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Abstract

BACKGROUND. Septoplasty is routinely used to resolve the deviated nasal septum. To obviate postoperative complications, some surgeons pack both nasal cavities and some other use suturing techniques after septoplasty.

OBJECTIVE. To investigate the efficacy of septal suturing and packing in patients post-septoplasty.

MATERIAL AND METHODS. This study was conducted in the Department of Otorhinolaryngology, Loghman Hakim, Tehran, Iran. 146 patients aged 17 years and above were enrolled for septoplasty. Septal suture was performed in 73 patients (group A) and nasal packing in the other 73 patients (group B). The principal outcomes in terms of bleeding, pain, respiratory problems, septal hematoma, adhesion and perforation were measured over a post-operative follow-up period.

RESULTS. A total of 146 patients, 74% female and 26% male, were enrolled. There were statistically significant differences between the two groups with respect to respiratory problems and patient comfort (p<0.001). The patients in both groups had no septal perforation.

CONCLUSION. Septoplasty using trans-septal suturing without packing can be safe and suitable to prevent or minimize postoperative complications.

Abstract

The authors conduct a review of the etiopathogenesis, the main diagnostic methods and the treatment principles in cervico-facial pain. Pain in otorhinolaryngology is a multifactorial symptom, based on the rich innervation and vascularisation of the cephalic extremity. Pain can be of central or peripheral origin, acute and chronic. With the diversification of methods for exploring pain-generating lesions, different treatment protocols could also be achieved.

Abstract

ENT surgeons frequently encounter a variety of neoplastic, non-neoplastic and inflammatory masses involving the nasal cavity, the paranasal sinuses or the nasopharynx. Among these, the angiomatous polyp or angiectatic nasal polyps are rare and account for 4-5% of all inflammatory nasal polyps. They have variable growth patterns and clinical features. In angiomatous nasal polyps, there is a prominent component of dilated capillary-type blood vessels. We present a review of the literature regarding the most important features of this pathology and an unusual case of a large angiomatous polyp arising from the maxillary sinus.

Abstract

Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential.

Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke.

By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

Abstract

OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis.

MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly.

RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064).

CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.

Abstract

Inverted or Schneiderian papilloma is a locally aggressive benign tumor with strong recurring tendency and a high potential to transform into a malignant squamous cell carcinoma. Although the clinical characteristics of inverted papilloma, along with the morphological features, have been adequately described, controversy remains with regards to the risk factors and disease etiology. The complete excision of the tumor by surgery is traditionally considered the mainstay of therapy.

This paper updates the state of knowledge and presents our experience from treating 52 patients, diagnosed with inverted papilloma, who underwent surgical treatment in our department. We performed genotyping for Human Papilloma Virus (HPV) for all the patients included in our study group.

Abstract

Headache is a common complaint which otolaryngologists frequently have to evaluate and treat in practice. Migraine, tension, cluster and sinus-rooted headaches are the most confronted ones in primary visits. Therefore, considerations of multidiscipline may be required to diagnose the rhinogenic and non-rhinogenic headaches. Rhinogenic headache is a distinct type of headache that has attracted an increased amount of attention in the recent years. The mechanism of headache is not yet known. In fact, the treatments of the above-mentioned headaches are different, but they may intersect in some cases. Non-steroid anti-inflammatory drugs (NSAID) and opioids are often used in headache treatment. Codeine, a well-known opioid derivative, has been prescribed for analgesia for a long time. This review aims to discuss the possible use and efficiency of NSAID and codeine combinations in the treatment of rhinogenic headaches.

Abstract

Congenital anosmia, isolated or as a symptom of Kallmann or Klinefelter syndrome, is a rare condition found in young patients and children. Anosmia is detected during childhood, being reported by the patient or by his/her family. Besides the clinical examination and olfactometric evaluation, imaging is mandatory for the olfactory pathways investigation. Multidisciplinary approach is needed for these patients in order to determine the etiology of the smell loss. In the current paper, we are presenting the case of an 11-year-old child diagnosed in our ENT Department with congenital anosmia.

Abstract

Angioedema with life-threatening site is one of the most impressive and serious reasons for presenting to the ENT doctor. Among different causes (tumors, local infections, allergy reactions), an important cause is the side-effect of the angiotensin converting enzyme (ACE) inhibitors drugs. ACE-inhibitors-induced angioedema is described to be the most frequent form of bradykinin-mediated angioedema presented in emergency and also one of the most encountered drug-induced angioedema. The edema can involve one or more areas of the head and neck region, the most affected being the face, the lips, the tongue, followed by the larynx, when it may determine respiratory distress and even death.

There are no specific diagnosis tests available and the positive diagnosis of ACE-inhibitors-induced angioedema is an exclusion diagnosis. The authors performed a review of the most important characteristics of the angioedema caused by ACE-inhibitors and present their experience emphasizing the diagnostic algorithm.

Abstract

BACKGROUND. Sinonasal polyposis represents a chronic inflammatory condition characterized by nasal obstruction, reduction in the sense of smell and impaired quality of life. Intranasal steroids play an important role in preventing the postoperative recurrences in these cases. We carried out a study to evaluate and compare intra nasal budesonide and intranasal fluticasone propionate in the postoperative management of ethmoidal nasal polyposis.

MATERIAL AND METHODS. 106 patients with ethmoidal polyposis were treated with endoscopic polypectomy and were postoperatively started and maintained on intranasal steroids. 54 patients were managed with budesonide and 52 patients maintained on fluticasone propionate nasal spray. The patients were followed-up for 6 months and recurrences and control of symptoms evaluated.

RESULTS. There was a statistical difference in the SNOT-22 (p<0.0001) and Lund-Kennedy scores (p=0.015) between patients using fluticasone propionate as compared to those using budesonide intra nasal spray by the end of the 6th month.

CONCLUSION. Both intranasal budesonide and fluticasone propionate are effective in controlling symptoms after endoscopic sinus surgery in patients with sinonasal polyposis; however, intranasal fluticasone propionate was more efficacious than budesonide in the control of postoperative symptoms.