CURATIVE BENEFIT OF SUBMUCOPERICHONDRIAL RESECTION OPERATION ON PULMONARY AR

Objective: We aimed at establishing a correlation between deviated nasal septum and pulmonary artery hypertension in patients reporting in Otorhinolaryngology (ENT) clinic at Combined Military Hospital Quetta, and evaluating the beneficial impact of sub mucoperichondrial resection (SMR) operation on right heart myocardial function, primarily related to Pulmonary Arterial Pressures of these patients of longstanding nasal septal deviation. Study Design: Descriptive; hospital-based cross-sectional survey. Place and Duration of Study: Departments of Otorhinolaryngology & Cardiology, Combined Military Hospital, Quetta, from Sep 2019 to Apr 2021. Methodology: Electrocardiographic and 2-Dimensional Echocardiographic parameters of 87 randomized patients suffering from symptomatic longstanding deviated nasal septum (DNS) who had consented to undergo sub mucoperichondrial resection (SMR) operation were compared and studied for any change in status of probability of pulmonary arterial hypertension before and two months after their surgery. Probability of pulmonary hypertension was estimated using probability criteria from updated European Society of Cardiology Pulmonary Hypertension Guidelines 2019. Patients were classified into low, intermediate and high probability depending upon the number of criteria fulfilled by echocardiographic parameters. Results: Two (2.3%) patients suffering from deviated nasal septum presented with p-pulmonale. Twelve (13.8%) reported with right bundle branch block, and 7 (8%) patients demonstrated right axis deviation on electrocardiography. Overall high probability to develop pulmonary hypertension was discovered in 2 (2.3%) patients. We observed a significant improvement in pulmonary artery pressures in patients suffering from long term upper airway obstruction, two months following sub mucoperichondrial resection operation, in terms of maximum velocity and peak tricuspid regurgitation, right ventricle/left..........

A Review on Deviated Nasal Septum: Classification, Clinical Features and Management

The nasal septum separates the right and left part of the nasal cavity and columellar septum, membranous septum and septum proper are the parts of it. Deviation of nasal septum is a common case of nasal obstruction presented in a clinic. A lot of classifications have been developed to help ease the study of deviated nasal septum but none of them is used as a standard. Some of the classifications include the one given by Vidigal, Guyuron, Cerek, Mladina and Cottle’s. Apart from nasal obstruction other common clinical features involving deviated nasal septum are sinusitis especially in horizontal deviation type V. Pressure on lateral wall by spurs can also cause pressure headache. Due to increased air flow in the nasal cavity, dryness occurs causing epistaxis. Obstruction of nasal cavity causes mouth breathing in return either exaggerating or leading to obstructive sleep apnoea. Septal deviation also effects the choroidal thickness and choroidal blood supply. Histopathologically, lymphocytic infiltration and squamous metaplasia occurs in septal mucosa. These changes occur mostly due to change in the aerodynamic flow. There is decreased cilia movement and inferior turbinate hypertrophy. Thickness of inferior turbinate gains importance while septoplasty as, if thickened a lot, the inferior turbinate demands excision. The deviated nasal septum is associated with sinusitis, chronic suppurative otitis media and Eustachian tube dysfunction. Management involves sub mucus resection or septoplasty. Out of the two, septoplasty is preferred as it is a conservative surgery. Only symptomatic and cosmetically grossly disfigured cases require a surgical treatment while the asymptomatic cases are generally not indicated for surgery. This study tries to review the Classification, Clinical Features and Management of Deviated Nasal Septum.

A CBCT Study for Anatomic Variations of Osteomeatal complex in Patients With Cleft Lip and Palate

Objective To evaluate the anatomy and variations of osteomeatal complex (OMC) by comparing patients with nonsyndromic cleft lip and palate (CLP) and control group. Design This case-control study was retrospectively analyzed using cone-beam computed tomography data. Setting Istanbul University Faculty of Dentistry Department of Dentomaxillofacial Radiology. Patients The study was conducted with 100 patients (44 females, 56 males) with CLP and 100 patients in the control group, which matched gender and age (with a maximum difference of 3 years). Variables OMC variations are grouped as follows: ethmoidal, conchal, uncinate process, and septal variations. Then, we evaluated the presence of these OMC variations and compared them between the two groups. Statistical analysis The McNemar's test was used to determine any significant differences between the groups for all indices at the 95% confidence level. Results The most common anatomic variation in this study was Agger nasi cell (97%) and concha bullosa (97%) in the patients with CLP, while Agger nasi cell was the most common variation (99%) in the controls. Moreover, the atelectatic uncinate process was the least observed variation in both groups (1%). The incidences of paradoxical concha (58%;42%), bifid concha (29%;11%), deviated nasal septum (92%;80%) were significantly higher in the CLP group ( p < 0.05). Conclusions The statistically significant results found when comparing OMC anatomy between the two groups reveal the importance of three-dimensional evaluation before functional endoscopic sinus surgery in patients with CLP.

Endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction: an assessment of post-operative outcomes at a tertiary health care centre

Background: Endoscopic dacryocystorhinostomy (Endo DCR) is a well-established surgical treatment for nasolacrimal duct obstruction (NLDO) cases. Advances in surgical technique and a better understanding of the anatomy have resulted in improvement of the success rate. The objective of this study is to assess the factors responsible for the recurrence of nasolacrimal system obstruction by evaluating the post-operative outcomes of Endo DCR at a tertiary health care centre.Methods: A retrospective study was conducted in the department of ENT, GVP IHC and MT, Visakhapatnam – Andhra Pradesh on 52 patients who underwent Endo DCR procedure from September 2018 to September 2021. The data regarding lacrimal drainage system, operative details, surgical outcomes and complications were analysed.Results: Fifty-two patients (18 male and 34 female) underwent 63 Endo DCR surgeries for NLDO. Success was achieved in 50 cases (79.4%), and failure in 13 (20.6%). Of the 13 failed cases, anatomical obstruction at the fistula site was found in 6 (46.2% of failed cases), whereas functional failure with no evidence of obstruction was found in 7 (53.8%).Conclusions: The success rate appears to be influenced by preoperative parameters like clinical as well as radiological examination of eye and nose; ruling out intraoperative conditions like sinusitis, deviated nasal septum, polyps. These are essential for better coordinating therapeutic expectations and better patient selection. Endo DCR proved to be a safe invasive procedure as it has direct approach to the sac and produced excellent results without any external scar.

Key Considerations in Practices and Principles of Endoscopic Septoplasty: Lessons, Mistakes and Future

Background: Conventional surgeries of the nasal septum improve the nasal airway but recent development and advancement of the knowledge about the endoscopic septoplasty has significantly changed the treatment modality and had brought focus over several aspects of possible advantages. This study aims to see the advantages, complications and limitations of endoscopic septoplasty. Methods: It was an observational prospective study conducted over 90 patients of symptomatic deviated nasal septum. It evaluated symptoms, anterior rhinoscopy and nasal endoscopy findings, objective and subjective improvement of symptoms using the nasal obstruction symptom evaluaiton (NOSE) score, post-operative pain using the visual analogue scale (VAS) and complication following the surgery. Results: Deviated nasal septum (DNS) either left or right side was the most common examination finding 97.78%. Post-operatively there was a good symptom relief and significant subjective improvement in NOSE scores with average decline in the score by 96.26%. Objective assessment of all patients showed improved airway. The complication rate was minimum 7.78%. Conclusion: Endoscopic septoplasty (ES) was found to have distinct advantages with good subjective and objective improvement of symptoms and lesser rate of complications. It should be an option offered to all patients requiring septoplasty. We also found that it helps in improving the learning curve and surgical skill of the trainees. Bangladesh J Otorhinolaryngol 2021; 27(2): 170-176

Clinicopathological profile and treatment outcomes of patients presenting with epistaxis: a hospital-based cross-sectional study in Southern railway headquarters hospital, Chennai

<p class="abstract"><strong>Background:</strong> Epistaxis (nose-bleed) is one of the commonest emergencies presenting to an otolaryngological emergency that affects up to sixty per cent of the population in their lifetime; in this, six per cent needs medical care.</p><p class="abstract"><strong>Methods: </strong>Hospital-based cross-sectional study carried between October 2018 to January 2020 in the department of ENT at Southern Railway Headquarters Hospitals, Perambur, Chennai.</p><p class="abstract"><strong>Results: </strong>The mean age of the subjects was 47.76±23.01. Females were less affected compared to males with 1.68:1 male: female ratio. The results of ENT examination/anterior rhinoscopic examination revealed that all 153 (100%) subjects had anterior epistaxis and 5 (3.27%) had posterior epistaxis. 143 (93.46%) had deviated nasal septum. Diagnostic nasal endoscopy revealed that 90 (58.82%) had deviated nasal septum to the left, and 55 (35.94%) had to the right. The majority of subjects, i.e., 86 (56.21%), were managed conservatively, followed by 52 (33.99%), 5 (3.27%), and 1 (0.65%) patient were given treatment with anterior nasal packing, anterior and posterior nasal packing, and cauterization respectively. Whereas 9 (5.88%) subjects needed a surgical mode of treatment to manage their epistaxis.</p><p class="abstract"><strong>Conclusions:</strong> Findings revealed that the incidence was high in elderly individuals, with male preponderance over females. Anterior epistaxis more commonly occurred in comparison to posterior epistaxis. Our research supports the conservative management methods’ credibility in the epistaxis treatment. The practice of simple nasal packing is the commonest conservative approach that has a high rate of success. As a result, this method will be the best choice for epistaxis management.</p>

Adenoid Hypertrophy with Deviated Nasal Septum in Young Adults

Adenoid hypertrophy is a common cause of nasal obstruction in children but relatively uncommon in adults, however adenoid hypertrophy in young adults is thought to be a persistence of untreated adenoid hypertrophy of childhood. This case series also notes that adenoid hypertrophy can be associated with deviated nasal septum. Coblation assisted endoscopic adenoidectomy usually has good result in adenoid clearance. Hence, routine endoscopic examination of nasopharynx helps in early diagnosis of adenoid hypertrophy and subsequent better management in young adults with complaints of nasal blockage. Nasopharyngeal vegetations were earlier described by Wilhelm Meyer in 1870 as forming part of Waldeyer’s ring of lymphoid tissue and he coined the term ‘adenoid’ to describe the same. In younger children, it has been thought that the adenoids may have an important role in development of an immunological memory. Physiologically it has been considered that hypertrophy of adenoid tissue occurs during 6 - 10 years and tend to regress and atrophy at 16 years. Grading of adenoid hypertrophy as described by Clemens et al. is as follows.1  Grade I: adenoid tissue filling 1/3rd. of the vertical height of choana.  Grade II: adenoid tissue filling up to 2/3rd of the vertical height of choana.  Grade III: from 2/3rd to nearly all but not completely filling the choana.  Grade IV: complete choanal obstruction We present three cases of adenoid hypertrophy with deviated nasal septums in adults who visited ENT outpatient department (OPD) at National Institute of Medical Sciences, Jaipur during COVID era of January 2021 to April 2021.

Comparison of the Efficacy of Septoplasty with NonSurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial

Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p = 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

A PROSPECTIVE STUDY ON CLINICAL PROFILE OF DEVIATED NASAL SEPTUM AND EFFICACY OF SEPTOPLASTY

Deviated nasal septum is one of the most common ENTnding . we did this study to nd out the clinical prole of deviated nasal septum Materials and methods: This study is a prospective, observational,single-center study .The study was conducted in Government sivagangai medical college hospital , sivagangai , tamil, India. A detailed clinical history was taken and clinical examination of the patient was carried out. Sixty symptomatic patients were taken up. Patient scored their symptom-related severity using a Likert scale preoperatively. All patients underwent conventional septoplasty. Postoperatively,their symptoms were scored on 30th, 45th, and 90th day. Results: Preoperative and Postoperative values were analyzed.Statistically signicant improvement was observed in the entire population: Nasal obstruction (p<0.001), headache(p<0.001), nasal discharge (p<0.001), facial pain (p<0.001),and hyposmia (p<0.001). Patient satisfaction was high and they used fewer nasal medications. Conclusion:After surgical correction of the septum and analysis of the subjective scale showed improvement in all symptoms.