Spontaneous Abscess of the Posterior Nasal Septum: An Unusual Cause of Nasal Obstruction in Children

Introduction: Nasal septal abscess is a rare disorder in pediatric patients and is mostly diagnosed as a complication of trauma or secondary to dental or sinonasal infection. Case Presentation: A 10-year-old girl presented with acute nasal obstruction, otalgia, and headache. Medical history was negative; physical examination and anterior rhinoscopy did not reveal signs of acute rhinosinusitis or septal abscess. Management and Outcome: A thorough nasal endoscopy was performed to rule out a posterior nasal infection, revealing a bilateral posterior septal bulging, in the absence of purulent discharge. CT scan and contrast-enhanced MRI were performed, confirming the diagnosis of a spontaneous posterior septal abscess. Trans-nasal endoscopic-assisted drainage was conducted under general anesthesia. Haemophilus influenzae was detected on culture. Discussion: Although rare, nasal septal abscess in the pediatric age is typically anterior and secondary to local trauma or infection. Accurate medical history and anterior rhinoscopy are usually sufficient to make the diagnosis. In cases where the clinical presentation is consistent with a nasal septal abscess, with no history of recent local trauma or infection, or signs of anterior septal bulging, nasal endoscopy should be performed to rule out spontaneous posterior septal abscess. Delay in diagnosis and treatment could potentially cause the rapid onset of life-threatening complications, including intracranial abscess, meningitis, and cavernous sinus thrombosis.

Assessing the Clinical Value of Performing CT Scan before Rhinoplasty Surgery

Introduction. The endonasal mucosal or anatomic pathologies could lead to poor functional results and dissatisfaction after rhinoplasty. Although computed tomography (CT) scan has become an integral part of the diagnostic paradigm for patients with pathologies of the paranasal sinuses, the use of CT scan for preoperative evaluation of patients seeking rhinoplasty is up for debate. Our aim in this study was to compare the efficacy of CT scan in diagnosing nasal pathologies with other evaluating tools in patients undergoing rhinoplasty. Design. In this randomized controlled trial study, 74 consecutive patients seeking cosmetic rhinoplasty referred to otorhinolaryngology clinic were randomly assigned into three groups based on the perioperative evaluation method: the CT group, the nasal endoscopy group, and the control group (anterior rhinoscopy only). Surgical planning was made according to perioperative findings, and the identified endonasal pathologies were corrected during the surgery. The functional and aesthetic outcomes of the rhinoplasty were assessed by Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and the Visual Analogue Scale (VAS) tools before surgery and at 12-month follow-up. Results. All outcome measures improved significantly in either group toward one year after rhinoplasty (all with p value <0.05). Subjects in the CT group demonstrated greater improvement in the NOSE, VAS, and ROE compared to other two groups (NOSE: p value = 0.17; VAS: p value = 0.024; ROE: p value = 0.042). Conclusions. According to our study, perioperative CT is associated with greater patients’ satisfaction and quality of life after rhinoplasty compared to either nasal endoscopy or anterior rhinoscopy. A preoperative CT scan may improve the outcomes of rhinoplasty.

Uncommonly sited rare tumour causing nasal obstruction

​​The study aims to discuss a case of an uncommonly sited rare tumour causing nasal obstruction and a literature review of angioleiomyomas in the nose. A 64-year-old woman presented with blockage of the right nostril, associated with a visible swelling on the undersurface of the alar cartilage, in the lateral wall of the nasal cavity. Anterior rhinoscopy highlighted a 1 cm cystic lesion, with areas of firmness, present at the mucocutaneous junction with a broad base. It was not attached to the underlying cartilage. There was no ulceration or bleeding on palpation. Nasal endoscopy did not show any extension further and the rest of the nasal cavity was clear. Endonasal resection of the tumour using a two-handed technique. This paper highlights not only the importance of considering angioleiomyomas within a differential diagnosis of nasal obstructions but also the uncommon site.​

Workplace based clinical procedural skills assessment using directly observed procedural skills in interns in Otorhinolaryngology rotation

Background: In view of changing requirements in healthcare systems and planned reforms of medical education curricula, effective teaching and assessment of clinical skills in the undergraduate setting has become more and more important. There is a need for implementation of newer methods of evaluation keeping in mind the principles of adult learning and self-directed learning. DOPS (directly observed procedural skills) is a highly structured assessment tool for assessment of the practical work performed by a trainee on a real patient under supervision of experienced faculty. This study aimed to make use of DOPS as a method of workplace based assessment for interns in otorhinolaryngology posting.Methods: 15 interns posted in department of otorhinolaryngology participated in the study. Three clinical procedural skills included were anterior rhinoscopy, otoscopy and indirect laryngoscopy. Three DOPS were undertaken for each skill. The performance was noted as DOPS ratings. The results were tabulated and statistically analysed.Results: A total of 135 DOPS were undertaken for 15 interns. Mean overall DOPS rating improved from DOPS 1 to DOPS 3. The difference in value between DOPS 1 and 3 for anterior rhinoscopy was statistically significant. For otoscopy and indirect laryngology, the difference between DOPS 1 and 2, DOPS 1 and 3 was statistically significant. Both faculty and interns found DOPS to be an efficient tool for assessment.Conclusions: DOPS is a cost effective assessment tool. It has an effective role in facilitating students’ learning and skill development as it is based on the direct observation of trainees’ procedural skills in real clinical environment.

The effects of different suture materials in the nasal cavity

Objective:To investigate the effects of different suture materials in the nasal cavity on encrustation and micro-organism colonisation.Methods:Four different suture materials were used to suture the nasal septum. The effects of suture materials on intranasal encrustation were evaluated with anterior rhinoscopy. The sutures were removed and evaluated in terms of micro-organism colonisation on the 7th and 21st post-operative days.Results:Monofilament sutures were found to cause less encrustation and micro-organism colonisation. There was increased late-stage encrustation if an absorbable monofilament suture remained in place for a long time. The removal of a non-absorbable monofilament suture in the early or late post-operative period made no difference in terms of micro-organism growth on the suture.Conclusion:The material and physical characteristics of sutures placed inside the nose may indirectly affect the healing process. It may be more appropriate to use different materials depending on the length of time the suture is to remain in place.

Oral and oral preparatory phase of swallowing in children with tonsil hypertrophy: Videofluoroscopy study

The purpose of this research was to determine the effect of respiratory obstruction due tonsils hypertrophy on bolus organization, lip posture, bolus propulsion, and on associated head and mandible movements during the preparatory oral and oral phases of swallowing in children. This is a transversal study in children with tonsils hypertrophy (Group 1 -n = 21, 8 girls and 13 boys; mean age 4.5 years) and nasal breathers children without tonsils hypertrophy (Group 2 -n = 10, 4 girls and 6 boys; mean age 4.6 years). The groups were evaluated for respiratory patterns (oroscopy, anterior rhinoscopy and nasopharyngoendoscopy), dental evaluation and videofluoroscopy of swallowing, for liquids and paste food. No significant differences were detected (p>0.05) between groups regarding liquid volume ingested, bolus organization, lip posture, bolus propulsion, or the presence of associated head and mandible movements. The results indicate that respiratory obstruction caused by tonsil hypertrophy in children with normal occlusion did not influence the variables studied regarding the preparatory oral and oral phases of swallowing for both consistencies.

Profil Pasien Rinosinusitis Kronik di Poliklinik THT-KL RSUP DR.M.Djamil Padang

Abstrak Rinosinusitis kronik adalah inflamasi kronik pada mukosa hidung dan sinus paranasal yang sering terjadi, tetapi belum ada data mengenai profil pasien rinosinusitis kronik di RSUP Dr.M.Djamil Padang. Penelitian ini merupakan penelitian deskriptif dengan mengambil data rekam medis THT-KL RSUP Dr.M.Djamil periode 1 Januari – 31 Desember 2012 dengan metode total sampling. Terdapat 63 kasus rinosinusitis kronik di poliklinik THT-KL RSUP Dr.M.Djamil Padang periode 1 Januari – 31 Desember 2012. Kasus rinosinusitis kronik paling banyak terjadi pada kelompok usia 46 – 55 tahun (22,22%) dan banyak terjadi pada perempuan (60,32%). Berdasarkan tanda dan gejala yang ditemukan paling banyak adalah deviasi septum (41,27%). Gejala klinik paling banyak adalah hidung tersumbat (88,89%). Berdasarkan pemeriksaan rinoskopi anterior dan nasoendoskopi ditemukan kelainan pada kavum nasi, konka inferior, konka media, dan sekret. Disimpulkan bahwa rinosinusitis kronik banyak terjadi pada usia dewasa, jenis kelamin perempuan, tanda dan gejala yang ditemukan deviasi septum, gejala berupa hidung tersumbat, sertaditemukan kelainan berdasarkan pemeriksaan rinoskopi anterior dan nasoendoskopi.Kata kunci: rinosinusitis kronik, pemeriksaan rinoskopi anterior, pemeriksaan nasoendoskopi AbstractChronic rhinosinusitis is a common chronic inflammation of the nose and paranasal sinuses mucosa, but there is no data about profile of chronic rhinosinusitis patients at ENT clinic Dr.M.Djamil general hospital Padang. This research uses descriptive method by taking the data from the medical records at ENT clinic of Dr.M.Djamil general hospital during 1 January – 31 December 2012 with the method is total sampling. There are 63 chronic rhinosinusitis cases at ENT clinic Dr.M.Djamil Padang general hospital during 1 January – 31 December 2012. Most cases of chronic rhinosinusitis occurred in the age group 46 – 55 years old (22.22%) and higher in female (60.32%). The most sign and symptom finding is septal deviation (41.27%). The most clinical symptom is nasal obstruction (88.89%). Fromanterior rhinoscopy and nasoendoscopy examination, there are founded abnormalility of nasal cavity, inferior turbinate, middle turbinate, and nasal discharge. The conclusion is chronic rhinosinusitis often happened at adult ages, female, septal deviation as the most sign and symptom finding, nasal obstruction as the clinical symptom, and abnormal findings from anterior rhinoscopy and nasal endoscopy examination.Keywords: chronic rhinosinusitis, anterior rhinoscopy examination, nasal endoscopy examination

Anterior rhinoscopy and middle meatal culture in acute rhinosinusitis

Objective:To assess the use of bacterial culture findings for middle meatal samples obtained via anterior rhinoscopy, in the diagnosis of adults with acute rhinosinusitis.Materials and methods:Microbial cultures were prepared for 30 adult patients with acute rhinosinusitis and suspected bacterial involvement, using samples from the nasopharynx, and from the nasal middle meatus obtained via anterior rhinoscopy. Findings for the ipsilateral maxillary antrum were used as a reference.Results:Seventeen patients had a bacterial infection as verified by a positive culture from the maxillary antrum. Middle meatal samples had a similar sensitivity but a better specificity, positive predictive value and negative predictive value, compared with nasopharyngeal samples, although predictive values were not statistically significant at a 95 per cent confidence level.Conclusion:Anterior rhinoscopy with culture of middle meatal samples can be recommended as a diagnostic procedure for acute rhinosinusitis. The results can also guide the decision on antibiotic treatment.

External rhinoplasty in post rhinoscleromatous bulbous Nose

A 22-year-old male presented to outpatient department with the complaint of widened nasal tip. He was a known case of rhinoscleroma diagnosed five years ago and had taken treatment for the same for one year. He has been asymptomatic since then. On clinical examination the patient had widening of the dorsum of the nose with a bulbous nasal tip. Anterior rhinoscopy was within normal limits. Rhinoplasty was done and the patient had an improvement in his cosmetic appearance. This is one of unique cases of rhinoplasty on bulbous tip due to rhinoscleroma. DOI: http://dx.doi.org/10.3329/bjo.v19i1.11604 Bangladesh J Otorhinolaryngol 2013; 19(1): 69-72