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Background: Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. Materials and Methods: This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Results: Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37 min in the Endoscopic group and 91.92 ± 15.35 min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Conclusion: Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. Key Message: Chronic otitis media is a cause of significant morbidity and hearing loss, especially in developing countries like India. The treatment options have evolved, with microscopic surgeries being the standard and endoscopic surgeries as a newer addition. The study included 209 patients over 4 years and compared hearing outcomes, graft uptake, postoperative pain, cosmesis, and hospital stay duration between endoscopic and microscopic tympanoplasty. Results showed similar AB gap closure and successful graft uptake in both groups, indicating comparable hearing outcomes. Endoscopic tympanoplasty had a significantly shorter duration of surgery, lower postoperative pain scores, and better cosmesis compared to microscopic tympanoplasty. Endoscopic tympanoplasty offers a better alternative with similar hearing outcomes, improved patient comfort, shorter hospital stay, and better cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Chronic rhino sinusitis (CRS) is a common disease. Maxillary sinusitis not cured by the medicines was addressed by the open surgical procedure namely Caldwell Luc operation. Thereafter introduction of nasal endoscopes in 1970's led to the minimally invasive surgery FESS which preserved the physiology of the nose and sinuses. In the year 2002 balloon sinuplasty was introduced in the western world and subsequently in India. Due to various logistics it was not performed and reintroduced in the year 2015 in India. It can be termed as micro minimally invasive surgery wherein anatomy as well as physiology of the nose and sinuses were preserved in cases of medically non responsive mild to moderate sinusitis. 20 cases were selected for exclusive balloon sinuplasty of maxillary sinus. Balloon sinuplasty is a relatively new procedure which can be termed as micro minimally invasive surgery addressing the CRS without the traditional forms for surgery like incision, cutting or microdebriding. The principle is causing microfractures by inflating the sinus opening and thus facilitating the drainage of the sinus contents. No immediate or late post operative complications were noted. Sinus patency 6 months later was present in 90% of the cases. Balloon sinuplasty is an excellent procedure for medically nonresponsive CRS without polyposis. The success rate is spectacular matching the FESS with almost no immediate post operative and late complication. The recurrence rate of sinusitis is low. We conclude that balloon sinuplasty is a micro invasive procedure which saves operating time, time of hospital stay of the patient and delivers excellent result with almost no complications. We hope it could be incorporated as a routine surgery for mild to moderate sinusitis not responding to medicines. [ABSTRACT FROM AUTHOR]

Glomangiopericytoma (GPC) is a rare benign sinonasal tumor originating from Zimmerman's Pericytes surrounding capillaries and accounting for less than 0.05% of all sinonasal tumors. Glomangiopericytoma has low malignant potential (5–10%) and is mostly diagnosed in the 6th or 7th decade of age with slight female preponderance. We presented here a case series of 5 patients with sinonasal GPC. This research was conducted at a tertiary healthcare centre in North India. In our case series, all the patients were evaluated and underwent endoscopic surgical resection. All patients underwent digital subtraction angiography (DSA) and preoperative embolization. The coblation technique used for haemostasis proved very effective and time-saving. All patients exhibited cytoplasmic SMA positivity (a marker of GPC) and CD34 negativity, while one patient exhibited a high Ki-67 index (> 10%), which is a predictor of aggressive tumor behavior. None of the patients showed any recurrence in follow-up. We recommend performing complete endoscopic surgical excision to prevent recurrence. The use of DSA, preoperative embolization, and intraoperative use of the coblation technique provides a cleaner surgical field and reduced operating time. [ABSTRACT FROM AUTHOR]

Chronic Rhinosinusitis (CRS) is a common condition causing significant symptoms to those affected, cause burden to the healthcare consumption and productivity loss (Fokkens et al. in Rhinol J 58:82–111, 2020). Chronic Rhinosinusitis is diagnosed clinically on the basis of characteristic symptoms with inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration (Fokkens et al. in A summary for otorhinolaryngologists Rhinology 50:1–12, 2012). Functional Endoscopic Sinus Surgery is a minimally invasive procedure recommended for chronic Rhinosinusitis. Patients are not routinely assessed specifically for functional and symptomatic improvement after surgery. Previous studies assessed either subjective or objective outcome of surgery (Elwany et al. in Eur Arch Otorhinolaryngol 255:511–514, 1998; Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitis – PMC, 2022. The present study assessed pre and post operative comparison of nasal mucociliary clearance, nasal patency and Sino-nasal outcome score and evaluated both subjective and objective outcomes of functional endoscopic sinus surgery simultaneously. To assess the effect of functional and symptomatic outcomes after Functional Endoscopic Sinus Surgery in patients with Chronic Rhinosinusitis visiting a tertiary care centre in South India. The present study was a hospital based cross-sectional study conducted in the Department of Otorhinolaryngology, in a tertiary care centre in South India, between February 2021 and May 2022. After obtaining informed consent all the patients fulfilling inclusion and exclusion criteria in the given time period were selected as the study population via consecutive sampling method. Detailed history, clinical examination and Diagnostic nasal endoscopy, Computed Tomography (CT) paranasal sinuses were done in all cases. Pre operative Saccharine transit time (STT), Peak nasal inspiratory flow rate (PNIFR) and Sino nasal outcome test (SNOT) 22 score were measured. All cases underwent Functional Endoscopic Sinus Surgery (FESS). Patients were followed up at 1st, 3rd and 6th month for functional and symptomatic outcomes. Data were analysed statistically using Friedman's ANOVA test. A total of 40 patients between the age of 20 and 60 with Chronic Rhinosinusitis with /without nasal polyposis were analysed. Incidence was found to be more common in middle aged group (37.5%). Among the study group 52.5% were females and 47.5% were males 55% was diagnosed as Chronic Rhinosinusitis with nasal polyp (CRSwNP) type and 45% as without nasal polyp (CRSsNP) type. On comparing the variation of Saccharine transit time, Peak nasal inspiratory flow rate and SNOT 22 score with post operative results done at, 1st, 3rd and 6th months using Friedman's ANOVA test showed statistically significant results (P value < 0.05). According to our study there is significant improvement in functional and symptomatic outcomes after Functional Endoscopic sinus surgery and restoration of mucociliary function in Chronic Rhinosinusitis patients. Thus, FESS is an excellent choice for treatment of CRS. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) is widely prevalent globally. Fungal rhinosinusitis is a subtype which requires early detection by using appropriate tests and to make an accurate decision regarding the treatment modality. This study aims at determining the clinicomycological profile of fungal rhinosinusitis (FRS). A total of 105 patients with CRS were included in the study which was prospectively done during a time period of 18 months in a tertiary care hospital. All patients were subjected to CT scans and diagnostic nasal examinations (DNE) preoperatively. The sinonasal specimens were subjected to KOH mount, fungal culture and histopathological examination following functional endoscopic sinus surgery (FESS). 53% of the patients with fungal sinusitis belonged to the age group 41–60 years. The prevalence of FRS was found to be 38% with aspergillus species accounting for about 85% cases. FRS is a disease which can have a wide spectrum of clinical presentations requiring early detection and appropriate treatment which is essential to avoid both short term and long term sequalae. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic sinus surgery is a frequently performed surgery for sinonasal polyposis. This includes various complications such as Crusting and synechiae formation etc. which can be reduced or minimised by regular nasal douching and nasal toileting in immediate post operative period. Methods: This study was conducted to assess the quality of life using SNOT 22 score and the efficacy of Triamcinolone Acetate impregnated anterior nasal packing based on the Peri-Operative Sinus Endoscopic (POSE) score and Lund Kennedy score on short and midterm post operative outcomes in patients undergoing Endoscopic Sinus Surgery for sinonasalpolyposis. This study was a prospective observational study comprising of 80 patients diagnosed with sinonasal polyposis. Patients were divided into two groups with 40 patients in group A (non absorbable Triamcinolone Acetate impregnated nasal packing) and 40 patients in group B(non absorbable Saline impregnated nasal packing). Study setting: This study was conducted at a tertiary care centre in South India from July 2017 to July 2019 after EthicsCommitteeapproval. Results of this study showed Improvement in quality of life index in the postoperative period in both Group A (Triamcinolone Acetate) and Group B (saline). Lund Kennedy and Peri operative sinus endoscopy score (POSE) showed statistically significant results with better and early healing among Group A (Triamcinolone Acetate) patients. Conclusion: This shows Triamcinolone Acetate nasal packing in intaoperative period helps to reduce early post operative complications such as edema,crusting and synechiae formation. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. Materials and Methods: We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. Results: A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. Conclusion: This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes. [ABSTRACT FROM AUTHOR]

Malignant tumors of sinonasal region are rare and affect less than 1 in 100,000 people per year. They are histologically diverse group and potentially pose significant management problems due to their proximity to the orbit and intracranial cavity. Although squamous cell carcinoma (SCC) is most common malignant tumor of paranasal cavity, tumors like adenocarcinoma, olfactory neuroblastoma, malignant melanoma, adenoid cystic carcinoma, sarcomas, haemoproliferative tumors, e.g. lymphoma may also occur. Retrospectively study was done in a tertiary care institute from January 2008 to December 2018 in India. Inclusion criteria—all biopsy proven PNS malignancy patients operated by endoscopic approach, irrespective of age and gender. Exclusion criteria- patients diagnosed with nasopharyngeal carcinoma, skin involvement, gross orbital involvement (muscle invasion), metastasis, operated by open approaches. 46 patients who underwent endoscopic tumor removal were reviewed. 36 (78.2%) were males and 10 (4.6%) females. Most common tumor in our study was adenoid cystic carcinoma. Recurrence was seen in 6 patients. Palliative therapy was given to all patients with recurrence. Management of malignant PNS tumor involving anterior skull base is multidisciplinary. R0 resection should be main goal in all malignant PNS malignancy. Tumors invading unresectable areas like cavernous sinus, brain parenchyma, carotids can be left in these places followed by palliation except in cases of squamous cell carcinoma. If R0 cannot be achieved surgically in SCC than patient should be considered inoperable and send for palliation. T1–T3 PNS malignant tumors can be managed by endoscopic approach followed by adjuvant therapy after a period of 6 weeks. Endoscopic excision should be converted to endoscopic assisted open approach in case of T4 tumors. We have tried to give a management protocol for management of malignant PNS tumors. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Rhino-orbital mycosis has been recently recognised as one of the sequelae in COVID-19 recovered patients. In India, detection of mucormycosis is declared as notifiable disease. In this article, the authors aim to describe the characteristics of patients presenting with post covid fungal infection which could be detected on 10% potassium hydroxide (KOH) wet mount and Giemsa stain put on crush biopsy smear. We describe 10 COVID-19 recovered patients admitted to ENT department of the hospital during second wave of COVID-19 infection. They presented with post covid fungal sinusitis and ophthalmic complications and planned for surgery. KOH mount and Giemsa stain were used for possible opinion and confirmed by culture. The observations were described in mean and percentages. All ten (100%) COVID-19 recovered patients were previously diagnosed with type 2 diabetes mellitus (DM) for 2–11 years. All 10 patients (100%) were given oral or intravenous corticosteroids for mean of 21 days (3 weeks—till presentation to ENT department). Simple procedures with 10% KOH mount and Giemsa stain could detect fungal hypae in all the cases and could provide possible opinion in 9 of 10 (90%) cases for timely management of the patients. The authors hypothesize that uncontrolled DM and prolonged use of corticosteroids may act as culprits of rhino-orbital mycosis in COVID-19 recovered patients. Simple and routine 10% KOH mount and Giemsa stain may provide early opinion of fungal hypae to ensure quick management and survival of the patients. [ABSTRACT FROM AUTHOR]

Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP) are two distinct endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of the study was to find the prevalence of eCRSwNP and neCRSwNP, their clinical comparison and to establish predictive values for clinical and diagnostic factors to differentiate between eCRSwNP and neCRSwNP in Indian population with CRSwNP. This study was a prospective cohort, multi- institutional study. A total of 162 patients who were diagnosed with nasal polyps at different military hospitals in India during the period from 2011 to 2020 were selected for study. They were diagnosed in accordance with EPOS guidelines. They were randomly divided into two groups as eCRSwNP and neCRSwNP based on the response to oral corticosteroids for 2 weeks duration and the prevalence of eCRSwNP was established. Blood samples were collected and endoscopic sinus surgery was performed in all patients after atleast 2 months of last steroid dose. Preop CT scan scores, preop nasal endoscopy scores, preop blood eosinophil counts, preop tissue eosinophil counts were compared between the groups. Postop followup was done at 6 months by comparing CT scan scores and nasal endoscopy scores. Predictive values for clinical and diagnostic factors were established to diagnose eCRSwNP in Indian population. Out of a total 162 patients, 121 (74.6%) patients were classified into eCRSwNP and 41 (23.6%) into neCRSwNP out of a total of 162 patients with CRSwNP. CRSwNP was seen in the 4th decade. eCRSwNP was seen in the later part and neCRSwNP was seen in the early part. eCRSwNP was more common in males and neCRSwNP was more common in females. Smoking, asthma and aspirin intolerance were more commonly seen in eCRSwNP than neCRSwNP, p < 0.001, p = 0.020 respectively. Preop total CT scan score, preop bood absolute eosinophil count,preop blood eosinophil percentage, tissue eosinophil percentage, postop nasal endoscopy score, postop CT scan score were stastically significant in eCRSwNP, p < 0.001 except preop total nasal endoscopic score. Tissue absolute eosinophil count had best predictive accuracy plotted with receiver operating characteristic (ROC) curve analysis, area under curve (AUC) 0.923(95% CI, 0.876–0.970). The cutoff points determined to diagnose eCRSwNP were ≥ 15 for preop total CT scan score, ≥ 378 × 106/L for preop absolute blood eosinophil count, ≥ 6.5% for preop blood eosinophil percentage, ≥ 14% for tissue eosinophil percentage, ≥ 16 for absolute tissue eosinophil count, ≥ 1 for 6 months postop total nasal endoscopy score, ≥ 2 for 6 months postop total CT scan score. eCRSwNP and neCRSwNP are two distinct endotypes of nasal polyps present in Indian population with CRSwNP. Two thirds of the patients with nasal polyps were eCRSwNP and the prevalence in Indian population is more than the East Asian population but less than the Western population. There is a high chance of recurrence and treatment failures for eCRSwNP than neCRSwNP. The cutoff points for various non invasive diagnostic predictors are useful to diagnose the patients with eCRSwNP during the outpatient visits and hence plan for better treatment strategies. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p < 0.05 was considered significant. RSDI and SNOTT 22 scores showed a mean change 34.78 and 33.04 respectively after FESS, with a p value of < 0.001, which was highly significant. The pre-operative factors which predicted a poor quality of life after FESS were smoking, Allergy and Asthma. Higher pre-operative Endoscopic and CT scores resulted in an improved quality of life after FESS. Gender, concurrent septoplasty and sinonasal polyposis did not influence the quality of life outcomes after FESS. The study determines the quality of life after FESS and also analyses the factors responsible for poor prognosis after functional endoscopic sinus surgery. This study will enable the ENT surgeons to adequately counsel the patients before surgery. [ABSTRACT FROM AUTHOR]