Nasal Disorders

Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.

Tongue Flap for Closure of Complex Oronasal Fistula

Complex oronasal fistula is one of the most frequent secondary complications of cleft palate correction and is considered a reconstructive challenge. Tongue flaps are one of the procedures for the treatment of complex fistulas associated or not with multiple previous procedures, offering a high success rate, few complications, and problems during its development. This study evaluates the efficacy in terms of functionality, esthetic, donor area morbidity and clarifies surgical technique steps. Descriptive cohort study was performed between August 2011 to August 2021 where an anteriorly based dorsal tongue flap was performed in 30 patients with complex palatal fistulas, evaluating outcomes in terms of technique reproducibility and flap viability, correction of oronasal regurgitation, speech, donor site morbidity, complications, and esthetics. The senior author has used this technique with consistent clinical outcomes to improve complex oronasal fistula with minimal complications, with a good success rate in terms of correction of the palatal defect with imperceptible alteration of the lingual donor area. In addition, establishes a specific definition of persistence and recurrence of oronasal fistula. The tongue flap is considered the gold standard in complex oronasal fistula reconstructions with satisfactory outcomes, and it offers an adequate amount of vascularized tissue achieving fistula closure without functional or esthetic impairment of the donor area and is a highly reproducible technique.

Secondary correction of nasal deformities in cleft lip patients using acellular dermal matrix grafting on the nasal tip with open rhinoplasty

Secondary nasal deformities in patients with unilateral cleft lip represent surgical challenges. Open rhinoplasty involving repositioning of the lower lateral cartilage has been shown to be a suitable technique for patients with cleft lip and nose deformities. This study aimed to explore a particular method of rhinoplasty and to assess the aesthetic outcomes for secondary unilateral cleft lip and nose deformities following its use. Fifty-seven patients treated for secondary unilateral cleft lip nasal deformities from January 2012 to December 2018 were enrolled in the study. Open rhinoplasty combined with a reverse-U incision and acellular dermal matrix grafting on the nasal tip was performed in all patients by the same surgeon. In our follow-up study we evaluated the results by measuring angles on photographs and scoring the appearance before and after operation. Data were statistically analysed using the t test. Appearances were improved in all patients. Both the alar base-nasal tip-columellar base angle and the nostril axis angles were smaller postoperatively (p < 0.001). According to the outcome scores, most patients (53/57) agreed that there was an obvious improvement in the appearance of their noses following surgery, and overall they were satisfied with the results of the revision procedure. A distinct improvement in nasal appearance can be achieved with this rhinoplasty. Our surgical method is effective and reliable in patients with secondary unilateral cleft lip and nose deformities, and is worth promoting in the clinic.

Effect of oral Xiao-xian decoction combined with acupoint application therapy on pediatric adenoid hypertrophy: A randomized trial

BACKGROUND

This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH).

METHODS

We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life.

RESULTS

The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment.

CONCLUSION

Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.

Acupuncture for nasal congestion in COVID-19: A protocol for systematic review and meta-analysis

BACKGROUND

From the end of 2019 to now, coronavirus disease 2019 (COVID-19) has put enormous strain on the world's health systems, causing significant deaths and economic losses worldwide. Nasal congestion, one of the symptoms of COVID-19, poses considerable problems for patients. In China, acupuncture has been widely used to treat nasal congestion caused by COVID-19, but there is still a lack of evidence-based medical evaluation.

METHODS

According to the retrieval strategies, randomized controlled trials on the acupuncture for COVID-19 nasal congestion were obtained from China National Knowledge Infrastructure, WanFang, VIP, PubMed, Embase, and Cochrane Library, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using Review Manager (RevMan 5.3) and STATA 14.2 software. Ultimately, the evidentiary grade for the results will be evaluated.

RESULTS

The study will provide a high-quality and convincing assessment of the efficacy and safety of acupuncture in the treatment of COVID-19's nasal congestion and will be published in peer-reviewed journals.

CONCLUSION

Our findings will provide references for future clinical decision and guidance development.

PROSPERO REGISTRATION NUMBER

NO.CRD42021299482.

Risk factors associated with obstructive sleep apnea-hypopnea syndrome in Chinese children: A single center retrospective case-control study

Pediatric obstructive sleep apnea-hypopnea syndrome is caused by multiple factors. The present study aimed to investigate the potential risks of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their correlation with the disease severity. A total of 338 pediatric patients with OSAHS (polysomnography (PSG) diagnosis) were enrolled between June 2008 and October 2010. These pediatric patients were divided into mild, moderate and severe subgroups according to the obstructive apnea index (OAI) and/or apnea hypoventilation index (AHI). A total of 338 pediatric patients with vocal nodules who were without obstruction of the upper respiratory tract were enrolled as the control group. The patients were analyzed retrospectively. The average number of upper respiratory tract infections each year and tonsil hypertrophy, adenoid hypertrophy, positive serum tIgE, chronic sinusitis, nasal stenosis, craniofacial features and obesity were significantly higher in OSAHS compared with controls (P<0.01). The parameters the average number of upper respiratory tract infections each year (OR: 1.395, 95% CI: 1.256–1.550), adenoid hypertrophy (OR: 8.632, 95% CI: 3.990–18.672), tonsil hypertrophy (OR: 9.138, 95% CI: 4.621–18.073), nasal stenosis (8.023, 95% CI: 3.633–17.717) and chronic sinusitis (OR: 27.186, 95% CI: 13.310–55.527) were independent factors of pediatric OSAHS (P<0.01). The distribution of chronic sinusitis, nasal stenosis, craniofacial features and obesity indicated a gradual increasing trend in the severity of OSAHS (P<0.01). Number of upper respiratory tract infections per year, adenoid hypertrophy, tonsil hypertrophy, chronic sinusitis, nasal stenosis, infections, allergic reactions, craniofacial features and obesity may be potential risk factors of pediatric OSAHS.

The characteristic of asthma control among nasal diseases population: Results from a cross-sectional study

Asthma affects a large number of patients in China, but comprehensive evaluation of risks associated with poor asthma control in asthmatic patients with nasal diseases was still limited. We conducted this study to provide a comprehensive estimate of asthma control in Chinese asthma patients with combined nasal diseases, to explore the effect of kinds of nasal diseases on the asthma control, and to identify risk factors associated with uncontrolled asthmatic patients with combined nasal diseases. 1756 asthma patients concomitant with nasal diseases aged ≥17 years and representing all regions of mainland China were surveyed. Multivariate logistic regression model with all related demographic characteristics and disease characteristics factors entered was used to identify risk factors associated with uncontrolled asthma. 56.4% of asthmatic patients with combined allergic rhinitis or rhinosinusitis or rhinopolyp remained uncontrolled. Concomitant without allergic rhinitis, younger age, better treatment adherence and higher education level might positively impact asthma control among asthmatic patients with combined nasal diseases. Perennial allergic rhinitis (OR = 1.5, P = 0.021), moderate-severe allergic rhinitis (OR = 2.2, P = 0.001) were all found to significantly increase the risk of uncontrolled asthma among asthma patients with combined allergic rhinitis. The high prevalence of uncontrolled asthma indicates that asthma management among adult Chinese asthmatic patients comorbid with nasal disease is still a challenge. Efforts should be made to raise the awareness of asthma management and to provide sufficient treatment will greatly contribute to improved quality of asthma management. It is possible to minimize the influence of allergic rhinitis on asthma control by improving nasal function, especially for more severe allergic rhinitis and perennial allergic rhinitis.

Three scenarios of nasal obstruction revealing sarcoidosis

The nasal location of sarcoidosis is rare. In this regard, we report three observations of sarcoidosis observed in three women with an average age of 53.6 years, revealed by annoying nasal manifestations. The presence of extra-nasal sites allowed us to suspect the diagnosis of sarcoidosis in all the patients.

Congenital nasal obstruction in infants: A retrospective study and literature review

OBJECTIVES

To identify etiologies of congenital nasal obstruction and describe clinical practice patterns in the evaluation, diagnosis, and treatment of symptomatic infants.

METHODS

An electronic chart review from 1/1/2006-10/1/2016 for all patients with a diagnosis of nasal obstruction within the first six months of life using ICD-9 and 10 codes 478.19 and J34.89.

RESULTS

A total of 34 patients were evaluated by the Division of Otolaryngology for this chief complaint. 38% of neonates were born premature and 32% were admitted to the NICU at birth, with a female-to-male ratio of 1:1.4. Presenting signs and symptoms included: stertor (44%), cyanosis (24%), stridor (24%), retractions (21%), rhinorrhea (21%), apnea (12%), and epistaxis (8%). 47% of patients received ancillary radiographic imaging (CT or MRI). Diagnoses observed include: midnasal stenosis (38%), pyriform aperture stenosis (21%), choanal stenosis (12%), dacryocystocele (6%), microrhinia (6%), septal deviation (6%), nasopharyngeal reflux (3%), nasopharyngeal teratoma (3%), neonatal rhinitis (3%), and pharyngeal wall collapse (3%). 71% of patients were noted to have bilateral nasal obstruction. 41% of infants were found to have an associated ear, nose, and throat anomaly. 15% of patients required surgical intervention. The mean time-to-resolution was 240 days.

CONCLUSION

Congenital nasal obstruction has a broad differential diagnosis: the timing, onset, and laterality of symptoms can provide insights into the source of upper airway compromise. Most infants improve through conservative management (i.e. suctioning, humidification) and medical therapies (i.e. intranasal drops, nasal sprays).

Comprehensive surgical. Orthodontic treatment of class III malocclusion in cleft patient involving minimally invasive surgery Case report and literature review

AIM

Surgical and orthodontic treatment of a teenage cleft patient.

CASE REPORT

Authors describe the case of a 13 year old female cleft patient presented with class III malocclusion RESULT: The patient underwent comprehensive surgical secondary bone grafting and orthodontic treatment. Stable skeletal and occlusal class I relationship was achived and maintained in the post treatment observation period till the age of 16.

DISCUSSION

Although several authors suggests primary gingivoperiosteoplasty, other advocates that such early intervention can cause later restrictions in maxillary growth. For alveolar reconstruction, maxillary growth and dental age were the main considerations in determining the timing of surgical intervention.

CONCLUSION

This case showed that borderline cases of complex dentoalveolar and skeletal anomaly in cleft patients could be successfully treated with comprehensive secondary bone grafting and orthodontic treatment thus avoiding the need for orthognatic surgery.

KEY WORDS

Alveolar bone grafting, Cleft, Malocclusion.

Outbreak of Methicillin-Resistant Staphylococcus aureus Colonization and Infection in a Neonatal Intensive Care Unit Epidemiologically Linked to a Healthcare Worker With Chronic Otitis

Objective.

To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).

Design.

Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).

Setting.

Level III NICU in a tertiary care center.

Participants.

Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.

Interventions.

Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.

Results.

Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.

Conclusion.

An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.

[The tongue and ventilation: a recipe for failure?]

Since publication of the studies by the functionalist school (Ricketts, Linder-Aronson, Gola...), the role of function, and ventilation in particular, appears to be taken more widely into account. The close interconnection of ventilation / growth / lingual function and malocclusion is now evident to all. However, although an ENT diagnosis of a ventilation defect and its etiology is now standard practice, treatment of the condition is not always sufficient to ensure a functional environment conducive to orthodontic stability, even when rehabilitation is prescribed. In some instances, certain highly-invasive surgical treatments can even exacerbate the initial situation.

Bilateral dacryocystocele with an intranasal cyst as the cause of respiratory distress in a newborn

A congenital dacryocystocele with an intranasal cyst is an uncommon lesion that is usually treated by ophthalmologists, although sometimes an otorhinolaryngologist is consulted first because of nasal obstruction. The nasal cavity is narrow in newborns and can easily be obstructed, even by small lesions. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding, since newborns are obligate nose breathers. Here we report a case of bilatera dacryocystocele with intranasal extension in a 3-day-old female infant. The infant presented with respiratory distress and episodic desaturation and was managed successfully by bilateral endoscopic marsupialization of the intranasal cysts. This case report discusses the diagnosis and management and reviews the relevant literature. These finding suggest tha congenital dacryocystocele with an intranasal cyst must be considered in the differential diagnosis of newborns suffering from nasal respiratory difficulty.

Pre-operative effects of the administration of systemic corticosteroids combined with antibiotics on a lobular capillary hemangioma in the nasal cavity

Lobular capillary hemangiomas (LCHs), also known as pyogenic granulomas, are benign, rapidly growing hemorrhagic lesions that usually develop in the oral or nasal cavities. In adults, LCHs occur in <5% of all pregnant women. A 30-year-old woman presented with a 4-month history of right-sided nasal obstruction and recurrent epistaxis 2 months post-partum. A fragile, pink-red lobulated tumor existed in the anterior portion of the right inferior turbinate; the biopsy revealed a LCH. Although the patient declined surgery using an external approach, treatment with systemic corticosteroids combined with antibiotics resulted in tumor regression and an endoscopic en bloc resection was possible. No recurrence has been noted to date (>1 year after surgery). Pre-operative treatment with systemic corticosteroids combined with antibiotics may be useful to induce tumor regression and to excise the lesion completely with an endoscopic approach.

Nasal chondromesenchymal hamartoma causing sleep-disordered breathing in an infant

Nasal chondromesenchymal hamartoma is an extremely rare neoplasm of the nasal and paranasal sinuses. We present the case of a 10-month-old boy with a huge nasal chondromesenchymal hamartoma that was complicated by sleep-disordered breathing. The mass was completely resected by image-guided endoscopic surgery and confirmed histopathologically as a chondromesenchymal hamartoma. In this report, we discuss the characteristics and treatment of this unusual tumor.

Extended followup of a cohort of chromium production workers

BACKGROUND

The current study evaluates the mortality of 2,354 workers first employed at a Baltimore chromate production plant between 1950 and 1974.

METHODS

The National Death Index (NDI Plus) was used to determine vital status and cause of death. Cumulative chromium (VI) exposure and nasal and skin irritation were evaluated as risk factors for lung cancer mortality.

RESULTS

There are 91,186 person-years of observation and 217 lung cancer deaths. Cumulative chromium (VI) exposure, nasal irritation, nasal perforation, nasal ulceration, and other forms of irritation (e.g., skin irritation) were associated with lung cancer mortality.

CONCLUSION

Cumulative chromium (VI) exposure was a risk factor for lung cancer death. Cancer deaths, other than lung cancer, were not significantly elevated. Irritation may be a possible mechanism for chromium (VI)-induced lung cancer.

Underestimation of Rhinogenic Causes in Patients Presenting to the Emergency Department with Acute Headache

OBJECTIVES

Differential diagnosis is essential, since secondary headache due to paranasal sinus lesions are similar in headache characteristics to primary headache. However, since patients visiting the emergency department due to acute severe headache are primarily treated by neurologists, paranasal sinuses lesions and anatomical variations of the nasal cavity causing the headache are commonly overlooked because of the clinician's lack of knowledge about rhinosinugenic headache. This study investigated the prevalence of paranasal sinus lesions and anatomical variations that may cause secondary headaches in patients who were diagnosed as primary headache and treated by neurologists in the emergency room.

METHODS

A retrospective study was done involving 1235 patients who visited the emergency department from January 2008 to December 2012 and who were diagnosed with primary headache. From the axial view of brain computed tomography, examination of sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma were done, and location and morphology was analyzed.

METHODS

Three hundred fifty-five of 1235 (28.7%) patients had sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma as possible causes for secondary headaches.

CONCLUSION

Differential diagnosis of primary headaches requires knowledge of paranasal sinus lesions including rhinosinusitis or anatomical variations. Also, interdisciplinary evaluation of acute headache presenting to the emergency room is necessary for accurate diagnosis and proper management.

Prosthetic rehabilitation of an edentulous patient with an oronasal fistula

The presence of an oronasal fistula presents a challenge to maxillary complete denture fabrication because leakage of air from the nasal cavity through the fistula prevents the formation of an adequate border seal. Although surgical repair or dental implants are possible solutions, these options are invasive and sometimes not feasible. This clinical report illustrates an alternative prosthetic solution by integrating a small retentive component into a maxillary complete denture.

Giant nasolabial cyst

Nasolabial (nasoalveolar) cysts are nonodontogenic soft tissue lesions derived from epithelial remanant of the nasolacrimal duct. These are generally slow-growing painless lesions. Additionally, they can cause obstruction, facial deformity and pain. This case report evaluates the facial deformity and boat-shaped resorption demonstrated on computerized tomography (CT) in a 28 years-old patient presenting with facial swelling and pain as a result of a nasolabial cyst. Nasolabial cysts must be kept in mind in patients suffering from facial deformity and infection as an underlying predisposing factor. Recurrences may be seen in cases not amenable to treatment by surgical excision.

Pyoderma Gangrenosum Associated with Nasal Septal Perforation, Oropharyngeal Ulcers and IgA Paraproteinemia

We report a case of pyoderma gangrenosum (PG) associated with nasal septal perforation, pharyngeal ulcers and IgA paraproteinemia. A 28-year-old woman first developed painful undermined ulcers on her perianal, inguinal and axillary areas when she was 22 years old. Histological findings from the cutaneous ulcers showed dermal and epidermal infiltrate of neutrophils, which was compatible with PG. Laboratory examinations did not detect any associations of systemic diseases other than polyclonal IgA paraproteinemia. Nasal fiberscopy revealed septal perforation and multiple ulcers on her pharynx. The biopsy specimen from the pharyngeal ulcers showed a polymorphous cellular infiltrate without necrotizing vasculitis or granuloma. However, there were no atypical lymphocytes that are typically seen in nasal NK/T lymphoma. By immunohistochemical analysis, the infiltrated lymphocytes were proved to be T cells and Epstein-Barr virus encoded RNA (EBER) was not detected. No pulmonary or renal lesions resembling Wegener's granulomatosis were found. Taken together, the nasal septal perforation was considered as nasal involvement of PG.

[Clinical analysis of nasogenic brain abscess]

OBJECTIVE

To investigate the clinical features of nasogenic brain abscess.

METHOD

Four patients with nasogenic brain abscess diagnosed in Tianjin huanhu hospital between June 2007 and January 2013 were reported and the relevant literatures reviewed.

RESULTS

All four patients were frontal abscess, however, the pathogeny of frontal abscess were different. These four patients were treated by different methods and followed up from 12-28 months, no recurrence was found. All four patients were cured.

CONCLUSIONS

The clinical manifestation of nasogenic brain abscess was hiding and was easy to misdiagnosis. Enhanced MRI is the key of the diagnosis. According to the pathogeny of brain abscess, it was important to cure nasogenic brain abscess with different ways.

Concha bullosa, nasal septal deviation and paranasal sinusitis; a computed tomographic evaluation

PROBLEMS/OBJECTIVES

Although concha bullosa, nasal septal deviation (NSD) and paranasal sinusitis are apparently three independent entities, some studies suggest that they are interconnected. Computed tomography (CT) is a useful and accurate imaging modality for examining this interconnection. The objective of this study is to use CT imaging to investigate the possible association between concha bullosa, NSD and paranasal sinusitis.

METHODOLOGY

We reviewed 206 nasal and paranasal CT images of individuals with sinonasal symptoms/cosmetic issues and investigated the association between the presence of concha bullosa and NSD with paranasal sinusitis.

RESULTS

There was no significant relation between the presence of concha bullosa and paranasal sinusitis. The mean NSD was significantly higher in the cases with frontal, maxillary, ethmoid and sphenoid sinusitis than in unaffected subjects. Similar findings were found in the patients with any involved paranasal sinus and the controls (6.49 +/- 3.060 vs. 3.31 +/- 1.99 degrees; p<0.001). An NSD > or =3.5% differentiated between the presence and absence of paranasal sinusitis, with a sensitivity and specificity of 77.8% and 76.5%, respectively. A significant positive correlation was found between NSD and the number of involved sinuses (Pearson's r=0.58, p<0.001). The laterality of sinusitis was not associated with NSD or concha bullosa.

CONCLUSIONS

Nasal septal deviation, but possibly not concha bullosa, is associated with paranasal sinusitis and its extent. An NSD > or = 3.5 degrees is a useful predictor of paranasal sinusitis.

[Clinical analysis of nasal mucosa contact headache]

OBJECTIVE

To investigate the efficacy of nasal mucosa contact point headache with the treatment of endoscopic sinus surgery.

METHOD

Clinical data of 75 cases with nasal mucosa contact point headache treated in our department from Jan 2008 to Nov 2011 were retrospectively analyzed. These patients were performed with endoscopic sinus surgery.

RESULT

All patients were followed up for more than six months. They all achieved significant efficacy and no complications occurred.

CONCLUSION

Nasal mucosa contact point headache and primary headache had different clinical features and different treatment. Misdiagnosis were easily made if not being carefully analyzed. Three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction can achieve satisfactory curative effect and can effectively prevent the occurrence of complications. Therefore, it is necessary to strengthen the awareness of this disease. Nasal structure abnormality is the main reason of nasal mucosa contact point headache. The implementation of individualized nasal endoscopic sinus surgery can achieve satisfactory curative effect.

Rock, paper, endoscopy: a baffling case of rhinolith

A 60-year-old woman presented with a bulky nasal mass. The mass was accidentally discovered during examination following a head injury. The patient, suffering from severe mental retardation, did not complain of any nasal symptoms, though her relatives, upon direct questioning, reported a two year history of fetid rhinorrhoea and occasional epistaxis. The CT scan showed a large inhomogeneous calcified mass in left nasal cavity, impacted on the choanal border. The patient underwent endoscopic nasal surgery under general anaesthesia in order to remove the mass. A transnasal approach granted a successful and complete removal. The patient was discharged the following day without any complication and no sign of recurrence or symptoms relapse was reported during a two year follow-up.

A rare cause of nasal septal abscess

We describe a patient with mid-facial pain and nasal obstruction due to a nasal septal abscess (NSA) complicating an occult fungal ball of the sphenoid sinus. We highlight the importance of suspecting unusual pathology in patients with NSA and no trauma history.

Headache pain of ear, nose, throat, and sinus origin

Pain of the ear, nose, sinuses, and throat is commonly encountered in clinical practice. For the most part, the pathologic process responsible for the patient's symptoms is easily identifiable after the physician performs a targeted history and physical examination. Unfortunately, the nature of this anatomic region makes it possible for the most thorough physician to miss pathologic factors that may ultimately harm the patient. For this reason, the following rules for the treatment of ear, nose, sinus, and throat pain serve both the patient and the clinician well: (1) take a targeted history; (2) perform a careful, targeted physical examination; (3) heed the warning signs of serious disease, such as fever, constitutional symptoms, or weight loss; (4) image early and frequently if the diagnosis remains elusive; (5) perform laboratory tests that help identify "sick from well," such as erythrocyte sedimentation rate, hematology, and blood tests; (6) avoid attributing the patient's pain to idiopathic or psychogenic causes; and (7) always assume that you have missed the diagnosis.

Intranasal tooth and associated rhinolith in a patient with cleft lip and palate

We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.

[A case of rhinolith and actinomycosis]

The patient presented with right nasal obstruction, purulent secretion in nasal meatus and dull headache for 3 years. A dark brown mass, irregular in shape, surface roughness and purulent secretion adherent, was seen in the nose, touched as coal tar stone. CT examination showed high density in the right nasal meatus. Postoperative pathological examination proved to be rhinolith and actinomycosis.

A different placement of the stone; rhinolithiasis

INTRODUCTION

Rhinolithiasis is a rare disease and formed by mineralization in the nasal cavity. Precipitated calcareous material on intranasal foreign substances forms the rhinoliths. It is start time could have since childhood.

MATERIALS AND METHODS

In this article, we present eight cases of rhinolithiasis who admitted to our Clinic between January 2001 and December 2010 with unilateral chronic nasal discharge, nasal obstruction and oral malodor.

CONCLUSIONS

Rhinolithiasis mostly manifests itself with unilateral purulent rhinorrhea, nasal obstruction and facial pain symptoms. We aimed to discuss these entity with similar cases in the literature.

Spontaneous cerebrospinal fluid rhinorrhea with pneumocephalus: an unusual manifestation of nasal tuberculosis

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.

[One-step rhinootosurgery. Clinical, economic and social aspects]

The objective of this work was to estimate from the clinical, economic, and social standpoints the efficacy of medical aid provided to the patients with chronic suppurative otitis media (CSOM) and concomitant pathology of the nasal cavity by means of the one-step surgical intervention. The study included a total of 208 patients presenting with CSOM of whom 108 ones were treated by the traditional multistage method and the remaining 108 by simultaneous rhinootosurgery. The latter approach was shown to be much more efficacious in terms of clinical, economic, and social considerations.

Complications of nose and paranasal sinus disease

BACKGROUND

Diseases of nose and paranasal sinuses can complicate to involve the orbit and other surrounding structures because of their close proximity. These diseases are usually infective or can be neoplastic in origin.

METHOD

All the patients presenting in ENT or Eye Departments of Ayub Teaching Hospital during the one year study period who had complicated nose or paranasal sinus disease were included in the study. A detailed history and examination followed by CT scanning and laboratory investigations to assess the type and extent of the disease, was carried out.

RESULTS

Infections were the most common cause of complicated sinus disease 11 (75%). The rest of the 4 (25%) cases were tumours. 12 (80%) of the cases presented with proptosis. In I of these 12 cases. there was complete blindness. In 2 (13%) of the cases there was only orbital cellulitis. Two of these patients had facial swelling and 2 had nasal obstruction and presented as snoring. Two patients presented with history of weight loss and these patients had malignant tumour of the paranasal sinuses. One patient presented with early signs of meningitis. In 1 case subperiosteal scalp abscess (Pott's puffy tumour) was the only complication noted.

CONCLUSION

Nose and paranasal sinus diseases can complicate to involve mostly the orbit, but sometimes brain, meninges and skull bones can also get involved.

Rhino-cerebral zygomycosis after allogeneic transplant: case report and literature review

The proportion of patients with hematological malignancies (HM) who develop rare invasive fungal infections (IFI) has increased worldwide over the past few decades. Zygomycosis is an opportunistic fungal infection, which begins in the nose and paranasal sinuses due to inhalation of fungal spores. Rhino-cerebral zygomycosis is the most common form of the disease, it typically develops in diabetic or immunocompromised patients and presents as an acute fulminate infection, which is often lethal. We report a case of rhino-cerebral zygomycosis in an allotransplanted patient to emphasize early diagnosis and treatment of this potentially fatal fungal infection. We discuss different risk factors, specific diagnosis procedures and review the current concepts in management of zygomycosis.

Sinonasal sarcoidosis. A case report

INTRODUCTION

Sarcoidosis is a granulomatous disease of unknown etiology, which in the majority of cases affects the lower respiratory tract. Although neck mass, parotid swelling and facial nerve palsy are considered the primary complaints in cases of head and neck sarcoidosis, sinonasal localization of the disease is also uncommonly reported.

CASE

A 46 year old woman presented in our clinic with complaints of nasal congestion over a six month period. The patient reported increasing symptom severity in the last month with occasional purulent discharge. No other symptoms were reported. The patient's medical record was significant only for sarcoidosis localized to the lower respiratory tract. On anterior rhinoscopy, the nasal mucosa presented marked hypertrophy, purplish discoloration and granulomatous appearance of the inferior turbinates on the left side. The diagnosis of sinonasal sarcoidosis was made based on histopathologic examination of biopsy specimens.

CONCLUSION

Sinonasal sarcoidosis presents a challenging issue for the clinicial as its mimicking features may be misleading and delay diagnosis. In the present paper we present a case of sinonasal sarcoidosis presenting as chronic rhinosinusitis.

Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study

The goal of this study was to compare the outcome of septoplasty in our patients with previous reports. We found some different outcomes of septoplasty at our center compared with the reports in the literature. One of the major differences between this and previous studies is in the mean age of patients undergoing surgery, 22.44 years in our study vs more than 40 years in most studies. In this study, 86 patients with septal deviation were asked using an outcomes instrument (the Nasal Obstruction Symptom Evaluation scale) before and 3 and 6 months after septoplasty. Seventy-seven patients (89.5%) reported a subjective improvement in their nasal obstruction, which is more than the experience of most authors. There was a significant improvement in mean Nasal Obstruction Symptom Evaluation score at 3 months after septoplasty, and some symptom improvement continued to 6 months. We conclude that younger patients who have nasal obstruction with septal deviation benefit more from septoplasty.

Rhinolithiasis: an unusual cause of sinusitis complicated with frontal osteomyelitis and epidural abscess

Rhinoliths are rare foreign bodies of the nose formed by in situ mineralization of endogenous or exogenous foreign material. They are often asymptomatic but may have various clinical presentations, with purulent rhinorrhea and nasal obstruction being the most common. They may go unnoticed for a long period and be diagnosed accidentally during a routine examination. We report a 6.5-year-old girl with rhinolithiasis complicated with sinusitis, frontal osteomyelitis and epidural abscess; she had a history dating back four years.

Nasal septal abscess complicating isolated acute sphenoiditis: case report and literature review

This report presents an extremely rare case of nasal septal abscess complicating acute sphenoiditis in a non-immunocompromised adult patient. A 56-year-old woman came to our emergency service with a 2 wk history of nasal obstruction, headache, and facial pain. A nontraumatic nasal septal abscess complicating acute isolated sphenoiditis was diagnosed. Under general anaesthesia, we drained the septal abscess and performed an endoscopic transnasal sphenoidotomy. Bacteriological cultures revealed viridans streptococci in the septal abscess and sphenoid cavity. We discuss the patient's diagnosis, possible complications, and treatment. There are limited reports in the literature on this subject. Our report emphasizes the need to determine whether an infection is associated with a non-traumatic nasal septal abscess. The incidence of severe complications is directly related to delays in diagnosis and treatment. Therefore, a prompt and correct diagnosis immediately followed by appropriate treatment is necessary.

Evaluation of non-viral risk factors for nasopharyngeal carcinoma in Thailand: results from a case-control study

Nasopharyngeal cancer (NPC) is rare in most populations but common in Southern China and Southeast Asia. To understand the role of environmental exposures on risk of NPC, a case-control study was conducted among 327 newly diagnosed case of NPC and 327 controls matched to case on sex, age and geographic residence. Information was collected by interviewer about demographic variables, cigarette smoking, alcohol drinking, eating habits, past history of disease, family history of cancer and a lifetime history of every job that was held for one year or longer. The result indicates that cigarette smoking was associated with an increased risk of NPC (OR=2.41, 95% CI 1.61-3.6). There was indication of increased risk with a history chronic ear or nose disease (OR=2.71, 95% CI 1.45-5.06). Occupational exposure to wood dust was also associated with a higher risk (OR=1.63, 95% CI 1.02-2.61). Furthermore, lower education was found to be positively associated with NPC (OR=2.71, 95% CI 1.45-5.06). There was no association between NPC and salted fish intake (OR=1.38, 95% CI 0.84-2.25) or alcohol consumption (OR=0.88, 95% CI 0.58-1.33). Our results suggest that cigarette smoking, past history of ear or nose disease and occupational exposure to wood dust may play a role in the development of NPC in the Thai population.

[Clinical analysis of orbital apex syndrome caused by sinus diseases]

OBJECTIVE

To investigate the clinical characters and therapeutic methods of orbital apex syndrome caused by sinus diseases.

METHOD

Six cases of orbital apex syndrome originated from sinus diseases were retrospective analyzed in our hospital from August 2003 to February 2009. Different therapeutic methods were taken according to different causes of disease.

RESULT

Four cases of sinus infection,one cases of sphenoethmoidal mucocele, one cases of sinus squamous cell carcinoma. The results of patients with orbital apex syndrome included cure and effectiveness in 2 cases respectively, death from myocardial infarction in one case, and one case is still following up.

CONCLUSION

Orbital apex syndrome originated from sinus diseases was rare, which was mainly caused by sinus infection. The key point is the correct etiology diagnosis in early phase. Treatment with endoscopic sinus surgery early is a good effective method for orbital apex syndrome caused by sinus diseases, in the same time with enough dosage of antibiotic and glucocorticoid therapy intravenously.

[The role of active rhinomanometry in the surgical treatment of nasal deformation with concomitant endonasal pathology]

This work was designed to substantiate the necessity of application of active rhinomanometry in rhinoplastic surgery bearing in mind that evaluation of the efficiency of surgical treatment requires the use of such objective methods as the rhinomanometric technique. The authors maintain that it may be helpful not only for the purpose of clinical research but also in practical otorhinolaryngological surgery providing an opportunity to collect objective information for the development of indications for the choice and extent of surgical intervention and the assessment of its outcome. Moreover, under present-day conditions, rhinomanometric measurements may be included in the legal basis on which the results of surgery are estimated if appropriate. The method under consideration serves as a diagnostic standard generally accepted worldwide.