Sources Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles. Review Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis. Results A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%). Conclusion The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.

Tobacco use and clinical leukoplakia lesions among south Indian tribes

Objectives Leukoplakia is a white mucosal thickening and perhaps undermining change in the oral mucosa transcendently found in tobacco users. Since the tobacco utilization is extensively higher with the indigenous groups in the Asia Pacific locale, the current examination implicated the prevalence of tobacco consumption and leukoplakial lesions and the relationship between the two. Methods This cross-sectional study was conducted through six tribal hamlets of Chithalayath Forest range at Wayanad district of Kerala, South India. Leukoplakia screening was led by a senior consultant on the basis of a visual investigation and pathological evaluation was not done. An organized questionnaire was utilized to gather data on demographic details and tobacco usage status and frequency. The prevalence of clinical oral lesions among tobacco users and non users was determined using statistical analysis. Results Clinical oral leukoplakia was diagnosed in 27 (8.5%) subjects among the 317 individuals screened. The prevalence of lesions was considerably higher among tobacco consumers in comparison with non users (11 vs. 3.7%). Also, the tobacco chewers group had a higher percentage of leukoplakia. Another significant finding of this study is that the incidence of provisional leukoplakia was observed to be comparatively high among the most frequent tobacco consumers 15 (65.2%) in comparison with 8 (34.8%) in the frequent and nonfrequent users. Conclusions Prevalence of abusive habits and clinical oral leukoplakial was substantial among the tribes. The cause and effect relationship and dose-response were also shown to have a significant association.

A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography

Background Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. Methods CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. Results Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18–65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. Conclusions The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.