CLINICAL PROFILE OF PATIENTS WITH SINONASAL MASSES - A CROSS SECTIONAL STUDY

It is challenging to diagnose and distinguish sinonasal masses as they can have varying clinical presentations. This study was done to see if sinonasal masses can be detected by clinical symptoms, signs and examination itself without resorting to investigations. This cross sectional study was conducted in the department of Otolaryngology, Government Medical College Thrissur, Kerala for a period of one year from December 2017 to December 2018. Total 104 cases were studied. Most of the sinonasal masses were identied by doing proper anterior and posterior rhinoscopy which don’t require much expertise to master. This can be considered only as a screening because any intervention should be preceded by radiological investigations and biopsy for a denitive management.

The Diagnostic Value of Traditional Nasal Examination Tools in an Endoscopic Era

Background: As the endoscope has become more common in the otolaryngologist’s office, there is a need to reevaluate the value of traditional nasal examination methods. The objective of this study was to determine the sensitivity and specificity of traditional nasal examination tools compared to those of the rigid endoscope. Methods: A prospective diagnostic study was conducted. Eligible patients with nasal symptoms were recruited and examined using 4 tools: (1) a nasal speculum, (2) an otoscope, (3) a posterior rhinoscopy mirror, and (4) a rigid nasal endoscope. The diagnostic value of each tool was evaluated. Results: There were a total of 53 patients eligible for inclusion in the study. The mean age of all patients was 40.9 years. The most common nasal symptom was nasal obstruction (90.6%). With regard to the tools used in anterior rhinoscopy, the nasal speculum had a sensitivity of 54.69% (95% confidence interval [95% CI]: 41.75-67.18) and specificity of 88.10% (95% CI: 74.37-96.02); and the otoscope had a sensitivity of 57.81% (95% CI: 44.82-70.06) and specificity of 85.71% (95% CI: 71.46-94.57). After application of topical anesthesia and decongestant, the nasal speculum had a sensitivity of 67.19% (95% CI: 54.31-78.41) and specificity of 85.71% (95% CI: 71.46-94.57); and the otoscope had a sensitivity of 65.62% (95% CI: 52.70-77.05) and specificity of 83.33% (95% CI: 68.64-93.03). The posterior rhinoscopy mirror had a sensitivity of 12.50% (95% CI: 5.18-24.07) and specificity of 94.00% (95% CI: 83.45-98.75). All adverse events in this study were minor. Conclusion: The traditional nasal examination tools exhibited excellent specificity. However, the sensitivity was only average, meaning that they may not be suitable for screening. We do not recommend routine use of topical anesthesia and decongestants when applying these tools, as the application of these agents did not improve the clinical sensitivity or specificity. The posterior rhinoscopy mirror had a lowest sensitivity. We thus do not recommend using a posterior rhinoscopy mirror to rule out pathologies of the posterior nasal cavity.

Posterior rhinoscopy revisited

Posterior rhinoscopy remains a valuable yet often difficult examination by conventional means. Fibreoptics, although providing an excellent alternative, may not always be available. We have combined a St. Clair Thomson's mirror with a Lack's metallic tongue depressor for ease of examination and patient cooperation. It is possible to examine the nasopharynx with 6 mm, 8 mm, 10 mm and 12 mm mirrors. The instrument may be boiled, is sturdy, economical and extremely useful in paediatric practice.

Dysphagin

Abstracts. Otorhinolaryngology. Dysphagin, according to Kosenbaum'a (D.med. Wroch. 1929, No. 5), is a good pain reliever for diseases of the pharynx and larynx. Due to its pleasant taste and the complete absence of toxicity, it is an irreplaceable pain reliever. The main components of dysphagin are the essence: Tutocain, Anasthesin aa 0.1 Menthol 0.005. The author used dysphagia in people who are difficult to posterior rhinoscopy and laryngoscopy.