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Objective: This study evaluated the relationship between frontal pain as a symptom in chronic frontal sinusitis and radiological and endoscopic findings, quality of life and disease severity. The aim was to determine its utility as a marker in chronic frontal sinusitis and in surgical decision-making. Method: This was a prospective study of 51 consecutive patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Patients ranked their frontal pain score on a numerical rating scale from 0 to 10. Facial pain or pressure, Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation score, Lund–Mackay score and modified Lund–Kennedy score were also collated. Statistical analysis was performed using analysis of variance and Pearson correlation coefficient. Results: Frontal pain scores were low and demonstrated no correlation with the extent of frontal sinus disease radiologically or the severity of overall sinus disease endoscopically. Higher frontal pain scores significantly correlated with poorer quality-of-life. Conclusion: This study does not support the use of frontal pain as a sensitive or specific marker of chronic frontal sinus disease. [ABSTRACT FROM AUTHOR]

Background/Objectives: Tissue remodeling, including dense eosinophil infiltration, is essential for forming inflammatory nasal polyps (NPs) and the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). Toxic eosinophil major basic protein (MBP) damages the sinus mucosa epithelium and lamina propria, which initiates reparative processes leading to tissue remodeling. MBP specifically binds to BMK‐13 antibodies allowing immunohistochemical (IHC) tissue staining for eosinophils. This study evaluated the association between NP stromal BMK‐13 and endothelial adhesion molecule staining, and clinical parameters of NP patients compared to IHC expression and clinical parameters in subjects with healthy nasal mucosa. Methods: We included 30 patients with bilateral NPs who were selected for endoscopic ethmoidectomy. The control group was of 30 subjects with non‐inflamed nasal mucosa but with middle turbinate aeration, chosen for surgery. All participants were clinically scored before surgery, according to quality of life (QoL) outcome and symptoms. The degree of disease extension on computed tomography scans of the paranasal sinuses was also evaluated. Tissue samples after surgery were IHC stained for BMK‐13 and endothelial proliferation markers CD31 and CD34. Results: Expression of BMK‐13, CD31, and CD34 in tissues of NPs was higher than in healthy nasal mucosa. Positive correlations were observed between BMK‐13 expression, impaired QoL, and radiologically assessed extension of inflammation in NP patients. Conclusion: Apart from the fact that the NP tissue has, as expected, more intense eosinophilic infiltration, the proliferation of blood vessels is more pronounced in the NP tissue than in the tissue of healthy nasal mucosa. Expression of MBP in the tissue of ethmoidal NPs could serve as a potential marker of the degree of expansion of CRSwNP and indicate the severity of the disease. Clinical Trial Registration: None, because it was a cross‐sectional study. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post‐surgery.A retrospective cohort of surgically treated, HDM‐sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22‐item sino‐nasal outcome test (SNOT‐22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin‐exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 109/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.Eighty‐six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post‐surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de‐escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation. [ABSTRACT FROM AUTHOR]

Background: Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. Methods: Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. Results: Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. Conclusion: Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training. [ABSTRACT FROM AUTHOR]

Background: Remimazolam is an ultrashort-acting benzodiazepine. Few studies have evaluated the effects of remimazolam-based total intravenous anesthesia (TIVA) on emergence agitation (EA). This study aimed to compare the incidence and severity of EA between TIVA using remimazolam and desflurane. Methods: This prospective randomized controlled study enrolled 76 patients who underwent nasal surgery under general anesthesia. Patients were randomized into two groups of 38 each: desflurane-nitrous oxide (N2O) (DN) and remimazolam-remifentanil (RR) groups. The same protocol was used for each group from induction to emergence, except for the use of different anesthetics during maintenance of anesthesia according to the assigned group: desflurane and nitrous oxide for the DN group and remimazolam and remifentanil for the RR group. The incidence of EA as the primary outcome was evaluated using three scales: Ricker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, and Aono's four-point agitation scale. Additionally, hemodynamic changes during emergence and postoperative sense of suffocation were compared. Results: The incidence of EA was significantly lower in the RR group than in the DN group in all three types of EA assessment scales (all P < 0.001). During emergence, the change in heart rate differed between the two groups (P = 0.002). The sense of suffocation was lower in the RR group than in the DN group (P = 0.027). Conclusions: RR reduced the incidence and severity of EA in patients undergoing nasal surgery under general anesthesia. In addition, RR was favorable for managing hemodynamics and postoperative sense of suffocation. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the stability of the nasal tip over time with the use of carved silicone among patients with nasal tip stability deficit, previous aesthetic rhinoplasty and manipulation of the nasal septum. Materials and methods: A descriptive, analytical, interventional study using the nasal tip stabilization reconstruction technique performed at a private clinic in the city of Lima, Peru, in 2022. The study included 22 cases of patients between the ages of 30 and 55 with tip instability, previous rhinoplasty and manipulated nasal septum, without comorbidities. The patients were evaluated in the first, third and sixth months and one year after the reconstruction and stabilization of the nasal tip. Non-probabilistic sampling was performed. No sample was used, since the total number of patients who met the inclusion criteria were included. All the participants underwent the surgical technique with carved silicone. Results: With the surgical technique using carved silicone, less bleeding and less bruising were observed. In the follow-up one year after surgery, the technique maintained similar characteristics over time, in both alignment and height of the nasal tip. One case of extrusion of the silicone sheet was evidenced as a complication following trauma caused by a patient's fall. Conclusions: Silicone is widely accepted as a material employed for facial contouring with extended use in rhinoplasty. Our study demonstrated that it provides long-lasting support for the nasal tip. It is a viable alternative in rhinoplasties that do not have autologous cartilage or where the use of costal cartilage is sought. Silicon, being a readily available synthetic material that is easily moldable and does not reabsorb, is a useful alternative that shortens operating time and maintains tip projection. [ABSTRACT FROM AUTHOR]

Key points: Expanded types of functional endoscopic sinus surgery (FESS) significantly improve quality of life and reduce revision surgeries rates, supporting their early application for moderate‐to‐severe cases.Minimal clinically important difference may play as a crucial role in defining surgical treatment response (i.e., responder and super‐responder conditions).Expanded FESS benefits patients with chronic rhinosinusitis with nasal polyps but more data are required to have a clearer understanding of its uses due to varied approaches and reported outcomes in the literature. [ABSTRACT FROM AUTHOR]

Background: Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate – termed cocaine-induced midline destructive lesions. Case report: A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. Conclusion: This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available. [ABSTRACT FROM AUTHOR]

Objective: To investigate epidermal growth factor, transforming growth factor-α and interleukin-8 production in nasal mucosa irrigated with hypertonic 2.3 per cent solution with algae extracts, in comparison to 0.9 per cent NaCl during the first two weeks after surgery for nasal polyposis, in relation to symptoms and local findings. Methods: This prospective study included 20 nasal polyposis patients postoperatively irrigated with hypertonic solution and 20 nasal polyposis patients postoperatively irrigated with isotonic solution. We evaluated nasal symptom score, endoscopic score and mediator levels in nasal secretions before and after irrigation. Results: Following treatment, nasal symptom score and endoscopic score were significantly lower in the hypertonic solution group (p = 0.023; p < 0.001, respectively). The increase in the epidermal growth factor and the decrease in the transforming growth factor-α and interleukin-8 concentration were higher in the hypertonic group (p < 0.001 for all mediators). Conclusion: Irrigation with a hypertonic solution was found to be more effective than an isotonic solution in nasal mucosa reparation. [ABSTRACT FROM AUTHOR]

Background: This paper reports a 10-year series of spontaneous nasal septal abscesses in immune-competent children, with suggestions for optimal management. Methods: A retrospective case note review was conducted of children undergoing an operation for incision and drainage of nasal septal abscesses between 2013 and 2023. Results: Six children were identified via electronic hospital records during the 10-year review period, five with a spontaneous abscess. The children were aged 10–14 years. All were immunocompetent and none had active sinus infection. The most common presenting features were nasal swelling, facial swelling, headache, nasal congestion and fever. The most common bacterial isolate was Staphylococcus aureus. All children received prompt surgical drainage and intravenous antibiotic therapy. Complications were seen in three children, with one child developing significant intracranial complications. Conclusion: To our knowledge, this is the first series of spontaneous nasal septal abscesses in immunocompetent children. The high prevalence of Staphylococcus aureus suggests spread from the nasal mucosa or vestibule. Early recognition, computed tomography scanning, surgical drainage and antibiotic therapy are the mainstays of treatment, to prevent potentially life-threatening complications. [ABSTRACT FROM AUTHOR]

Purpose: Our study goal is to review the efficacy of tranexamic acid in reducing blood loss and operative time in nasal surgeries. Methods: We included randomized clinical trials using oral or intravenous tranexamic acid, excluded non-randomized studies, topic administration, coagulopathy, and using other drugs interfering in the coagulation cascade. Online databases, National Library of Medicine (MEDLINE-PubMED), Latin American and Caribbean Literature on Health Sciences (Lilacs), Cochrane Library, Embase and Google Scholar were used to perform the search. The review was registered in PROSPERO by no CRD42022310977. Two authors, independently, selected the articles meeting the inclusion criteria. They extracted the data and used RevMan 5 software to perform the meta-analysis. Results: Our search resulted in 16 RCTs that were included in the meta-analysis totalizing 1108 patients. Studies were evaluated resulting in a low risk of bias for the five domains. The use of tranexamic acid resulted in significant reduction in duration of surgery (DOS) and intraoperative blood loss (IBL) had significant reduction. The level of evidence according to GRADE System was high in all studies and variables. Conclusion: Tranexamic acid has an important role in reducing intraoperative blood loss and duration of surgery. Our study has some limitations due to the low number of RCTs available in the literature. [ABSTRACT FROM AUTHOR]

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded–functional endoscopic sinus surgeries (E–FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical outcomes in CRSwNP patients who underwent E-FESS versus those subjected to L-FESS. Quality of life, endoscopic and radiological outcomes were compared at the baseline and two years after surgery. The clinical status of the responder was defined when a minimal clinically important difference of 12 points in SNOT-22 change was achieved. (3) Results: A total of 274 patients met the inclusion criteria and were analyzed; 111 underwent E-FESS and 163 were subjected to L-FESS. Both groups exhibited significant clinical improvements, although a greater magnitude of change in SNOT-22 (14.8 ± 4.8, p = 0.002) was shown after E-FESS. Higher significant improvements for endoscopic and radiological scores and lower surgical revision rates were also noted in the E-FESS group. (4) Conclusions: E-FESS provides better clinical outcomes and reduced revision surgery rates when compared to L-FESS in CRSwNP patients two years after surgery, irrespective of any comorbidity. Further randomized prospective studies are needed to comprehensively contrast these results. [ABSTRACT FROM AUTHOR]

Purpose: The techniques to be performed for bullous middle turbinates are well-defined and widely accepted in the literature. However, in the case of solid middle turbinate hypertrophy, information on surgical techniques that take into account function and sense of smell is very limited in the literature. The aim of this study was to compare the airway patency and olfaction results of patients diagnosed with solid middle turbinate hypertrophy, who underwent subtotal (transverse) resection or medial flap turbinoplasty of the middle turbinates. Methods: Thirty-five adult patients who were diagnosed with solid middle turbinate hypertrophy were divided into two groups, namely medial flap middle turbinoplasty (study group = 17) and transverse resection to the middle turbinate (control group = 18). Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test, and n-butanol threshold measurements were performed before and 3 months after the surgery. In addition, preoperative and postoperative nasal obstruction and olfactory senses of the patients were evaluated with visual analog scale and nasal obstruction symptom evaluation scale. Results: Visual analog scores for olfaction were significantly higher in the study group compared to the control group. In odor identification test, a significant improvement was observed in the study group, while a decrease was observed in the control group. While there was a decrease in the n-butanol thresholds values in the study group, there was an increase in the control group. Conclusions: Medial mucosal flap technique is an effective and functional turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of enhanced airway healing and olfactory results. [ABSTRACT FROM AUTHOR]

Merocel is a commonly used material for nasal packing; nevertheless, the majority of patients experience pain when the nasal packing is removed. Aims/Objectives: This study aims to introduce a novel technique for nasal packing using Surgicel-wrapped Merocel. Patients who underwent septoplasty received either Merocel or Surgicel-wrapped Merocel as nasal packing. Clinical complications related to bleeding and subjective symptoms associated with the packing materials were assessed. Between 2018 and 2021, a total of thirty-three patients with a deviated nasal septum underwent septoplasty. Among them, eight patients received Merocel nasal packing, while twenty-five patients were treated with the new nasal packing technique involving Surgicel-wrapped Merocel. We observed a significant reduction in pain during removal in the Surgicel-wrapped Merocel group compared to the Merocel group (p =.008). However, no significant differences were noted in other discomforts related to packing or bleeding after removal between these two groups. Conclusions and Significance: Using Surgicel-wrapped Merocel as nasal packing following septoplasty is an effective method to alleviate pain during removal. [ABSTRACT FROM AUTHOR]

Objective: A statistically significant improvement in nasal obstruction ratings following septoplasty is not necessarily clinically important. This study aimed to establish useful measures of septoplasty success, namely the minimal clinically important difference and the desirable clinically important difference. Methods: Patients rated nasal obstruction on a 0–100 visual analogue scale pre-operatively and at 5.5 months post-operatively. Global outcome rating (completely, much, or somewhat improved, unchanged or worse) served as the anchor post-operatively. Minimal clinically important difference is the visual analogue scale value between 'somewhat improved' and 'unchanged', and the desirable clinically important difference is that between 'much' and 'somewhat improved'. Results: Statistically significant improvement in visual analogue scale scores was not clinically important. The minimal clinically important difference (daytime value of 9.5) represented 15.1 per cent improvement and the desirable clinically important difference (daytime value of 28.5) represented 45.2 per cent, without gender or age differences. Conclusion: Clinical success can be defined using a minimal clinically important difference of 15 per cent improvement over a patient's baseline value. Other studies' ratings of 'satisfactory' outcome coincided with a desirable clinically important difference of 45 per cent over baseline. These values are suggested as relevant indicators of septoplasty success. [ABSTRACT FROM AUTHOR]

Background: A simulated education, prior to surgery about postoperative nasal stuffiness and ease of breathing through the mouth may help patients tolerate discomfort after nasal surgery. This study aimed to investigate the effect of preoperative simulated education on immediate postoperative opioid requirements in patients undergoing elective nasal surgery. Methods: This randomized controlled trial of 110 patients undergoing nasal surgery randomly allocated patients into either a control (group C) or an education group (group E). One day before surgery, patients in group E were intensively trained to breathe through the mouth by using a nasal clip, with informative explanations about inevitable nasal obstruction and discomfort following surgery. Patients in group C were provided with routine preoperative information. Total intravenous anesthesia (TIVA) with propofol and remifentanil was used for anesthesia. No further opioid was used for analgesia intraoperatively. The primary outcome was index opioid (fentanyl) requirements at the post-anesthesia recovery unit (PACU). Secondary outcomes were emergence agitation, pain scores at the PACU, and postoperative recovery using the Quality of Recovery-15 (QoR15-K). Results: The rate of opioid use in the PACU was 51.0% in the group E and 39.6% in the group C (p = 0.242). Additional request for analgesics other than index opioid was not different between the groups. Emergence agitation, postoperative pain severity, and QoR15-K scores were comparable between the groups. Conclusion: Preoperative education with simulated mouth breathing in patients undergoing nasal surgery did not reduce opioid requirements. Trial registration: KCT0006264; 16/09/2021; Clinical Research Information Services (https://cris.nih.go.kr). [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic sinus surgery (ESS) is a surgical procedure widely used in the treatment of various sinonasal conditions. Excessive bleeding during ESS leads to potentially major complications. The primary aim of this trial was to explore any different effects of bisoprolol and nifedipine on the intraoperative surgical field. In addition, the correlations regarding surgical field state, total blood loss (TBL), mean arterial pressure (MAP), and heart rate (HR) were also examined. Methods: A prospective, triple-blinded, randomized, placebo-controlled trial was conducted, including 72 patients between 18 and 65 years of age who underwent ESS. As an indicator of the worst state of the intraoperative surgical field, the Boezaart scale score was used, as evaluated by two surgeons. Appropriate statistical analysis was conducted to explore score comparisons across groups and correlations between vital signs, bleeding, and the operative field state. Results: No statistically significant difference was found among different intervention groups regarding the worst state of the surgical field (p = 0.367 > 0.05). The Boezaart scale score was positively correlated with TBL (rxy = 0.619, p = 0.000 < 0.001) and MAP (rxy = 0.259, p = 0.028 < 0.05). Furthermore, MAP was positively correlated with HR (rs = 0.254, p = 0.32 < 0.05). Conclusion: Our study demonstrates that preoperative administration of bisoprolol and nifedipine does not affect the worst state of the operative field. However, vital signs seem to either directly or indirectly affect bleeding and operative field state, and agents affecting them are worth exploring further. [ABSTRACT FROM AUTHOR]

Background: Nasal bone fractures are treated by manipulation under general or local anaesthesia procedures. Data on long-term benefits of manipulation under local anaesthesia are limited. This study aimed to quantify the proportion of patients requiring septoplasty or septorhinoplasty after manipulation under general and local anaesthesia procedures. Methods: Anonymised data were collected from electronic records of all patients who underwent manipulation under anaesthesia at our centre over a 10-year period, including demographics, manipulation under anaesthesia timing and further surgery requirements. Results: The study identified 625 manipulation under general anaesthesia and 52 manipulation under local anaesthesia procedures. Manipulation under local anaesthesia procedures were performed earlier (local anaesthesia = 9 days, general anaesthesia = 15 days; p < 0.05) and were more likely to achieve manipulation (local anaesthesia = 83 per cent, general anaesthesia = 76 per cent; p < 0.05). There was no difference between techniques in the percentage of patients requiring further surgery. Conclusion: This paper describes a large cohort of patients who underwent manipulation under anaesthesia over a 10-year period. Manipulation under local anaesthesia procedures have increased since the coronavirus disease 2019 pandemic, and the results are comparable to manipulation under general anaesthesia, with reduced delays between injury and manipulation. [ABSTRACT FROM AUTHOR]

Purpose: To report biomarkers present in the olfactory mucosa in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with nasal polyps and to nasal mucosal tissues from control patients. To evaluate the kinetics of smell over 6 months in patients who underwent Reboot surgery. Methods: Cohort study from May 2021 to May 2022. We collected samples of olfactory mucosa and nasal polyps from 16 CRSwNP patients and inferior turbinate samples from 20 control subjects. The study was not randomized for surgical and/or medical treatment. Samples were analyzed by Luminex and Unicap 100 to measure biomarkers of inflammation (IL1-β, IL4, IL5, IL6, IL17, CCL3, CCL4, G-CSF, SE-IgE, total IgE and ECP). 12 of the CRSwNP patients underwent Extended Sniffin'tests at timepoints 1–4 days pre-surgery, and 1, 3 and 6 months after Reboot surgery. Results: Type-2 markers were significantly elevated in OM and polyp tissue in CRSwNP (n = 16) vs. controls (n = 20), P < 0.05. TDI scores improved already 1 month (P < 0.05) after surgery and remained stable for 6 months. Type-2 inflammation in nasal polyps was associated with decreased sense of smell and taste before surgery, but improved after surgery (P = 0.048). Type-3 inflammation was present in the olfactory mucosa and was associated with a better sense of smell before surgery, but a smaller improvement of smell afterward. Conclusions: Type-2 inflammation is present in the olfactory mucosa in CRSwNP patients and is associated with smell loss. Reboot surgery, aiming to completely remove inflamed sinus mucosa, significantly improves the smell in this group of patients. [ABSTRACT FROM AUTHOR]

Angiomyolipoma is a benign, mesenchymal, hamartomatous lesion often described in the kidney and may be associated with tuberous sclerosis. Nasal angiomyolipoma is an extremely rare tumor with fewer than 20 cases reported in the literature. We report a case of angiomyolipoma arising in the right nasal vestibule in a 68-year-old male with mild, recurrent right-sided epistaxis, and nasal obstruction. With the exception of arterial hypertension, the patient did not have any comorbidities. Gross examination showed a well-circumscribed, lobulated mass. On the microscopic level, it was composed of mature smooth muscle cells, thick-walled blood vessels of varying sizes, and islands of mature adipose tissue. Angiomyolipoma should be considered as a differential diagnosis for unilateral nasal masses, especially those situated in the nasal vestibule. [ABSTRACT FROM AUTHOR]

Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53–- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results. [ABSTRACT FROM AUTHOR]

Objective: Post-operative success and patient satisfaction were assessed following septoplasty for mild to severe anterior septal deviation. Methods: The study included patients with an anterior nasal septal deviation in the form of a 'C' shape and close to the nasal valve in the anterior septal area. Deviation severity was classified as severe (group 1), moderate (group 2) or mild (group 3). Open or closed septoplasty procedures were performed. All patients were surveyed twice using the Nasal Obstruction Symptom Evaluation scale and the 36-Item Short Form Health Survey. Results: The mean Nasal Obstruction Symptom Evaluation score for group 1 was 15.58 ± 2.34 prior to surgery and 6.61 ± 3.29 following surgery. The corresponding pre- and post-surgery scores in group 2 were 11.9 ± 2.82 and 6.3 ± 3.03, respectively. In group 3, these values were 8.28 ± 2.63 and 7.12 ± 3.18, respectively. The mean 36-Item Short Form Health Survey physical function value for groups 1 and 2 increased after surgery; in group 3, this value decreased after surgery, but the result was not statistically significant. Conclusion: Septoplasty is very successful for treating moderate or advanced deviations, but great care should be taken when employing septoplasty for mild deviations. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study was to conduct a meta-analysis of the effects of intraoperative pharyngeal packing on postoperative nausea, vomiting, and sore throat in nasal surgery patients. Methods: Databases were searched from inception to December 2022. Randomized controlled trials comparing saline-soaked pharyngeal packing (packing group) with no packing (control group) during intubation in patients undergoing nasal surgery were included. The primary outcomes of interest were the incidence of postoperative nausea, vomiting, and sore throat at 24 hours. Results: Eleven studies, including a total of 931 patients, were included. There was no significant difference between the two groups in the incidence of postoperative nausea and vomiting and severity scores at 2, 6, and 24 hours postoperatively. The incidence of throat pain was higher in the packing group than in the control group immediately after surgery and at 24 hours postoperatively. However, no significant difference was observed between the two groups in the incidence of sore throat at 6 and 12 hours postoperatively. Conclusion: Intraoperative saline-soaked pharyngeal packing did not significantly decrease postoperative nausea and vomiting. However, the use of pharyngeal packing was associated with a higher incidence of sore throat in the initial recovery period. [ABSTRACT FROM AUTHOR]

Objective: Our aim is to evaluate the effect of topical tranexamic acid (TA) on bleeding and surgical quality field in the functional endoscopic sinus surgery (FESS). Methods: A total of 74 patients who underwent FESS due to chronic rhinosinusitis were included. The patients were randomized into 2 groups. TA group (n = 37) received a topical cotton pledget soaked with TA and placebo (PL) group (n = 37) received a pledget soaked with saline solution. Results: A significant effect was noted for the TA group versus the PL group in the grade 1 of the Boezaart scale at 35 minutes (4 for TA group and no case for PL group). This effect was absent for higher grades. We did not notice a significant effect between the 2 groups at 5 minutes. Blood loss was 359 ml in the TA group versus 441 ml in the PL group. No significant change was observed between the 2 groups concerning the blood parameters. No side effects were reported. Conclusion: Despite its safety when administrated locally and its low cost, TA provides limited effect on quality of surgical field after 35 minutes of the start of FESS in the patients with chronic rhinosinusitis. This effect was absent at the start of the intervention and when analyzing the blood loss and hematologic parameters. [ABSTRACT FROM AUTHOR]

Lobular capillary hemangioma (LCH) is a benign capillary proliferation with a microscopically distinctive lobular architecture, composed of small to medium-sized vessels of capillary type. Rarely, it originates from the mucosa of the nasal cavity, most frequently from the anterior nasal septum, turbinates, and nasal vestibule. Etiology is unclear, but previous investigations suggest that this lesion is associated with injury, hormonal factors, some viral infections, and therapy with some drugs. We present a case of LCH arising from the medial wall of the maxillary sinus in a 15-year-old boy, which was completely excised by preoperative embolization and endoscopic sinus surgery. To our knowledge, this is the second reported case of an LCH originating from the maxillary antrum. Etiology, pathogenesis, diagnosis, and treatment modalities of LCH were also discussed. [ABSTRACT FROM AUTHOR]

Purpose: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.Methods: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.Results: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.Conclusions: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies. [ABSTRACT FROM AUTHOR]

Midline nasal masses are rare and challenging for surgeons. This study examined the site with the highest risk of recurrence following midline nasal mass excisions.Surgical outcomes were retrospectively reviewed following excision of midline nasal masses between 2010 and 2022 in the predominantly pediatric patient cohort. The primary outcome measure was the recurrence rate.Overall, 22 nasal masses were resected from 20 patients. Of these masses, 16 were nasal dermoid sinus cysts (NDSC), 2 were hamartomas, 1 was an epidermoid cyst, and 1 was a mature teratoma. Five of the nasal masses were classified as intracranial lesions, 11 were classified as intraosseous lesions, and 6 were classified as superficial lesions. The open rhinoplasty approach was chosen in 65% of the surgeries. For the intracranially extended lesions, a combined nasocranial approach was performed. Four revision surgeries were performed due to superficial recurrences at the nasal dorsum of lesions, that were primarily classified as intraosseous lesions.All recurrences had a superficial extension and were easily excised. Intraosseous NDSC have the highest risk of recurrence, but conversely, they also occur most frequently. [ABSTRACT FROM AUTHOR]

To determine the aerodynamic change in voice, its effect on voice-related quality of life in patients who underwent endoscopic sinus surgery (ESS) and/or septoplasty. Material and Methods: Demographic characteristics, medical history, complaints, operation were prospectively recorded. Voice evaluations were performed preoperatively and at 3 months postoperatively. Subjective and objective voice assessment were done with the Voice-Related Quality of Life (VRQoL) Scale and Voice Handicap Index, maximum phonation time (MPT) and S/Z ratio. Results: Our study was conducted with a total of 42 patients, 20 (47.6%) male and 22 (52.40%) female. The mean age was 39.02±14.38 years. Septoplasty were performed to 24 (57.14%) patients, and septoplasty and ESS were performed to 18 (42.86%) patients. While 23 of the patients (54.8%) had a history of intubation due to another surgery, 28 (66.7%) of them stated that they experienced preoperative voice changes.. However, no statistically significant difference was found between the complaint of preoperative voice change and intubation history or gender (p>0.05). It was observed that the MPT was prolonged after surgery (p=0.003), particularly in men (p=0.005). The social, physical and total VRQoL increased after surgery (p=0.035, p=0.002, p=0.001, respectively). There was a greater improvement in total VRQoL Scale values in patients who underwent ESS (23.83 vs. 2.62; p=0.005). Conclusion: Our study shows that septoplasty and ESS may increase voice-related quality of life and have a positive effect on the aerodynamic structure of voice. More studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the time for recovery of the sense of smell in patients with CRSwNP who underwent Reboot surgery compared to patients undergoing ESS in a long-term follow-up study. Methods: Data were collected retrospectively from 168 patients with severe uncontrolled CRSwNP, who underwent revision surgery, either as Extended Endoscopic Sinus Surgery (Reboot, 140 patients) or as regular Endoscopic Sinus Surgery (ESS, 28 patients) between January 1, 2014, and December 31, 2015, aiming to compare the outcome of surgeries after 2 years of follow-up. Sense of smell was scored as judged by the patient using scores 0 to 3 reflecting a percentage estimate of remaining smell. Results: Smell improved similarly in the Reboot and ESS groups over the first 9 months, which was maintained over 24 months in the Reboot, but not the ESS group (p = 0.007 after 18 months, p = 0.001 after 24 months). Furthermore, polyp recurrence rates were significantly lower in the Reboot group. Conclusion: Reboot surgery significantly improved olfactory function and significantly reduced nasal polyp recurrence rates over 2 years post-operatively. Therefore, Reboot should be considered for patients with uncontrolled severe CRSwNP, specifically when ESS failed, to offer long-term smell and a polyp-free status. Level of evidence: 3b. [ABSTRACT FROM AUTHOR]

Objective: Nasal septum perforation (NSP) is defined as a communication between the nasal passages due to a full layer defect of the septum. The condition has a broad spectrum of potential symptoms, such as scabbing inside the nose, dryness, epistaxis, and breathing difficulty. The aim of this study was to evaluate the symptomatology of NSP and the relationship between the subcomponents of the Nasal Obstruction Symptom Evaluation (NOSE) scale assessment of quality of life and the size and localization of NSP. Materials and Methods: This prospective study included patients who presented at the otolaryngology policlinics of 2 hospitals and were diagnosed with NSP. The NSPs were grouped according to the length of the long axis, that is, small: 1--10 mm, medium: 11--20 mm, or large: 21--30 mm, and the localization was categorized as anterior, middle, or posterior. A Turkish version of the NOSE scale has been validated as a reliable tool. Results: A total of 61 patients, 31 (50.8%) females and 30 (49.2%) males, were evaluated. The mean NOSE score was 59.50±20.58. No significant difference was seen in the NOSE score based on the size of the perforation; however analysis of variance revealed a significant difference according to the localization of the perforation in the scale items of NOSE-2 (p=0.007), NOSE-3 (p=0.048), NOSE-4 (p=0.011), and the total NOSE score (p=0.015) (p<0.05). Conclusion: The results of the NOSE scale analysis indicated that the NSP patients experienced a high level of symptoms, regardless the size and localization of the perforation. The NOSE scale is easy to administer and provides useful information, particularly when the subcomponents are evaluated. [ABSTRACT FROM AUTHOR]

Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case–control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation. [ABSTRACT FROM AUTHOR]

Background: In modern rhinoplasty there are new concepts aimed at achieving the ideal model of a nose. Many techniques have become old, but new, less invasive ones have emerged. Objective: to describe the results of rhinoplasty using the autograft relocation technique in patients with nasal deformities. Methods: a descriptive case series study conducted at the Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos. 25 patients were included in the research, who attended the Maxillofacial Surgery consultation due to nasal deformities, between 2009 and 2019, to whom the rhinoplasty surgical technique (the modified Joseph technique) was applied. Age, sex, skin color, type of graft, technique used (endonasal, open) and type of anesthesia were analyzed. Results: female sex and white skin color predominated. The most used surgical technique was endonasal (20 patients). All were operated under local anesthesia. The largest age group was 15-30 years old. The osteocartilaginous hump was the graft used in 72% of the cases. Conclusion: with the autograft relocation technique, favorable results were obtained in the case series described. This is one of the most advanced in the context of nasal cosmetic surgery. [ABSTRACT FROM AUTHOR]

Background: Open septorhinoplasty is a common facial plastic surgery procedure that requires extensive planning and knowledge to achieve predictable outcomes. Many patients want to keep their nasal tip characteristics, and the surgeon's task is to reliably meet this expectation and provide stable long-term results. Techniques used to reconstruct nasal tip support include the tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures. Methods: We assessed the 1-year reliability of tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures in maintaining nasal tip rotation and projection in open septorhinoplasty. We conducted a retrospective case series review of septorhinoplasty cases between 2015 and 2019 at the Medical University of South Carolina. Cases with intention to change nasal tip rotation or projection were excluded. Two blinded reviewers analyzed standardized preoperative and 1-year postoperative photographs. Results: Fifty-seven patients fit the inclusion criteria and were included in the analysis. Mean preoperative and postoperative nasal tip rotations and projection ratios were similar (P=0.62, P=0.22, respectively). Twenty-six patients underwent a tongue-ingroove procedure, 24 had a caudal septal extension graft, and 7 had a caudal septal replacement graft with preoperative nasal tip rotations of 98.93°, 99.35°, and 96.89°, respectively (P=0.73). At 1 year, patients who received a tongue-in-groove procedure had a significant increase in nasal tip rotation to 101.24° (P=0.013), while patients who received a caudal septal extension graft had a significant decrease in nasal tip rotation to 97.25° (P=0.009). Patients who received a caudal septal replacement graft had no significant change in nasal tip rotation (P=0.117). The preoperative and postoperative projection ratios were not significantly different among the 3 techniques. Conclusion: Tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft are reliable techniques for maintaining nasal tip projection in open septorhinoplasty. In our experience, when attempting tomaintain preoperative nasal tip rotation, the tongue-in-groove technique resulted in a significant increase in tip rotation of 2.31°, while the caudal septal extension graft resulted in a significant decrease of 2.1° at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

Objective: There are gaps within current meta-analyses looking at the effects of tranexamic acid on sino-nasal surgery. This study aimed to update and summarise all current available evidence on the use of tranexamic acid in sino-nasal surgery. Method: A literature search was performed using four medical databases, Cochrane Library, Embase, Medline and PubMed. Data analysis was performed using dedicated meta-analysis software Review Manager (Revman). Results: Thirteen studies were included in the meta-analysis. The amount of blood loss and duration of surgery in tranexamic acid groups was statistically lower than placebo for both sinus and nasal surgery. Tranexamic acid improves the surgical field quality in sinus surgery but worsens the field in nasal surgery. Topical or intravenous administration of tranexamic acid in sinus surgery reduces blood loss, duration of surgery and improves the quality of the surgical field. Conclusion: This study suggests that the use of tranexamic acid in sinus surgery reduces blood loss, decreases surgical duration and improves surgical field quality. [ABSTRACT FROM AUTHOR]

Purpose: One of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis. Methods: We collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up. Results: Altogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery. Conclusion: The use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account. [ABSTRACT FROM AUTHOR]

Objective: As prospective outcomes of septoplasty with or without turbinoplasty beyond the first year are few and have diverging results, this study evaluated later septoplasty results three to four years post-operatively. Methods: Patients undergoing septoplasty completed the Nasal Surgical Questionnaire pre-operatively, and at 6–12 months (early post-operative assessment) and 36–48 months (late post-operative assessment) after surgery. Primary outcome was visual analogue scale ratings for nasal obstruction (with a scale ranging from 0 to 100). Results: In 604 patients with high response rates, the largest improvements in nasal obstruction were from pre-operative to early post-operative assessments (daytime score reduction = 33.9, night-time reduction 40.5). Nasal obstruction ratings worsened slightly between early and late post-operative assessments (daytime score increase = 5.3, night-time score increase = 9.7). Improvements were better in patients aged over 35 years and in those with pre-operative nasal obstruction scores of more than 62. There were no differences based on surgery type, septal deviation, allergy or smoking. Conclusion: Septoplasty improves nasal obstruction in both the first and the fourth year after surgery. Post-operative improvements decline slightly over time but remain significant. [ABSTRACT FROM AUTHOR]

Objective: Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty. Methods: Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up. Results: Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43). Conclusion: Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention. [ABSTRACT FROM AUTHOR]

Background: Opioid abuse is a public health crisis and the perioperative period can be a time of first opioid exposure. Little is known about postoperative pain management after endoscopic skull base surgery (ESBS). Methods: This investigation was a single‐institution, longitudinal, prospective cohort study of adult patients undergoing ESBS between November 2019 and March 2020. Participants completed preoperative questionnaires and were contacted every 48 hours postoperatively to quantify pain and opioid consumption. Results: A total of 33 patients were enrolled and 28 of 33 patients (85%) underwent ESBS for sellar pathology. Mean total morphine milligram equivalents (MME) consumed was 381.9 ± 476.0. History of a headache disorder (p = 0.025) and previous opioid use within 60 days preoperatively (p < 0.001) were significantly associated with greater opioid use. Mean duration of opioid use was 6.7 ± 5.1 (range, 0‐20) days. Headache disorder (p = 0.01), depression (p = 0.03), anxiety (p = 0.03), age ≤46 years (p = 0.029), and previous opioid use (p = 0.008) were all associated with longer mean opioid use. Patients with headache disorder also reported higher mean postoperative pain scores. Fewer than half of the participants required opioids by postoperative day 8. Prescription of nonsteroidal anti‐inflammatory drugs at discharge was significantly associated with less outpatient opioid use (p = 0.032). At 2‐month follow‐up, 37% of patients reported keeping excess opioids. Conclusion: After ESBS, greater total opioid use was significantly associated with history of headaches and previous opioid use within 60 days. Overall, opioid use declined among all patients in the postoperative period, but several factors may contribute to longer duration of use. [ABSTRACT FROM AUTHOR]

Purpose: Septal deviation and nose deformities are widely prevalent. As a consequence, patients may complain about difficulties in nasal breathing leading to a perception of diminished disease-specific quality of life. In a prospective randomized trial, we aimed to analyse the outcome of septoplasty (SPL) and septorhinoplasty (SRP) on patient satisfaction. Methods: Patients with functional indication for SPL (n = 19) or SRP (n = 54) were included and randomized for additional turbinoplasty. Preoperative clinical symptoms were collected with SNOT-20 GAV (Sinu-nasal outcome test-20—German adapted version) and NOSE© (nasal obstruction symptom evaluation) questionnaires. The final evaluation of treatment success was performed 9 months after surgery with SNOT-20 GAV, NOSE© and a self-established feedback questionnaire. Nasal breathing and obstruction were objectively measured with rhinomanometry and acoustic rhinometry [minimum cross-sectional area 2 (MCA2)]. Results: Minimum cross-sectional area 2 was statistically improved compared to the pre-treatment value in SPL (p = 0.0004) and SRP (p = 0.0001). Regarding MCA2 values of matched patient groups, similar findings were detected (SPL: p = 0.0013, SRP: p < 0.0001). Sinu-nasal outcome test-20 GAV and NOSE© scores were significantly reduced after both surgical procedures (NOSE©: SPL: p < 0.0001, SRP: p < 0.0001; SNOT-20 GAV: SPL: p = 0.0068, SRP: p < 0.0001). Evaluation of patient satisfaction in a self-established feedback questionnaire revealed a motivation of 81% of patients to redo the surgery (SPL 13/16, SRP 34/42) and a notably general satisfaction of 86% for SPL and 80% for SRP. Conclusion: Rhinosurgery leads to quantitative better nasal breathing and increased disease-specific satisfaction. However, this study implies the importance of the right selection of patients and the correct indication of the surgical technique. [ABSTRACT FROM AUTHOR]

Background: The study aimed to evaluate nasal reconstruction techniques customized for Asians. The currently available nasal reconstruction guidelines are based on Caucasian patients, and their applicability is limited in Asian patients due to differences in anatomical and structural features. Methods: A retrospective analysis was performed of the medical records of 76 patients who underwent nasal reconstruction at a single center between January 2010 and June 2020. A comprehensive evaluation was conducted of patients' baseline demographics and clinical characteristics, including age, sex, medical history, defect size and location, reconstructive procedure, pathological diagnosis, postoperative complications, and recurrence. Results: In 59 cases (77%), nasal defects resulted from tumor ablation, and the remaining 17 cases involved post-traumatic (20%) and infection-induced (3%) tissue damage. The most common defect location was the alae, followed by the sidewalls, tip, and dorsum. Forehead flaps were the most commonly used reconstructive technique, followed by nasolabial advancement flaps, rotation flaps, and skin grafts. Each procedure was applied considering aspects of structural anatomy and healing physiology specific to Asians. Complications included nasal deformity, hypertrophic scarring, secondary infection, and partial flap necrosis, but no cases required additional surgical procedures. Tumors recurred in two cases, but tumor recurrence did not significantly affect flap integrity. Conclusion: Nasal reconstruction techniques applied considering Asians' facial features resulted in fewer postoperative complications and higher patient satisfaction than the approaches that are currently in widespread use. Therefore, this study is expected to serve as an essential reference for establishing treatment guidelines for nasal reconstruction in Asians. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis. Method: Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not. Results: Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01). Conclusion: These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

Background and Aims: Baska Mask, a newly designed third-generation supraglottic device, has a sump where the pharyngeal secretions can collect and be suctioned out continuously. We aimed to study the effectiveness of Baska Mask in preventing airway contamination during nasal surgeries. Our primary objective was to assess airway soiling using fibreoptic bronchoscopy. Total airway manipulation time, haemodynamic parameters during device insertion and post-operative oro-pharyngeal morbidities were the secondary objectives. Methods: Eighty-four participants undergoing nasal surgeries were randomised to either have their airway maintained with Baska Mask (Group-BM) or Endotracheal tube (Group-TT). Fibreoptic bronchoscopy was performed at the end of the surgery and the airway was inspected for signs of contamination. Total airway manipulation time, haemodynamic parameters during device insertion and post-operative oro-pharyngeal morbidities were also assessed. Unpaired Student's t test was used for parametric data and Chi-square test for nonparametric data. One-way analysis of variance (ANOVA) was used for the intra-group analysis of haemodynamic data. Results: Tracheal contamination was not observed in any patient in either group. Time taken for device insertion (Group TT: 24.24 ± 6.86 s vs. Group BM: 24.22 ± 7.3 s; P = 0.97) was similar in both the groups. The total airway manipulation time was 2 min longer in Group-TT (P = 0.000) due to additional time taken for insertion of throat pack. Haemodynamic parameters during device insertion were stable and post-operative oro-pharyngeal morbidities were fewer with Baska Mask when compared to Tracheal tube. Conclusions: Baska Mask is non-inferior to tracheal tube in preventing tracheal contamination in patients undergoing nasal surgeries. [ABSTRACT FROM AUTHOR]

Background: In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process. Methods: This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port. Results: A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability. Conclusion: This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting. [ABSTRACT FROM AUTHOR]

This research was conducted to investigate the contribution of visual and written expression to nasal surgery education and the preferences of usage. The research was conducted with the observation of cases in the Ear, Nose and Throat (ENT) Surgery Department of Ondokuz Mayıs University Medical Faculty. During the study, the processes of the 'closed dorsum rhinoplasty' cases were observed. The case illustrations made as a result of the observations were presented to the study population comprising 36 medical students from 3 different universities (Ondokuz Mayıs University, Hitit University, İstanbul Medeniyet University). Data were obtained concerning the sampling of the research, the specialization areas of the participants, title groups, number of participants, and the information from the Likert type responses and the nonparametric statistical findings. The results showed that although the use of illustrations was seen to be more important according to the opinion of specialists and non-specialists in the area, sole use was concluded to be insufficient. A total of 43 of 60 ENT specialists and 9 of 11 Plastic Surgery specialists preferred the use of illustrations, photographs and written expression together. Non-specialists were seen to be undecided about their responses while no significant difference was found between specialists. The preferences of the participants were determined to be illustration, photography and written expression, respectively. The results of this study indicate that the use of visual and written expression forms together when they are available is related to the quality of surgery education at a semantic level. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this prospective study was to evaluate the effect of modified extracorporeal endonasal septoplasty on nasal tip shape and function in patients with severe caudal septal deviation.Methods: The study population comprised of 55 patients undergoing modified extracorporeal endonasal septoplasty, which called marionette septoplasty. To analyse the aesthetic objective outcomes, postoperative photographs were measured for projection index (PI), tip projection (TP), nasolabial angle (NLA), tip deviation angle (TDA), nasofrontal angle (NFA), supratip height (STH), columellar height (CH), at three times (2 weeks, 3, and 6 months after surgery) and were compared with preoperative photographs. Functional and aesthetic outcomes were also evaluated using nasal obstruction symptom evaluation (NOSE) scale and standardized cosmesis and health nasal outcomes survey (SCHNOS).Results: Between the pre- and post-operative 6th-month examinations, a significant increase in PI and TP were 7%, and 5% respectively. There was a significant alteration in the NLA and TDA values following the last examination (mean difference ± standard error of mean 9.68 ± 0.9° and 1.5 ± 0.8°, respectively). Moreover, the technique did not make a significant change in the final NFA, STH, and CH, measurements. Following surgery, the NOSE and SCHNOS scores were decreased significantly and the improvement continued over time until the last examination.Conclusion: The present study findings suggest that the marionette septoplasty technique is an effective to correct and stabilize severe caudal septal deviations. This technique also can provide tip support and protection with a low incidence of dorsal irregularity. [ABSTRACT FROM AUTHOR]

Objective: to analyze the characteristics of the facial profile as a fundamental tool in functional rhinoseptoplasty of patients who consult in the Rhinology Unit of the Otolaryngology Service of the Hospital Militar Dr. Carlos Arvelo, between January and April 2016. The face is made up of structures anatomical that provide certain characteristics. The nose occupies a central place, the precise diagnosis of nasal alterations is the most important and complex step of a functional rhinoseptoplasty. The purpose of the surgical restoration of the nose is to ensure proper function and harmony in shape, so the angles of the facial profile are relevant in the presurgical assessment. Materials and methods: descriptive-observational cross-sectional study. The sample consisted of 25 patients who voluntarily agreed to carry out a photographic study and rhinomanometry. Results: prevalence of the female sex with 72% of the total sample. The preponderant age group was made up of 92% young adults. Regarding the nasolabial and nasofacial angles, 56% and 24% presented alterations respectively. Rhinomanometry was performed on the population showing 100% alteration (valvular factor), of which 80% presented modification of the nasofacial and nasolabial angles. Conclusions: the correlation between the variation of the nasofacial and nasolabial angles with nasal patency establishes that facial analysis can be considered as a fundamental tool for determining aesthetic and functional corrections in functional rhinoseptoplasty. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the surgical outcomes in patients who underwent in one session caudal septal division, strip excision and unilateral bony batten graft procedures, a method described for the correction of caudal septal deviations. Methods: In this retrospective study, 27 patients with C-shaped caudal septal deviation who underwent endonasal septoplasty using caudal septal division, strip excision and unilateral bony batten grafting in our hospital in the period from August 2014 through October 2018 were reviewed. Patients were included in the study if their pre-operative and post-operative questionnaires and post-operative follow-up data (average follow-up period was 13.9 months) were available in full. Results: The average age of the 27 patients (6 women and 21 men) was 29.6±12.4 years. Postoperative observations revealed that a straight septum was achieved in 23 patients (85.1%). Average pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) scores were 85.1±20.4 and 22.4±4.2, respectively (p<0.0001). Septal hematoma developed in one patient in the postoperative period. Conclusion: The surgical outcomes of patients in whom we used caudal septal division, strip excision and unilateral bony batten graft to correct caudal septal deviations demonstrated the potential of this technique as an alternative to be used by surgeons. [ABSTRACT FROM AUTHOR]

The endoscopic endonasal approach (EEA) has been increasing in popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathological entities. The purpose of the present study was to examine the outcomes of patients who had undergone EEA resection of orbital lesions at our center. We performed a retrospective medical record review of patients who had undergone the EEA for resection of orbital lesions and orbital apex decompression from January 1, 2006 to December 1, 2019. For all the patients, the demographic data, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including 6 male patients and 3 female patients. The mean age was 49.4 years, and the mean follow-up period was 3.8 years (range, 1–13.5 years). The orbital pathological lesions that were treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumor, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis. All the patients presented with exophthalmos of the affected orbit. Of the 9 patients, 5 presented with decreased visual acuity on examination. Postoperatively, 1 of these 5 patients had improved to baseline visual acuity, 3 had stable vision, and 1 had brief improvement before experiencing progressive visual decline 1 month postoperatively. Two patients presented with diplopia, and both improved postoperatively. Three patients experienced new, transient, and self-limiting postoperative diplopia. For patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to explore the developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization. Materials and Methods: In total, 143 patients with a diagnosis of septal deviation who underwent septoplasty were included. The patients were divided into three groups in terms of the angles of the septal deviation. The angle of the septal deviations was defined as mild (<9 degrees), moderate (between 9 and 15 degrees) and severe (15 degrees and above). The degree of the mastoid pneumatization of each groups were compared. Results: In right-sided septal deviation subjects, the right mastoid air cell volumes of group mild, moderate and severe were 6,31±2,33 cm³, 5,20± 1,51 cm³, and 5,31±1,57 cm³, respectively. The mean right mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). The mean left mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). In right-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). In left-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). Conclusions: No developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization was observed in the study. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes. Methods: We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated. Results: A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications. Conclusion: When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group. [ABSTRACT FROM AUTHOR]