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Le Normand F, Djennaoui I, Debry C, Fath L. Inferior turbinate lateralization. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:173-176. [PMID: 37872042 DOI: 10.1016/j.anorl.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.
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Affiliation(s)
- F Le Normand
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
| | - I Djennaoui
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France
| | - C Debry
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France; Unité Inserm 1121, Biomatériaux et Bioingénierie, Centre de Recherche en Biomédecine de Strasbourg, 1, rue Eugène Boeckel, 67000 Strasbourg, France
| | - L Fath
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France; Unité Inserm 1121, Biomatériaux et Bioingénierie, Centre de Recherche en Biomédecine de Strasbourg, 1, rue Eugène Boeckel, 67000 Strasbourg, France
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Kokavec A, Zahabi S, Rocha T, Rotenberg BW, Sowerby LJ. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08655-4. [PMID: 38652299 DOI: 10.1007/s00405-024-08655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. METHODS A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. RESULTS 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. CONCLUSION Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.
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Affiliation(s)
- Andrew Kokavec
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Yong M, Aravinthan K, Kirubalingam K, Thamboo A, Hwang PH, Nadeau K, Walgama E. In Response to Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis. Laryngoscope 2024; 134:E14-E15. [PMID: 38153190 DOI: 10.1002/lary.31247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Michael Yong
- Pacific Neuroscience Institute, Santa Monica, California, U.S.A
| | - Kaishan Aravinthan
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Andrew Thamboo
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai, Los Angeles, California, U.S.A
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Rigaut C, Deruyver L, Niesen M, Vander Ghinst M, Goole J, Lambert P, Haut B. What Are the Key Anatomical Features for the Success of Nose-to-Brain Delivery? A Study of Powder Deposition in 3D-Printed Nasal Casts. Pharmaceutics 2023; 15:2661. [PMID: 38140002 PMCID: PMC10747338 DOI: 10.3390/pharmaceutics15122661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Nose-to-brain delivery is a promising way to improve the treatment of central nervous system disorders, as it allows the bypassing of the blood-brain barrier. However, it is still largely unknown how the anatomy of the nose can influence the treatment outcome. In this work, we used 3D printing to produce nasal replicas based on 11 different CT scans presenting various anatomical features. Then, for each anatomy and using the Design of Experiments methodology, we characterised the amount of a powder deposited in the olfactory region of the replica as a function of multiple parameters (choice of the nostril, device, orientation angle, and the presence or not of a concomitant inspiration flow). We found that, for each anatomy, the maximum amount of powder that can be deposited in the olfactory region is directly proportional to the total area of this region. More precisely, the results show that, whatever the instillation strategy, if the total area of the olfactory region is below 1500 mm2, no more than 25% of an instilled powder can reach this region. On the other hand, if the total area of the olfactory region is above 3000 mm2, the deposition efficiency reaches 50% with the optimal choice of parameters, whatever the other anatomical characteristics of the nasal cavity. Finally, if the relative difference between the areas of the two sides of the internal nasal valve is larger than 20%, it becomes important to carefully choose the side of instillation. This work, by predicting the amount of powder reaching the olfactory region, provides a tool to evaluate the adequacy of nose-to-brain treatment for a given patient. While the conclusions should be confirmed via in vivo studies, it is a first step towards personalised treatment of neurological pathologies.
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Affiliation(s)
- Clément Rigaut
- Transfers Interfaces and Processes (TIPs), École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium; (P.L.); (B.H.)
| | - Laura Deruyver
- Laboratoire de Pharmacie Galénique et Biopharmacie, Faculté de Pharmacie, Université Libre de Bruxelles, 1050 Brussels, Belgium; (L.D.); (J.G.)
| | - Maxime Niesen
- Department of Ear, Nose and Throat and Cervico-Facial Surgery, CUB Hôpital Erasme, Hôpital de Bruxelles (HUB), 1070 Brussels, Belgium; (M.N.); (M.V.G.)
| | - Marc Vander Ghinst
- Department of Ear, Nose and Throat and Cervico-Facial Surgery, CUB Hôpital Erasme, Hôpital de Bruxelles (HUB), 1070 Brussels, Belgium; (M.N.); (M.V.G.)
| | - Jonathan Goole
- Laboratoire de Pharmacie Galénique et Biopharmacie, Faculté de Pharmacie, Université Libre de Bruxelles, 1050 Brussels, Belgium; (L.D.); (J.G.)
| | - Pierre Lambert
- Transfers Interfaces and Processes (TIPs), École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium; (P.L.); (B.H.)
| | - Benoit Haut
- Transfers Interfaces and Processes (TIPs), École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium; (P.L.); (B.H.)
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Cergan R, Berghi ON, Dumitru M, Vrinceanu D, Manole F, Serboiu CS. Biologics for Chronic Rhinosinusitis-A Modern Option for Therapy. Life (Basel) 2023; 13:2165. [PMID: 38004305 PMCID: PMC10672088 DOI: 10.3390/life13112165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is an important ENT pathology which affects about 5-12% of the general population. The treatment of CRS can be pharmacological (nasal sprays, douches, systemic antibiotics and steroids), surgical (endoscopic sinus surgery) or immunological according to established algorithms. CRS was divided for many years into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). New ways of classifying CRS by endotypes (presence of neutrophilia, eosinophilia, fibrosis, glandular hypertrophy and epithelial dysmorphisms) appeared after the most recent understandings of the pathophysiology of the disease. Other classifications divide CRS into primary and secondary forms, localized/diffuse types and anatomical presentation. A new type of treatment has been administered in the last years, biologics. For the moment, biologics are indicated just in the cases of the patients who have undergone ESS or have contraindications for surgery and have bilateral polyps and meet a minimum of three of the following criteria: the necessity for systemic therapies with oral or parenteral corticosteroids or contraindications to systemic steroids, significant loss of smell or impaired QoL score, comorbid asthma and type 2 inflammation. This article aims to present the most relevant studies which used the three types of biologics (anti-IgE, anti-IL5 and anti-IL4/IL3) and wishes to increase the awareness of this new type of treatment that can be used in some CRS cases.
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Affiliation(s)
- Romica Cergan
- Anatomy Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Ovidiu Nicolae Berghi
- Saint Mary Laboratories and Clinics, Carol Davila University of Medicine and Pharmacy, 011013 Bucharest, Romania;
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Felicia Manole
- ENT Department, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania;
| | - Crenguta Sorina Serboiu
- Cellular Biology and Histology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Alves de Sousa F, Santos M, Casanova M, Nóbrega Pinto A, Gonçalves Ferreira M, Meireles L, Coutinho MB. Pediatric inferior turbinate surgery: A review and meta-analysis of midterm nasal patency. Int J Pediatr Otorhinolaryngol 2023; 172:111661. [PMID: 37480809 DOI: 10.1016/j.ijporl.2023.111661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The surgical treatment of children with enlarged inferior turbinates is still controversial. Foundational evidence for indicating turbinoplasty is still scarce, and there is a myriad of proposed techniques. This work aimed to address the midterm nasal obstruction outcomes of pediatric inferior turbinate surgery. MATERIAL AND METHODS A Literature search across PUBMED and Cochrane collaboration databases was undertaken, using the MeSH terms: turbinates, nasal obstruction, surgery, and children. Articles focusing on turbinate surgery with an exclusively pediatric cohort were included. The minimum follow-up time for inclusion was set at four months, and only the latest available follow-up in each study was considered. All the integrated studies used objective instruments to quantify nasal obstruction before and after surgery. A comprehensive review and meta-analysis were performed to assess nasal outcomes after the intervention. The 95% confidence interval of the effect magnitude for each study was calculated to elucidate effect sizes. RESULTS Seven studies met the inclusion criteria for review, and five were included in the meta-analysis, accounting for a total of 510 patients. The follow-up period ranged from 4 months to 1 year. Pooled results showed that nasal patency was significantly improved after surgery (p < 0.001) in the midterm follow-up. No significant differences were found between bone-sparing and bone-removal procedures (p = 0.38). CONCLUSION This is the first meta-analysis to address midterm results of pediatric turbinate surgery. Our results suggest a positive impact of inferior turbinate surgery on nasal patency, irrespective of technique.
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Affiliation(s)
- Francisco Alves de Sousa
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Mariline Santos
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Maria Casanova
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Ana Nóbrega Pinto
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Miguel Gonçalves Ferreira
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Luís Meireles
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Miguel Bebiano Coutinho
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
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Mowery AJ, Razavi CR. Functional nasal surgery in the office-based setting. World J Otorhinolaryngol Head Neck Surg 2023; 9:236-241. [PMID: 37780672 PMCID: PMC10541160 DOI: 10.1002/wjo2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/24/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Nasal obstruction is a very common problem often addressed by functional nasal surgery. Increasingly, these procedures are being performed in the office setting secondary to decreased down time, cost, and obviation of general anesthesia. Our goal with this review is to discuss how to appropriately select patients for office-based procedures, what procedures may be considered, and current outcomes with in-office functional nasal surgery. Data Sources PubMed, Scopus, Google Scholar. Methods Research databases were searched for articles discussing techniques for performing functional nasal surgery in an office setting, and outcomes of various in-office functional nasal procedures. Results Studies found and included in this review discuss many aspects of office-based functional nasal surgery, including practical points on patient selection and office set-up, what procedures can safely be performed, and outcomes of different techniques to address specific problems. Broadly, procedures amenable to performance in the office address the internal and external nasal valves, the nasal septum, and the inferior turbinates. Conclusion A wide range of techniques to aaddress the nasal valves, septum, and inferior turbinates can be performed in a safe and effective manner without the need for an operative suite.
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Affiliation(s)
- Alia J. Mowery
- Department of OtolaryngologyJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Christopher R. Razavi
- Department of Otolaryngology, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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Agarwal M, Lobo R, Srinivasan A. Postoperative Imaging Appearances of the Paranasal Sinuses. Semin Roentgenol 2023; 58:248-260. [PMID: 37507167 DOI: 10.1053/j.ro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Froedtert and Medical College of Wisconsin, Milwaukee, WI.
| | - Remy Lobo
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
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Abdul Latiff AH, Husain S, Abdullah B, Suppiah P, Tan V, Ing Ping T, Woo K, Yap YY, Bachert C, J Schunemann H, Bedbrook A, Czarlewski W, Bousquet J. ARIA Care Pathways 2019: Next-Generation Allergic Rhinitis Care and Allergen Immunotherapy in Malaysia. J Pers Med 2023; 13:jpm13050835. [PMID: 37241005 DOI: 10.3390/jpm13050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
An increase in the prevalence of allergic rhinitis (AR) worldwide presents a significant burden to the health care system. An initiative was started in Europe designated as Allergic Rhinitis and Its Impact on Asthma (ARIA) to develop internationally applicable guidelines by utilising an evidence-based approach to address this crucial issue. The efforts are directed at empowerment of patients for self-management, the use of digital mobile technology to complement and personalise treatment, and establishment of real-life integrated care pathways (ICPs). This guideline includes aspects of patients' and health care providers' management and covers the main areas of treatment for AR. The model provides better real-life health care than the previous traditional models. This review summarises the ARIA next-generation guideline in the context of the Malaysian health care system.
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Affiliation(s)
- Amir Hamzah Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Jalan Bukit Pantai, Taman Bukit Pantai, Kuala Lumpur 59100, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Palaniappan Suppiah
- Otorhinolaryngology, Gleneagles Hospital Penang, 1, Jalan Pangkor, George Town 10050, Malaysia
| | - Vincent Tan
- Otorhinolaryngology, KPJ Klang Specialist Hospital, Persiaran Rajawali, Bandar Baru Klang, Klang 41150, Malaysia
| | - Tang Ing Ping
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kota Samarahan 94300, Malaysia
| | - Kent Woo
- Allergy & Immunology Clinic, Gleneagles Hospital Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur 50450, Malaysia
| | - Yoke-Yeow Yap
- Otorhinolaryngology, KPJ Johor Specialist Hospital, 39B Jalan Abdul Samad, Johor Bahru 80100, Malaysia
| | - Claus Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, 48149 Münster, Germany
- International Airway Research Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, 9000 Ghent, Belgium
| | - Holger J Schunemann
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | | | - Wienczyslawa Czarlewski
- ARIA & MASK-air, 34090 Montpellier, France
- Medical Consulting Czarlewski, 92300 Levallois, France
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany
- University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
- Inserm Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
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Manimaran V, Babu DM, Lakshmanan S, Palanisamy T. Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:973-977. [PMID: 37206707 PMCID: PMC10188758 DOI: 10.1007/s12070-023-03491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023] Open
Abstract
Aim To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. Materials and Methods We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. Results A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. Conclusion This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Divya Macherla Babu
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Somu Lakshmanan
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Thirunavukarasu Palanisamy
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Efficacy of various surgical methods in the treatment of allergic rhinitis: A network meta-analysis. Allergol Immunopathol (Madr) 2023; 51:137-147. [PMID: 36916099 DOI: 10.15586/aei.v51i2.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/02/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE We often use surgery to treat allergic rhinitis (AR) patients who have failed drug treatment, but there is currently no clear gold standard for the treatment of allergic rhinitis. Using network meta-analysis, we evaluated the efficacy of different surgical methods in the treatment of AR. METHODS PubMed, Embase, The Cochrane Library, Web of Science, CBM, Wan Fang Data, and CNKI databases were searched to collect clinical randomized controlled trials of AR with different surgical methods that met the inclusion criteria. After two investigators independently screened literature, extracted data, and assessed the risk of bias of included studies, R software was used to evaluate inconsistency using the node splitting method, and Stata15.1 was used to estimate the ranking probability of treatment. RESULTS A total of 47 randomized control studies involving 17 surgical schemes and 4144 participants were included. The results showed that after excluding surgical methods that did not form a closed loop, in AR patients without chronic rhinosinusitis and nasal polyps, surgical efficiency and symptom score ranked the same, which were posterior nasal neurectomy (PNN), Vidian neurectomy (VN), anterior ethmoid neurectomy (AEN), nasal septal reconstruction (NSR), and bilateral inferior turbinoplasty (BIT). In AR patients with chronic rhinosinusitis with nasal polyps, the effective rate (OR = 5.06; 95% CI = 2.75-9.32) and symptom and sign scores (MD = -3.80; 95% CI = -6.50-1.09) of PNN + FESS (functional endoscopic sinusitis surgery) were higher than FESS, and there was a significant difference. CONCLUSION Our findings suggest that PNN is the best single operation for patients with AR and without chronic rhinosinusitis and nasal polyps, and the combination of multiple procedures may be better than a single operation. FESS + PNN is more effectual in AR patients with chronic rhinosinusitis with nasal polyps.
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Muacevic A, Adler JR, Cazzaniga J, Bhandarkar ND. Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease. Cureus 2023; 15:e34280. [PMID: 36855496 PMCID: PMC9968500 DOI: 10.7759/cureus.34280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.
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Muacevic A, Adler JR, Ntarladima V, Catalli B, Kosmidou A, Filippou D, Georgalas C. Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques. Cureus 2022; 14:e32579. [PMID: 36654608 PMCID: PMC9840750 DOI: 10.7759/cureus.32579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common cause of nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatment is often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The study was performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens. The study population comprised 205 patients that underwent surgery and were monitored in the hospital. Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery, postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16 patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operatively and 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24), 16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.
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Muacevic A, Adler JR, Simmen D. Pyriform Turbinoplasty and Lateral Nasal Wall Lateralization: Practical Hints on How We Do It. Cureus 2022; 14:e32584. [PMID: 36654570 PMCID: PMC9841554 DOI: 10.7759/cureus.32584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Pyriform turbinoplasty (PT) is a surgical option for the management of turbinate hypertrophy. The philosophy and goal of the procedure are to improve the symptoms of a restricted airway while preserving function. We report a case of surgical management of inferior turbinate (IT) hypertrophy with PT and lateral nasal wall lateralization (LNWL). PT and LNWL improve nasal airflow, providing a wider nasal cavity by the removal of the bone of the IT. Sustained symptomatic improvement has been documented and is less susceptible to the influence of turbinate hypertrophy with other techniques.
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15
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Nagarajah D, Kueh YC, Lazim NM, Abdullah B. The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis. Syst Rev 2022; 11:246. [PMID: 36401259 PMCID: PMC9675124 DOI: 10.1186/s13643-022-02113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. METHODS An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. RESULTS A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD - 0.51, 95% CI - 0.84 to - 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD - 9.02, 95% CI - 11.76 to - 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD - 56.4, 95% CI - 57.30 to - 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD - 0.60, 95% CI - 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). CONCLUSIONS The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. TRIAL REGISTRATION PROSPERO registration number: CRD42019117083.
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Affiliation(s)
- Darshini Nagarajah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Unit Biostatistic and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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16
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Zhang K, Pipaliya RM, Miglani A, Nguyen SA, Schlosser RJ. Systematic Review of Surgical Interventions for Inferior Turbinate Hypertrophy. Am J Rhinol Allergy 2022; 37:110-122. [DOI: 10.1177/19458924221134555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique. Objective This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques. Methods PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT). Results A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery. All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3–6 months follow-up. Conclusions All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year.
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Affiliation(s)
- Kathy Zhang
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Royal M. Pipaliya
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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17
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Kanesan N, Norhayati MN, Hamid SSA, Abdullah B. Microdebrider-assisted inferior turbinoplasty versus other surgical techniques. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:415-426. [PMID: 36541379 DOI: 10.14639/0392-100x-n1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
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18
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Bin Lajdam G, Alaryani K, Ghaddaf AA, Aljabri A, Halawani A, Alshareef M, Algarni M, Al-Hakami H. Septoplasty versus septoplasty with turbinate reduction for nasal obstruction due to deviated nasal septum: a systematic review and meta-analysis. Rhinology 2022; 60:411-420. [PMID: 36150153 DOI: 10.4193/rhin22.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Compensatory inferior turbinate hypertrophy is a common accompanying manifestation in patients with nasal obstruction due to deviated nasal septum (DNS). The grounds for inferior turbinate reduction (ITR) in this population are still not well established. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of septoplasty with ITR versus septoplasty alone. METHODS Computerised search in Medline, Embase, and CENTRAL was performed. Eligible for inclusion were randomised controlled trials (RCTs) comparing septoplasty to septoplasty with unilateral, contralateral, ITR in adults with DNS. Primary outcomes were health-related quality of life and nasal patency. The secondary outcome was the occurrence of adverse events. Standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS Twelve RCTs that enrolled 775 participants were found eligible. Data were reported at follow-up periods ranging from 1 month to 48 months. The pooled effect estimate showed a statistically significant improvement with unilateral, contralateral, ITR in Nasal Obstruction Symptom Evaluation scale (NOSE) scores. The rate of adverse events was significantly higher with ITR. CONCLUSIONS Unilateral reduction of the hypertrophied contralateral inferior turbinate during septoplasty resulted in better subjective relief of nasal obstruction in adults with DNS than septoplasty alone. However, caution is warranted since only few well-designed RCTs were identified.
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Affiliation(s)
- G Bin Lajdam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - K Alaryani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Aljabri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Halawani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - M Alshareef
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - M Algarni
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Al-Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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19
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Shetty S, Al-Bayatti S, Alam MK, Al-Rawi NH, Kamath V, Tippu SR, Narasimhan S, Al Kawas S, Elsayed W, Rao K, Castelino R. Analysis of inferior nasal turbinate volume in subjects with nasal septum deviation: a retrospective cone beam tomography study. PeerJ 2022; 10:e14032. [PMID: 36172494 PMCID: PMC9511997 DOI: 10.7717/peerj.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate.
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Affiliation(s)
- Shishir Shetty
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Saad Al-Bayatti
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Natheer H. Al-Rawi
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Vinayak Kamath
- Department of Public Health Dentistry, Goa Dental College, Goa, India
| | - Shoaib Rahman Tippu
- Department of Diagnostic and Surgical Dental Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Sangeetha Narasimhan
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Walid Elsayed
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Kumuda Rao
- Department of Oral Medicine and Radiology, Nitte (Deemed to be University), Mangalore, India
| | - Renita Castelino
- Department of Oral Medicine and Radiology, Nitte (Deemed to be University), Mangalore, India
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Sheik-Ali S, Ellis S, Bondin D. Scarring of the Eustachian tube: an unusual presentation following septoplasty and inferior turbinate reduction. Ann R Coll Surg Engl 2022; 104:e236-e238. [PMID: 35446169 PMCID: PMC9433198 DOI: 10.1308/rcsann.2021.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 09/03/2023] Open
Abstract
Septoplasty and inferior turbinate reduction is a common operation performed by ear, nose and throat surgeons for obstructive nasal symptoms. We present a case of complete unilateral scarring of the Eustachian tube orifice, a previously unreported complication, following septoplasty and inferior turbinate reduction for nasal obstruction. It is important to consider this differential diagnosis in patients presenting with unilateral middle ear effusion postoperatively.
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Affiliation(s)
| | - S Ellis
- Tameside and Glossop Integrated Care NHS Foundation Trust, UK
| | - D Bondin
- Tameside and Glossop Integrated Care NHS Foundation Trust, UK
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21
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Gelardi M, Giancaspro R, Bocciolini C, Salerni L, Cassano M. Turbinate surgery: which rhinitis are most at risk. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022249. [PMID: 36043980 PMCID: PMC9534261 DOI: 10.23750/abm.v93i4.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs. Methods: The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients. RESULTS Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a "pure" allergy. NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively. CONCLUSION Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology.
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Affiliation(s)
- Matteo Gelardi
- Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Rossana Giancaspro
- Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Corso Bocciolini
- Department of Otolaryngology-Head and Neck Surgery, Maggiore Hospital, Bologna, Italy
| | - Lorenzo Salerni
- Department of Otolaryngology, University Hospital of Siena, Siena, Italy
| | - Michele Cassano
- Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy
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22
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Ciprandi G, Tosca MA. Turbinate Hypertrophy, Allergic Rhinitis, and Otitis Media. Curr Allergy Asthma Rep 2021; 21:44. [PMID: 34591196 DOI: 10.1007/s11882-021-01021-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Otitis media (OM) is a disease with high prevalence in infancy; it has a substantial burden on healthcare resources, and a relevant impact on the quality of life of families. The link between OM and allergic rhinitis (AR) is still debated. However, there is agreement about the relevance of type 2 inflammation on turbinate hypertrophy (TH) generation. There is also evidence that TH is associated with middle ear dysventilation: a pathogenic factor promoting OM. Therefore, a vicious circle among AR, TH, and OM may occur. RECENT FINDINGS There are some recent studies exploring this issue through different approaches, such as epidemiological, mechanistic, and therapeutic. Identifying allergy as a pathogenic factor for OM could improve the management of OM patients. Vice versa, suspecting AR in OM patients, could be reasonable in selected patients. The current narrative review provides an overview of the evidence concerning the potential role of AR, and associated TH, in OM patients.
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23
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Ciprandi G, Tosca MA. Turbinate Hypertrophy, Allergic Rhinitis, and Otitis Media. Curr Allergy Asthma Rep 2021; 21:40. [PMID: 34390424 DOI: 10.1007/s11882-021-01016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Otitis media (OM) is a disease with high prevalence in infancy; it has a substantial burden on healthcare resources and a relevant impact on the quality of life of families. The link between OM and allergic rhinitis (AR) is still debated. However, there is agreement about the relevance of type 2 inflammation on turbinate hypertrophy (TH) generation. There is also evidence that TH is associated with middle ear dysventilation: a pathogenic factor promoting OM. Therefore, a vicious circle among AR, TH, and OM may occur. RECENT FINDINGS There are some recent studies exploring this issue through different approaches, such as epidemiological, mechanistic, and therapeutic. Identifying allergy as a pathogenic factor for OM could improve the management of OM patients. Vice versa, suspecting AR in OM patients could be reasonable in selected patients. The current narrative review provides an overview of the evidence concerning the potential role of AR, and associated TH, in OM patients.
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Affiliation(s)
- Giorgio Ciprandi
- , Allergy Clinic, Casa di Cura Villa MontallegroVia P. Boselli 5, 16146, Genoa, Italy.
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