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To evaluate the outcome and complications of Endoscopic endonasal Dacryocystorhinostomy (DCR) using an inferiorly based mucosal flap as compared to a conventional posteriorly based mucosal flap with flap preservation and no stenting. 36 patients presenting with nasolacrimal duct obstruction were divided into two groups: the first group underwent endoscopic DCR using an inferiorly based mucosal flap, and the other group used a posteriorly based mucosal flap. In both groups, the mucosal flap was preserved, and bone was removed using Kerrison's punch. No stenting was done in any of the cases. The patency of the ostia was determined by syringing, and nasal endoscopy was done to look at the neo-ostium at follow-up visits to determine success and complications in each group. All 18 cases in the inferiorly based flap group had patent ostia with good mucosalization of the neo-ostium at 6-month follow-up. 3 of the 18 cases in the conventional posteriorly based flap group had failure due to granulation tissue formation around the neo-ostium. The use of an inferiorly based mucosal flap is easy to fashion and reposition at the end of the surgery. This technique has a good outcome with patent ostia during the follow-up period of 6 months. [ABSTRACT FROM AUTHOR]

Introduction: The imaging of the paranasal sinuses has advanced from plain X-ray films to CT and MRI. This advancement in the radiological field helps to yield more accurate information and aids in arriving at a proper differential diagnosis, especially for rhinosinusitis. However, CT should be used cautiously among patients considering its effects due to radiation. Aim: This study aims to correlate the pre-operative radiological findings with the intraoperative functional endoscopic sinus surgery findings in a series of 100 cases. Materials and Methods: A retrospective case series was conducted among 100 cases who had complaints relating to nose and paranasal sinuses in a tertiary care hospital, Chengalpattu. Their symptoms, clinical examination, pre-operative radiological findings, and intra operative findings have been recorded. The collected data was analyzed for correlation and agreement between pre-operative radiological findings and intraoperative findings. Results: Almost all the CT revealed pathologies like polyps, mucosal thickening, and anatomical variations. However, intraoperatively, only 64.5% had mucosal thickening and 23.6% had polyps. Poor to acceptable correlation has been reported among patients with OMC obstruction, polyps, and mucosal thickening, respectively. Yet, no agreement was seen between pre-operative radiological and intraoperative findings. Conclusion: Endoscopy remains the most valuable test to diagnose, confirm the severity and manage sinus related diseases. [ABSTRACT FROM AUTHOR]

Endoscopic optic nerve decompression is a highly effective and reliable approach for patients with select cases of optic neuropathy. It reduces the hydrostatic pressure and helps in relieving the compressive forces within the intracanalicular portion of the optic nerve consequently preserving and arresting the deterioration of vision. The advantages of the endoscopic approach over other procedures include preservation of olfaction, quick recovery, lack of external scars and less morbidity. The objective of the study is to assess the surgical outcome of endoscopic optic nerve decompression in patients with traumatic and atraumatic optic neuropathy. The case records of consequent patients attending ENT department with defective vision due to traumatic and atraumatic causes were reviewed. The outcome was measured in terms of improvement in visual acuity by log MAR scale. Among the 14 patients studied, 57% were females and the median age of presentation was 33 years. As compared to preoperative baseline visual acuity, the overall improvement was achieved in 11 patients, with an effective rate of 78.5% postoperatively. Patients presenting with no light perception and residual vision had significant improvement in visual acuity after surgery. Trans-nasal endoscopic surgery helps in decompressing the optic nerve with proper exposure of the orbital apex and optic canal without any intracranial or intra-orbital complications. Further, being a minimally invasive procedure has great advantage in cases of optic neuropathy. [ABSTRACT FROM AUTHOR]

Introduction- Endoscopic minimally invasive pituitary surgery (MIPS) is advantageous over microscopic technique, as it provides superior close up, wide angle view of surgical target area. Image guided navigation system (IGNS) guides the surgeon to localize the lesion. In the present study we analyzed the Image Guided Surgical procedure and outcome of Endoscopic minimally invasive pituitary surgery and shared our experiences regarding disease clearance. Materials and methods: During the period of April 2015 to August 2022 a total 104 patients, diagnosed with pituitary adenoma underwent surgery and further followed up in a multidisciplinary team approach in a tertiary care hospital of Kolkata, India. The data obtained were reviewed statistically to satisfy the study objectives. Results: Total 104 operations were done on 98 patients and total cases taken for calculation and analysis was 98, which consist of 11 microadenomas, 81 macroadenomas. Among 35 patients with normal preoperative hormonal assay, one patient developed postoperative hypopituitarism. Among 6 patients with preoperative hypopituitarism 4 patients (66.6%) recovered after surgery. Overall, 85 cases had total disease clearance as detected on post-operative MRI. In functioning pituitary adenoma (FPA) clinical and endocrinological improvement occurred after primary surgery in 85.36% (n = 35) and after revision surgery it was 84.44% (n = 38). Macroadenomas, giant adenomas were found to have statistically significant higher risk of incomplete disease clearance but large adenomas do not have statistically higher risk of incomplete clearance. Conclusion: IGNS requires extra time for setup, but with proper registration of tracker instruments it adds precision to the surgery. IGNS supplements endoscopic visualization with localization of target lesion by real time stereotactic feedback using preset preoperative imaging data, thus increasing accuracy, safety and effectiveness of minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Objective. To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap. Study design. Randomised prospective cohort design. Setting. Tertiary academic centre. Subjects and Methods. 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1st week, 2nd week, 1st month, and 3rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist. Results. Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96% at 3rd month in case group A and 98%, 92% and 82% respectively at the end of 2nd week, 1st month and 3rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B. Conclusions: Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the relationship between frontal sinus pneumatization and its effect on various variations of paranasal sinuses on paranasal sinus CT scan. A total number of 100 patients (51 males, 49 females) were included in this study. Patients were divided into three groups on the basis of their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations like pneumatization of upper and middle turbinate, presence of agger nasi, Haller and Onodi cell, maxillary sinus hypoplasia, extent of sphenoid sinus pneumatization, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve types were ascertained and compared within each group. The prevalence of Onodi cell, anterior clinoid process and greater wing of sphenoid pneumatization and optic nerves type 3 and 4 were higher in Type 3 frontal sinus pneumatization group as compared with other groups. Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between these variations preoperatively for avoiding complications. [ABSTRACT FROM AUTHOR]

We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial. [ABSTRACT FROM AUTHOR]

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]

Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio. [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]

Objective: To study the efficacy of coblation in the endoscopic surgery of sinonasal and skull base masses. Study Design: Prospective Interventional Study. Method: 100 patients with signs and symptoms of nasal obstruction were enrolled for 14 months. On the basis of diagnosis they underwent endoscopic sinus surgery using coblator and their intra-operative blood loss, operation time, post-operative pain threshold using VAS(Visual analogue scale) were enlisted. Result: 80% had Sinonasal polyp followed by Inverted papilloma in 8%, Angiofibroma in 5%, Hemangioma in 3%, Esthesioneuroblastoma in 2% and Rhinosporidiosis in 2%. The Minimum blood loss was 50 ml and Maximum was 600 ml. 30% patients had no pain, 60% had Mild pain and 10% had Moderate pain post procedure. Mean Operation time was 112.86 min. Conclusion: Coblation has proven to have reduced operation time, blood loss and faster wound healing. It has now established itself as an essential tool for advance tumours in nasal surgeries. [ABSTRACT FROM AUTHOR]

Rhinosinusitis is a prevalent condition worldwide affecting the developed and the third world countries alike. SNOT-22 is a validated disease-specific questionnaire designed to use in Chronic Rhino Sinusitis (CRS), which means to quantify patients perception of their disease burden. SNOT 22 questionnaire can chart patients nasal as well as psychological symptoms arising due to CRS and very well become marker of individual symptomatic improvement. To study the correlation between disease specific quality of life and endoscopy score after 1 month and 6 months of Endoscopic Sinus Surgery in patients with Chronic Rhinosinusitis. In the present study, ESS surgery showed improvement in Endoscopy score and all the symptoms assessed by SNOT-22. The total percentage of improvement in the SNOT-22 score was 70% after 1 month and 89% at the end of 6 months. We conclude that after the procedure of ESS not only endoscopic evaluation is necessary but also psychological and symptomatic assessment by SNOT 22 is very necessary as nasal and psychological factors were equally decisive for the seeking of the treatment (pharmacological/surgical) by the patient. [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]

The study was carried out to correlate the inflammatory markers (NLR, ELR, PLR) before and after endoscopic sinus surgery and their role in the prediction of recurrent nasal polyps. This was a hospital-based observational study carried out the 43 patients, aged between 18-45 years, admitted to the department of ENT with CRSwNP and underwent endoscopic sinus surgery. NLR, ELR & PLR values were compared for each patient and calculated from complete blood counts taken before and after surgery follow-up period at post-op 1st week, 3rd week, 3rd month, and 6th month. In our study, 12 out of 43 patients who underwent ESS showed recurrence. The mean value of ELR was higher in the pre-operative and post-operative 1st week in recurrent nasal polyp patients than in non-recurrent nasal polyps. (p-value < 0.05) but there were no significant changes in ELR values in subsequent follow-ups. There were no significant changes in NLR & PLR in the pre-operative and post-operative periods. Although recurrence was common in CRSwNP after endoscopic sinus surgery. Inflammatory markers could be used to predict the chances of recurrence. In our study, ELR is a better parameter than NLR and PLR in the assessment of the chance of recurrence. [ABSTRACT FROM AUTHOR]

Aim & objectives-To assess and compare the nasal obstruction in patients before and after undergoing FESS using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy. Introduction- Chronic Rhinosinusitis with, or without nasal polyps can lead to nasal obstruction. Patients refractory to medical treatment undergo Functional endoscopic sinus surgery (FESS). FESS has been shown to improve subjective quality of life outcomes and objective endoscopic improvement. Material & methods- A prospective study conducted in the department of Ear, Nose & Throat, of a tertiary care medical college and associated Hospital between January 2021 and October 2022. Subjective and objective assessment of nasal obstruction was done using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy before and after surgery at 1st, 3rd and 6th month. Results- Post FESS, there was a significant improvement in nasal obstruction on Visual analogue scale, sinuses were healthy and drainage was adequate on Diagnostic nasal endoscopy, statistically significant (P < 0.05) decrease in nasal resistance was seen on Rhinomanometry. Conclusion- A good subjective outcome on Visual analogue scale and a good objective outcome on Diagnostic nasal endoscopy and Rhinomanometry can be obtained with FESS in patients with Chronic Rhinosinusitis. [ABSTRACT FROM AUTHOR]

Purpose: This study designed to compare the symptomatic profile of diagnosed patients of chronic rhinosinusitis (CRS) before and after functional endoscopic sinus surgery (FESS) by a 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. Study design: Observational mixed-design study. Materials and Methods: It is an observational mixed-design study conducted in the department of ENT, Dr. S.N. Medical College, jodhpur from February 2021 to September 2022. A total of 50 patients were included in our study who underwent functional endoscopic sinus surgery. Their symptomatic improvement based on the SNOT-22 score, was compared before and after surgery. Follow-up of patients was done at 1 month and 3 months by SNOT-22 score. Results: A total of 50 patients were included in our study, 42 patients were telephonically communicated and followed up, and 8 patients were lost to follow-up, so 42 patients' data were analyzed. The mean age was 35.42 years. The mean total SNOT-22 score preoperatively was 45.64, postoperatively at 1 month was 6.57, and postoperatively at 3 months was 2.52. The mean difference between preoperative and postoperative scores was 43.11. This shows a significant reduction in postoperative scores as well as improvement in symptoms at the end of 3 months. Conclusion: Preoperatively 64.24% of the patients had a grand total score of 20–50 (showing a moderate impact on quality of life) and 35.71% of patients having a score > 50 (showing a severe impact on quality of life). Observations in our study suggest that Functional endoscopic sinus surgery provides a significant symptom-specific improvement as well as a significant quality of life improvement in patients with chronic rhinosinusitis with or without polyposis. SNOT-22 questionnaire provides an ideal way to understand and grade the disease severity preoperatively and compare the symptomatic improvement after functional endoscopic sinus surgery in patients with chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

Rhino sinusitis, is a common inflammatory disease that affects the nasal cavity and paranasal sinuses in millions of individuals. Chronic sinusitis patients complain of a combination of nasal obstruction, rhinorrhea, post nasal drip and facial pain. To identify the risk factors of the recurrence of nasal polyps in chronic rhino sinusitis patients after endoscopic sinus surgery. After a review of 60 patients with chronic rhino sinusitis with failed medical treatment requiring FESS presenting in Kasr Alainy Hospital in Cairo University and October 6 University Hospital from May 2022 to March 2023. All patients were subjected to history taking, clinical examination including endoscopy, subjective evaluation of symptoms and CT-scan. Of our patients, six patients (15%) were diagnosed with recurrence of nasal polyps with chronic rhino sinusitis and needed revision surgery. There are multiple risk factors related to the recurrence of nasal polyps including smoking followed by having a history of an asthma, the presence of an allergy, septal deviation, prior sinus surgery, and turbinate hypertrophy. Other factors, as proper medical treatment such as topical steroids and treatment of allergy had a significant role in decreasing the recurrence rate. Risk factors related to the recurrence of nasal polyps should be avoided before surgery. The avoidance of risk factors protects the patients from the recurrence of nasal polyps, the hazards of anaesthesia on surgical treatment, and the financial cost of surgery. Follow up is important in the prevention of recurrence of nasal polyps and improves the symptoms. [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]

Sino-Nasal Outcome Test (SNOT-22) symptom score is the most widely used questionnaire due to its easy interpretation with respect to quality of life (QOL) in patients with chronic rhinosinusitis (CRS). It helps in deciding further treatment plan in patients with refractory CRS despite maximal medical therapy (MMT). Endoscopic sinus surgery (ESS) is suggested in patients not responding to medical treatment. The preoperative and post-operative QOL for patients with CRS is assessed using SNOT-22. To assess SNOT-22 score change in CRS resistant to MMT. This is a longitudinal study conducted from April 2021–September 2022 included patients diagnosed to have CRS, satisfying the inclusion criteria. SNOT-22 for symptom severity assessed at the first visit, 1 week and 12 weeks and after MMT. Patients who failed MMT, posted for ESS. Post-operatively SNOT-22 symptom score re-assessed at 15 days, 1 month, 2 months and 3 months. 56 patients (male-51% and female-49%) who failed to respond to MMT included in the study. The five major troublesome symptoms nasal blockage (92.86%), need to blow nose (75%), facial pressure/pain (53.57%), post nasal discharge (51.79%), and sneezing (42.86%). The mean SNOT-22 symptom score when compared with pre-operatively (69.54 ± 8.973) and after FESS (2.09 ± 1.881) had improved significantly (p < 0.001). CRS is more frequently seen in males aged between 21 and 30 years. The patient-based outcome measures, like SNOT-22 helps to foresee the extent of post- operative improvement. The effective management of CRS is by surgical intervention. [ABSTRACT FROM AUTHOR]

The upper and lower airways are typically subjected to identical inflammatory stimuli and comprise a single organ that is functionally connected. 40 patients with chronic rhinosinusitis with nasal polyps who had failed medical treatment and undergone FESS participated in our study. Prior to surgery and three months after surgery, nasal obstruction symptoms were measured using the NOSE score system and pulmonary function tests were evaluated using spirometry. The mean Nose Score was 70 before surgery but dropped to 4 afterward, with a p value < 0.001 showing a statistically significant improvement in the nasal symptoms following FESS. The mean pre-operative FVC, FEV1, and FEV1/FVC% values were 3.19, 2.53, and 78.81%, respectively, while the mean post-operative values were 3.14, 2.5, and 79.01%. Following FESS, there wasn't a statistically significant change in lung function tests. Our study showed that percentage of change of total NOSE score has a statistically significant Negative correlation with percentage of change of pulmonary function tests parameters. This study demonstrates the positive effects of FESS on nasal polyposis patients' quality of life and nasal obstruction symptoms without having any negative impacts on the lower airways. [ABSTRACT FROM AUTHOR]

Despite antibiotic treatment applied in Otorhinolaryngology, orbital complications due to chronic rhinosinusitis are considered a threat to the functions of the eyes. If timely intervention is not provided, orbital complications could rapidly progress to optic neuritis or life-threatening intracranial complications. A retrospective study included four patients between the ages of 29–70 years with orbital complications due to chronic sinusitis. Diagnosis was based on history, clinical examination, and imaging. In all cases, treatment was initiated with intravenous antibiotics and steroids. Surgical intervention was performed in all the patients when symptoms failed to resolve after 48 h of intravenous treatment. In our study, we encountered patients with orbital complications which included pre-septal cellulitis (75%) and frontal sinus fistula (25%). Average time of hospital stay was 9.5 days. All patients underwent surgery after 48 h of intravenous treatment and showed resolution of orbital symptoms within 2–6 months post-operatively. No recurrences have been encountered till date. Orbital complications are severe pathologies which require immediate attention and aggressive treatment via endoscopic approach as well as antimicrobial treatment to prevent unwanted threat to life. [ABSTRACT FROM AUTHOR]

The purpose of our study was to assess the prevalence of variations and type of sphenoid sinus and its adjacent structures pneumatization and its significance. This prospective study included 114 patients who underwent CT of the paranasal sinuses. The CT scan in axial, coronal and mid sagital section were analysed to assess the type of pneumatization of the sphenoid sinus and its adjacent structures like; anterior clinoid process, greater wing of sphenoid and pterygoid process. The sphenoid sinus pneumatization was classified into Conchal, Presellar, and Sellar types, later comprised of sellar and post-sellar types. Out of 114 cases of pneumatized sphenoid sinus, 5.2% cases were conchal type, 26.3% cases Presellar type and 68.4% cases sellar type. The one or more adjacent structures was pneumatized in 71 (62.2%) of cases. The adjacent structures which found to be pneumatized are anterior clinoid process in 26.3%, Pterygoid process in 23.6%, and greater wing of sphenoid in 12.3% cases. The pneumatization of adjacent structures was more prevalent in sellar type of sphenoid sinus, followed by pre-sellar type and no pneumatization in conchal type. The anterior clinoid process pneumatization was present in 26.1% of cases, in which 3 (2.6%) cases in pre-sellar type and 27 (23.5%) cases in sellar type. It was unilaterally pneumatized in 13 (11.4%) and bilaterally in (17 (14.9%) cases. The pterygoid process pneumatization was present in 27 (23.6%) of cases, unilateral in 16 (14%) cases and bilateral in 11 (9.6%) cases. The Greater wing of sphenoid pneumatization was found in 14 (12.3%) cases, no cases in conchal types, 2 (1.8%) in pre-sellar type, and 12 (10.4%) in sellar type There was no statistically difference found in between right and left side of sphenoid sinus and its structure pneumatization. The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sinus diseases, sellar and central skull base lesions. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 − 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time. [ABSTRACT FROM AUTHOR]

The authors aimed to develop an extensive preoperative checklist of CT scan findings during endoscopic access to the ventral skull base and implement it in clinical practice. A comprehensive literature review was conducted to identify the radiological landmarks crucial to endoscopic skull base surgery. Four electronic databases were searched: PubMed, MEDLINE, EMBASE, and Google Scholar using search terms/keywords such as "radiological landmarks," "endoscopic skull base surgery," "CT scan," "pituitary surgery," "anatomical variations," "internal carotid," "optic nerve," "sphenoid sinus," "pneumatization," "dehiscence," and "protrusion". Inclusion criteria were limited to original articles and systematic reviews published in English, between the years 2000 and 2021, which pertained to the radiological landmarks to be identified during endoscopic skull base surgery. Full-text articles were retrieved and collated into a narrative review focused on a 12-item checklist the authors agreed upon. The mnemonic "O ROAD TO SELLA" was used to represent the checklist and include the following landmarks: Sphenoid Ostium, Sphenoid Rostrum, Onodi cells, Anatomic variations of the sphenoid sinus, Distance between the carotids, Tumor characteristics, Optic nerve dehiscence/protrusion, Septation/insertion of the sphenoid sinus, Entrance to the sellar floor, Lateral recess of the sphenoid sinus, cLinoid process pneumatization, and internal carotid Artery dehiscence/protrusion. The checklist is designed to be used by attending physicians, fellows, and residents and the authors intend to implement it into electronic medical records at the institution's medical center to monitor the outcomes of EEPS after implementation. [ABSTRACT FROM AUTHOR]

A 14-year-old girl suffered a rare injury when a pen pierced her left eye, leading to a foreign object lodged in her ethmoid sinus. Prompt diagnosis and endoscopic sinus surgery (ESS) effectively removed the object, highlighting ESS as a valuable approach for managing uncommon sinus foreign bodies while minimizing complications. [ABSTRACT FROM AUTHOR]

Lacrimal bypass tubes create a fistula from the conjunctiva to the lacrimal sac or the nasal cavity. Fluoroscopic nonoperative placement of a plastic stent has shown successful results in the treatment of epiphora. Polyurethane lacrimal stents have been reported as a safe, easy, non-surgical treatment in the treatment of distal lacrimal obstruction. Recurrence due to stent occlusion of the granulation tissue is common. Stent displacement is very rare. We presented the first case of the stent protruded into the mouth in the literature. [ABSTRACT FROM AUTHOR]

The inflammatory process involving the maxillary sinus is often exacerbated by a functional obstruction due to laterally displaced uncinate process which obstructs the infundibulum and the natural ostium. Physiologically the drainage pathway may be adequate but during periods of inflammation resulting in nasal oedema, the ostium/infundibulum interface is inadequate, preventing adequate ventilation and drainage of the maxillary sinus. Incomplete removal of the uncinate process without including the natural ostium may result in failure and recurrence. This method of Middle meatal antrostomy that does not include the natural ostium of the maxillary sinus, leads to the missed ostium sequence and continued sinus disease. Here a case of missed maxillary sinus syndrome and its management is presented. A 28-year-old man with complaints of post nasal drip and Left facial pain for 4 months. 3 years prior the patient underwent functional endoscopic sinus surgery (FESS), following surgery patient had recurrent episode of sinusitis. Diagnostic nasal endoscopy revealed presence of mucopurulent discharge in left middle meatus, CT scan Paranasal sinus was suggestive of opacity in left maxillary sinuses and in left middle meatus with wide maxillary antrostomy. Revision FESS surgery was performed, where two ostia were present was converted into single wide middle meatal antrostomy using a back bitting forceps and microdebrider to avoid maxillary sinus mucus recirculation phenomenon. On follow up 1 year later, patient had no symptoms of repeated sinusitis. Missed maxillary sinus ostium syndrome has to be recognized and timely addressed by joining the natural and surgically created ostia as single wide middle meatal antrostomy window. [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]

Retromaxillary cell (RMC), one of the anatomical variations of the posterior ethmoidal cell and is often overlooked during primary functional endoscopic sinus surgery. The incomplete removal of the disease from RMC leads to need for revision surgery. This study was aimed at analyzing Computed tomography scans of patients' paranasal sinuses for the incidence, types and radiological evaluation of Retromaxillary cell. Incidence of RMC was 74% (74/100 sides). The sex distribution was 31 (62%) males and 19 (38%) females. 34 patients (85%) had bilateral RMC and 6 patients (15%) had unilateral RMC. Lateral extension of RMC ranged from 1.03 to 11.3 mm. Out of 74 sides examined, 20 (27.02) were type I, 36 were type II (48.64%) and 18 (24.32%) were type III. The incidence of maxillary sinus disease on RMC sides and non-RMC sides has no significant difference (p < 0.5). RMC is lateral extension of posterior ethmoidal cell beneath the orbit and posterosuperior to maxillary sinus. The depth of the RMC is highly variable. The risk of residual disease in FESS is high in Type III RMC and one should pay attention to presence or absence of RMC and type of RMC prior to the endoscopic sinus surgery. Radiological study of RMC helps in preoperative planning and therefore intraoperative complete clearance of disease in endoscopic sinus surgery. [ABSTRACT FROM AUTHOR]

While some volume of pneumocephalus occurs following any surgery entailing dural breach, tension pneumocephalus (TP) is a rare complication of endoscopic endonasal surgery described in less than 1% cases including expanded endoscopic endonasal approaches (EEEA). It is a neurosurgical emergency warranting urgent decompression. Two cases, who developed TP following EEEA are presented. One had sinonasal malignancy (adenoid cystic carcinoma) eroding the anterior skull-base (T4N0M0) and the other was a large olfactory groove meningioma. TP was heralded in both by sudden deterioration in neurological status. Both cases underwent bifrontal craniotomy for decompression with simultaneous skull-base repair incorporating a vascularised pericranial flap. Brief literature review regarding the pathophysiology, contributing factors, diagnosis, management, and prevention of TP following EEEA is presented. TP, a life-threatening neurosurgical emergency, warrants meticulous precautions for its prevention, and vigilant postoperative monitoring for early detection. Urgent decompression with thorough skull-base repair is imperative to prevent complications. [ABSTRACT FROM AUTHOR]

The most common cause of nasal obstruction is a deviated nasal septum. It causes breathing difficulties and may eventually also cause sinusitis, epistaxis, sleep disturbances and snoring. The traditional surgeries of the nasal septum improve the nasal airway but do not fulfil the essential criteria in most instances. Endoscopic septoplasty is a fast-developing concept and gaining popularity as it provides a direct targeted approach to the septal anatomic deformity allowing a minimally invasive procedure under excellent visualization. The aim of this study is to compare the post-operative morbidity among conventional and endoscopic septoplasty. The present prospective study was conducted on 50 patients having deviated nasal septum. Patients were randomly divided into two groups of 25 each. Out of 50 patients, in 25 patients (Group A) Conventional septoplasty was done, whereas in other 25 patients (Group B) endoscopic septoplasty was done. The patients were followed up post-operatively at 2 weeks, 4 weeks and 8 weeks. Study Design: comparative study. The mean of operating time (min) in Group A was 60.47 ± 8.16 which was significantly higher as compared to Group B (39.7 ± 6.73). (p value <.0001). The Mean of blood loss (mL) was significantly higher in Group A (88.67 ± 8.77) as compared to Group B. (54.6 ± 7.18). (p value <.0001). Post-operative NOSE score at one month was 7.33 ± 1.5 in group A which was significantly higher as compared to Group B (5 ± 1.41). (p value = 0.0007) whereas post-operative NOSE score at 3 months in Group A was 6.53 ± 1.25 which was significantly higher as compared to Group B (4.4 ± 1.78). Proportion of post-operative complications was comparable in Group A and Group B (No complication 80% vs. 92% respectively). According to the present study, both the conventional and endoscopic septoplasty procedures were effective in relieving nasal obstruction in the patients. Endoscopic septoplasty showed significantly better result than conventional septoplasty in terms of time taken for surgery, blood loss during the surgery, post-operative complications and in terms of quality of life as assessed by NOSE Score. [ABSTRACT FROM AUTHOR]

Background: Isolated frontal sinus involvement in mucormycosis is seen very infrequently. Recent technological advances including image guided navigation and angled endoscopes have shifted paradigm towards minimally invasive surgeries. Open approaches are still relevant for the disease of frontal sinus with lateral extension where effective clearance cannot be obtained if approached endoscopically. Objectives: The objective of this study was to describe the presentation and management of patients of mucormycosis with isolated frontal sinus involvement with help of external approaches. Materials and methods: The available records of the patients were retrieved and analysed. The literature, the associated contributory clinical features and management techniques were reviewed. Results: 4 patients presented with isolated frontal sinus mucor involvement. 3 out of 4 patients had history of diabetes mellitus (75%). All patients had history of covid-19 infection (100%). 3 out of 4 patients had unilateral frontal sinus involvement and were operated by Lynch Howarth approach. Mean age of presentation was 46 years with male predominance. Bicoronal approach was used in one case with bilateral involvement. Conclusion: Although conservative endoscopic surgeries are preferred nowadays for frontal sinus clearance but the extensive bony destruction with lateral extension in our series of patients with isolated frontal sinus mucormycosis warranted the need for open procedures. [ABSTRACT FROM AUTHOR]

Mucoceles are respiratory epithelium-lined cystic lesions found in the paranasal sinuses. Pyocele occurs when a mucocele becomes infected. Mucoceles develop as a result of obstruction of the normal sinus drainage tract with superadded infection. Inflammatory mediators are secreted, which lead to bone resorption and expansion of the mucocele. Concha bullosa is one of the most common anatomical variations in the nasal cavity. It refers to an air-filled cavity within the middle turbinate. Obstruction of the concha bullosa can rarely lead to the formation of a mucocele which may be secondarily infected forming a mucopyocele. The mucocele of the middle turbinate may present as an uncommon cause of nasal obstruction, headache, and other nasal or ocular symptoms, which, if correctly diagnosed, can be completely reversed by endoscopic surgery. [ABSTRACT FROM AUTHOR]

Endoscopes have revolutionised and have added a new dimension to the surgical domain. Many surgical techniques have reformed from the open surgical approach to a minimal access endoscopic one. In otolaryngology too, the indications and the use of endoscopes have been increasing in the last few decades. Even in otology, slowly and steadily Wulstein's microscopic techniques have been changing to endoscopic techniques. The only disadvantage of endoscopic ear surgery is that it is a single handed technique as the non dominant hand is utilised in holding the endoscope. We have developed portable endoscope holder based on the Goose neck system with rack and pinion mechanism. The goose neck system acts as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various endoscopic ear nose and throat surgeries. We present our experience of feasibility and applicability of this endoscope holder. [ABSTRACT FROM AUTHOR]

Functional endoscopic sinus surgery (FESS) is the gold standard treatment for medically refractive chronic rhinosinusitis, aimed at removing diseased tissue and improving natural sinus drainage and aeration. Irrigation of the sinuses has been known to improve sinus mucosal health and is an essential adjunct to surgery. There are a number of methods, devices, and solutions available which are used for nasal irrigation. Neti Pot, squeeze bottle, syringe, rubber bulb and commercially available nasal sprays are some of the simpler used devices used for douching. Electric devices like flosser, Hydropulse and the Navage nasal irrigation systems are available but it's not clear if they provide any advantage over the other methods. We use and propose a gravitational pressure-pulsed device which provides adequate volume and force without the need for external pressure. Salt with sodium bicarbonate is the most used solution base. Hypertonic saline has been described to be more efficacious compared to isotonic saline. Additives such as sodium hypochlorite, antibiotics, corticosteroids, manuka honey and xylitol have proven to be beneficial. Large volume positive pressure irrigations have proven to be beneficial. Optimal position for irrigation varies for low or high-volume irrigation systems. Patient education regarding precautions and disinfection of the device is a must. [ABSTRACT FROM AUTHOR]

Background: Congenital Choanal Artesia (CCA) is a rare cause of upper airway obstruction, yet it is the most common congenital anomaly of the nose. While the unilateral condition could be undiagnosed, bilateral CCA may be life-threatening, especially for newborns. Some CCA may be associated with other congenital abnormalities, which leads to a systematic screening during the diagnostic assessment. The diagnosis is easy. However, surgical management is still controversial. Methods: We conducted a retrospective study gathering data on management of CCA over 42 months. We reported epidemiological aspects and results of our series, and discussed management issues. Results: We operated 22 choanae using the endoscopic technique. The age of bilateral CCA patients on the day of surgery ranged from 8 to 21 days (mean 11.7+/_ 2.6 days). Their birth weight ranged from 2.9 to 4.5 kg (mean 3.4 +/_ 0.5 kg), and their gestational age ranged from 30 to 41 weeks. Surgery duration for neonatal bilateral CCA repair ranged from 75 to 110 min (mean 90 min +/_ 11.5 min). We performed an exclusive endonasal endoscopic approach for all patients with no stenting or mitomycin C application. We deplore one post operative complication related to minor palatal perforation resolved spontaneously. Conclusion: Since newborns solely depend on nasal breathing during the first month of life, bilateral CCA is an emergency. Endonasal endoscopic management is the primary procedure. Currently, surgery steps are standardized. However, how to prevent post-operative synechiae and restenosis is still controversial. The mainstream is meticulous post-operative nursing with frequent endonasal saline irrigation, regular removal of crust, and prevention of inflammation due to reflux or infection. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge of variable anatomy, narrow frontal sinus ostium and vital anatomical structures near outflow tract, is very important during preoperative planning for exposure of the frontal sinus recess during endoscopic sinus surgery. Preoperative knowledge of distance of nasofrontal beak and anterior skull base from columella is very helpful in avoiding intraoperative complication by deeper penetration into cranial cavity. Aim: To analyse distance from columella to the anterior and posterior border of the Frontal sinus ostium in males and females by CT PNS. Materials and methods: This retrospective observational study carried out in katihar medical college, Katihar during the period of 01 July 2021 to 31 December 2021 including 31 patients. Result and Conclusion: A distance approx 60.9 mm in men and 57.34 mm in women from the columella to frontal sinus ostium is safe during endoscopic sinus surgery. [ABSTRACT FROM AUTHOR]

Aims: The traditional approach for the management of benign laryngeal lesions is transoral microsurgery. In cases of anatomic particularities, such as insufficient cervical extension, short mandible, temporomandibular joint ankylosis etc., and contraindications for general anesthesia, transoral microsurgery is not possible. In such cases transnasal flexible endoscopic surgery under local anesthesia can be a relevant alternative. The purpose of the study was to assess the possibilities of flexible endoscopic management of benign nonepithelial lesions of the larynx. Materials and methods: Flexible endoscopic surgical interventions were performed on 315 patients with different benign nonepithelial lesions of the larynx. The larynx pathology was represented by following lesions: myxoid polyp, polypoid degeneration of vocal folds, fibrous polyp, angiofibrous polyp, angiomatous polyp, nonspecific granuloma, cyst, lipoma, neurofibroma and amyloidosis. In 97,8% of the cases interventions were performed under local anesthesia with spontaneous respiration. In 88,6% of the cases interventions were performed as outpatient procedures. Results: In all the cases the expected result was obtained – complete ablation of the visible lesion. In 7 cases repeated interventions were performed for recurrent lesions. Conclusion: Flexible endoscopic surgery is an efficient method for the treatment of benign nonepithelial lesions of the larynx, that offers a relevant therapeutic alternative, especially for the patients who have contraindications for general anesthesia or transoral microsurgery. The advantages of the method, worthy of mentionning, are positive economic effect and time economy, the intervention being possible in an outpatient setting for the majority of patients. [ABSTRACT FROM AUTHOR]

To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3–14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not. [ABSTRACT FROM AUTHOR]

We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach. [ABSTRACT FROM AUTHOR]

Surgical approaches in the treatment of TMJ pathologies are a much-debated topic in literature. We propose a new surgical approach performed by intraoral access and completed by endoscopic magnification and long-tip piezosurgery assistance. A piezosurgery (Piezosurgery Plus, Mectron s.p.a. 2014) with a long angled tip (MT5-10 L) was used to perform an endoscopically assisted condylectomy. [ABSTRACT FROM AUTHOR]

The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery to reach the nooks and corners of the middle ear. In this manuscript, we describe the angle rendered to the flag knife. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study is to evaluate the clinical applicability of laser energy during an oro-nasal endoscopic approach (ONEA) in the management of the anterior maxillary sinus wall. Methods: An experiment on three adult human cadavers was performed to study the nasal cavities with angled rigid scopes and using the ONEA technique. In order to evaluate the effectiveness of laser energy on the bone, the drilling effect was compared to laser energy (1470 nm diode laser, continuous wave, power 8, 9 and 10 W). Results: Compared to a rigid angled scope, the ONEA technique allowed complete visualization of the anterior wall of the maxillary sinus. Microscopic analysis of frontal bone revealed similar bone Exeresis with high-speed drilling (270.28 μm) and laser approaches (285.73–456.6 μm). Conclusions: The laser ONEA technique is an innovative, mini-invasive, and safe approach to the anterior wall of the maxillary sinus. Additional study is warranted to further develop this technique. [ABSTRACT FROM AUTHOR]

Many studies have described the detection of Helicobacter pylori (HP) in the nasal polyps; however, although gastroesophageal reflux has been associated with chronic rhinosinusitis and nasal polyps development, the role of HP remains unclear. Our aim was to describe the prevalence of HP detection in nasal polyps and its association with gastric HP infection and gastroesophageal reflux dsease (GERD). The prospective study involved 36 patients with nasal polyps, who underwent to endoscopic surgery removal of nasal polyps. Before surgical procedure all patients were tested for gastric HP infection by 13 C-urea breath test, while tissue samples from nasal polyps were tested for HP detection, using rapid urease test (CLO test) and histological examination with Giemsa stain. All patients were asked about GERD-related symptoms. HP in nasal polyps was detected in 9 out of 36 patients (25%) using histological examination with Giemsa stain, while the detection rate of HP was 30.5% (11/36) using CLO test. Furthermore, 28 out of 36 patients (77.7%) had gastric HP infection. All patients with HP colonization in nasal polyps had gastric HP infection and all patients with HP in nasal polyps reported symptoms related to GERD. HP was detected in approximately one out of three patients in nasal polyps, while all patients with HP detection in nasal polyps had concurrently gastric HP infection and reported GERD-related symptoms, suggesting a gastro-nasal route of HP. [ABSTRACT FROM AUTHOR]

To study the incidence and prevalence of fungal sinusitis and its variants in cases of chronic rhinosinusitis in department of ENT and Head and Neck surgery. The study group consisted of 100 patients of chronic rhinosinusitis attending the outpatient and inpatients in department of Otorhinolaryngology. History was taken and diagnostic nasal endoscopy was performed. Patients underwent endoscopic sinus surgery and systemic treatment when required. Pre surgery serum IgE and post-surgery Histopathology was sent. Out of 100 patients, Males > Females and median age was 45.50 years (range 34.25–59.25 years). On DNE, 88% had polyps with 88.1% males and 87.8% females in their respective groups. 47% had allergic mucin with 49.2% males and 43.9% females in their respective groups. 34% had discharge with 28.8% males and 41.5% females in their respective groups. 37% had fungal filaments with 37.3% males and 36.6% females in their respective groups. 26% had fungal sinusitis in our study among which 53.8% were males and 46.1% were females. Peak fungal sinusitis was in 3rd to 5th decade. Commonest organism isolated was Aspergillus. Serum IgE was higher in patients with fungal sinusitis and nasal polyposis. In conclusion, the proportion of patients with Fungal Sinusitis was 26% among 100 patients with chronic rhinosinusitis. We isolated Aspergillus as the predominant fungus followed by Biporalis and Mucorales genus. Serum IgE was higher in patients with fungal sinusitis and Nasal polyposis. Both immunocompromised and competent individuals were managed surgically and/or medically when required. Our study showed that early fungal sinusitis detection leads to better management practices and prevents its progression into more severe disease with complications. [ABSTRACT FROM AUTHOR]

The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. The focal length of the microscope allows a greater working distance for manipulation of the instruments. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence reaching to the corners of the middle ear becomes impossible with the straight micro-ear instruments during endoscopic ear surgery. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery. [ABSTRACT FROM AUTHOR]

Skull base reconstruction has been a widely debated issue. Both autologous and heterologous materials have been proposed, however the formers are usually preferred due to their optimal healing outcomes and integration. Nevertheless they are still associated with donor-site functional and aesthetic morbidity. The aim of this study is to report a preliminary experience of different sites defects skull base repair with Cadaver homologous banked fascia lata graft. Patients who underwent reconstruction of skull base defects with Cadaver homologous banked fascia lata between January 2020 until July 2021 were included in the study. Three patients were finally identified for the study. Patient 1 underwent combined craniotomic-endoscopic surgical access for extended anterior skull base neoplasm with subsequent repair with homologous cadaver fascia lata. Patient 2 underwent endoscopic transphenoidal surgery for sellar-parasellar neoplasm. After tumor debulking the surgical cavity was obliterated with homologous cadaver fascia lata. Patient 3 finally had politrauma with otic capsule-violating fracture with profused CSF leak. An endoscopic obliteration of external and middle ear was performed using homologous cadaver fascia lata with blind sac closure of external auditory canal. No graft displacement or reabsorption was observed in these patients at the last follow-up. Cadaver homologous banked fascia lata has proved safety, efficacy and ductility in reconstruction of different skull base defects. Level of Evidence: Level IV-retrospective cohort study. [ABSTRACT FROM AUTHOR]

We present the clinical case of a 51-year-old male patient, affected by common variable immunodeficiency (CVID). In his history recurrent orbital cellulitis, exacerbation of chronic right dacryocystitis, lacrimal sac empyema with periodic episodes of dacryocutaneous fistolization. The coexistence of these particular immunological defects and the lack of literature about similar cases required an accurate evaluation of each step of the diagnostic and therapeutic approach. We performed an endoscopic endonasal dacryocystorhinostomy with "cold" instruments. No surgical complications were observed in the immediate postsurgical period. We balanced the necessity of a follow-up based on frequent office evaluation and the current pandemic emergency, in order to not expose the patient to an additional infectious risk. The discussion will focus on several aspects: the adequacy of radiological, the "cold" surgical technique, the choice of avoiding endocanalicular prostheses. We will discuss also about the use of oral and topical therapy, avoiding probable post-surgical infectious complications. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cysts (ABCs) are uncommon lesions in head and neck area that could be primary or secondary in origin. The main problem with the traditional curettage and debridement is the high rates of recurrence, and cosmetic disfigurement with the open approach. In this article, we describe the use of a combined endoscopic sinus surgery and endoscopic assisted Caldwell approach to achieve a complete surgical excision of left maxillary sinus ABC extending to the left infratemporal fossa, and to avoid facial disfigurement in a 13-year-old female patient presented to our hospital with diplopia, facial pain, and headache. The patient had uneventful post-operative recovery period with resolution of the presenting symptoms with no complications. Hence, we recommend this combined endoscopic surgical approach in such cases. [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]