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Medical treatment options for patients with rhinitis during pregnancy need careful considerations. It is important to distinguish between the causes of rhinitis, as this can influence treatment. Conservative options are important for patients with pregnancy-induced rhinitis (PIR) and pre-existing allergic or non-allergic rhinitis. Education and knowledge that PIR symptoms will resolve after pregnancy can offer some relief. Other strategies such as exercise, positioning, saline nasal douching/lavage, and nasal valve dilators are safe in pregnancy and can have a benefit in these patients with rhinitis of any aetiology. The main medical therapies usually used in rhinitis cannot always be directly translated to pregnant patients due to potential teratogenic effects. Topical corticosteroids have generally shown to be safe with budesonide having the strongest recommendations. Oral corticosteroids are mostly used in moderate-severe disease and should be avoided in the first trimester. Oral decongestants have associations with cardiac, ear, gut and limb abnormalities and are not recommended in the first trimester. Loratadine and cetirizine have been the most well-studied second-generation antihistamines and are generally considered safe. There has been no reported increased risk of teratogenicity with anticholinergics or cromones, with the latter being one of the first line options in pregnant women with allergic rhinitis. The role of allergen immunotherapy needs further research, but current guidance states it can be continued if already initiated prior to pregnancy. The management of rhinitis in pregnancy can therefore be complex. This review aims to evaluate the current medical management options for rhinitis in pregnancy. [ABSTRACT FROM AUTHOR]

In cases of narrowing of the internal nasal valve angle, we address all structures that commonly contribute to the internal valve area obstruction. We term this the 'triple-procedure technique'. The aim of this study was to assess the efficacy of this technique in improving patients' subjective nasal patency. A prospective longitudinal case study was conducted in a tertiary hospital in northeast of England. All consecutive patients who complained of nasal obstruction and were diagnosed with the internal nasal valve angle narrowing due to septal deviation were offered to have a triple-procedure operation (septoplasty, turbinate surgery and internal nasal valve surgery). Patients completed a validated nose-related questionnaire (Nasal Obstruction Symptom Evaluation (NOSE)) preoperatively, which was repeated 3 months after the operation. The change in NOSE score was the outcome measure. Eight of the nine patients recruited to the study completed the questionnaires (88% response rate). The total and the domain scores improved after the operation, which were clinically and statistically significant. The effect size proved to be very large (total NOSE score effect size, 4.0). Our study shows that addressing all three structures commonly affecting the internal valve area is an effective technique in improving the obstruction caused by the narrow internal nasal valve angle. [ABSTRACT FROM AUTHOR]

Tutoplast fascia lata (TFL) has been used as an onlay graft for nasal dorsal augmentation in open approach rhinoplasty; however, insertion of layers of moist TFL in the closed approach is technically challenging. We have presented a 'sandwich' technique which facilitates graft insertion in a closed approach rhinoplasty. The available autologous graft (cartilage or perpendicular plate of ethmoid) is sandwiched and secured between layers of TFL (sandwich technique) prior to insertion of the graft for nasal dorsal augmentation in a closed rhinoplasty approach. All our cases of nasal dorsal augmentation were reviewed in a 2 year period. Eight cases of nasal dorsal augmentation in secondary rhinoplasty through a closed approach were reviewed. The ease of insertion and the subsequent manipulation of the graft were noted in all the cases. Good aesthetic results have been noticed in all the cases after an average of 14 months follow-up. The sandwich technique ensures ease of the graft insertion and the subsequent manipulation in a closed approach secondary rhinoplasty for dorsal augmentation. [ABSTRACT FROM AUTHOR]

Abstract: Intrathecal fluorescein injection has a long history of use by surgeons to determine the exact site of a cerebrospinal fluid (CSF) leak from the skull base. This method, however accurate, is not without complications. We present a case of grand mal and absence seizure after intrathecal fluorescein injection and discuss the possible aetiological factors. We also review the articles in the diagnostic methods for the CSF rhinorrhoea and the complications of the intrathecal fluorescein injection. [Copyright &y& Elsevier]

Background: Anecdotal evidence suggests that listening to oneself eating results in a more pleasurable eating experience. Maximising the sensory experience of eating can result in increased oral intake and is potentially valuable in improving nutritional status in at-risk patients. Objective: This pilot study investigates the association between listening to the sound of oneself eating and the consequences on enjoyment of eating. Design: Prospective, randomized, controlled, cross-over trial of 10 fit, adult volunteers.Participants were timed eating a standardised amount of bread, and were randomized to eat in silence or whilst listening to their own amplified chewing and swallowing. Measurements of pulse and blood pressure were recorded throughout the procedure. Subjective pleasure scores were documented and the procedure repeated in the alternate study arm. Results: There was no significant relationship demonstrated between listening to oneself chewing and the enjoyment of eating. Conclusion: Although this small pilot study was unable to demonstrate a significant relationship between listening to oneself chewing and enjoyment of eating, other evidence suggests that distraction techniques have a beneficial effect on dietary intake. Such techniques can be applied in a clinical setting and further work in this area has valuable potential. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation. Methods: All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured. Results: A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321. Conclusion: Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor. [ABSTRACT FROM AUTHOR]

There have been conflicting recommendations in the literature with regards to the screening of infectious mononucleosis (IM) in quinsy patients. Our aim was to ascertain an accurate rate of IM in quinsy patients and find any criterion by which we can decide which quinsy patient to screen for IM. We conducted a retrospective study on all quinsy patients admitted to our hospital in a 2-year period (374 patients) and detected the rate of IM to be at 4%. There were no IM-positive quinsy patients above the age of 30 in our study. Monocytosis was detected in 85% of the cases. This is the largest study evaluating the rate of IM in quinsy patients. Our study shows that a small minority of quinsy patients (4%) are IM positive. Routine screening of IM in quinsy patients might not be financially justifiable; however, we recommend screening for IM in patients under the age of 30 years especially when monocytosis is present. [ABSTRACT FROM AUTHOR]

Objectives: It is a common teaching that two thirds of branchial cysts occur on the left side of the neck. We reviewed the evidence behind this statement and assessed whether they actually do present twice as often on the left side. Methods: Our study comprised two parts: 1) a historical review of branchial cysts and 2) a retrospective review of 91 histologically confirmed cases operated on at two British hospitals in the years 1999 to 2005. The side of the branchial cyst was recorded. Results: Early studies on branchial cysts did not always rely upon histologic diagnosis; the definition of a branchial cyst has varied throughout medical history. The statement ‘two thirds of branchial cysts occur on the left’ is based upon these early studies in which the definition was variable. In our study, right-sided branchial cysts were actually more common than left-sided branchial cysts (53.8% versus 45%; χ² test, p = .399). One percent were bilateral. Conclusions: Ours is the largest single study in the past 50 years to look at the side predilection of branchial cysts in terms of histologic proof. We propose that branchial cysts may not present more commonly on the left side of the neck, as is commonly taught in medical schools. [ABSTRACT FROM AUTHOR]

Objectives: We set out to create Consensus Guidelines, based on current evidence and relative risks of adverse effects and the costs of different treatments, which reflect the views of the British Rhinological Society (BRS) Council on where the use of biologics should be positioned within treatment pathways for CRSwNP, specifically in the setting of the National Health Service (NHS). Design: An expert panel of 16 members was assembled. A review of the literature and evidence synthesis was undertaken and circulated to the panel. We used the RAND/UCLA methodology with a multi‐step process to make recommendations on the use of biologics. Setting: N/A. Participants: N/A. Results: Recommendations were made, based on underlying disease severity, prior treatments and co‐morbidities. A group of patients for whom biologics were considered an appropriate treatment option for CRSwNP was defined. Conclusions: Although biologics are not currently available for the treatment of CRSwNP, the BRS Council have defined a group of patients who have higher rates of "failure" with current treatment pathways, higher resource use and are more likely to suffer with uncontrolled symptoms. We would urge NICE to consider approval of biologics for such indications without applying further restrictions on use. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smell during the COVID‐19 pandemic. Design: After undertaking a literature review, we used the RAND/UCLA methodology with a multi‐step process to reach consensus about treatment options, onward referral, and imaging. Setting and participants: An expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. Main outcome measures: The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID‐19 pandemic. Using a 9‐point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. Results: Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A drops. Alpha‐lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses, and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made. Conclusion: This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID‐19‐related loss of sense of smell. The guideline may evolve as our experience of COVID‐19 develops. [ABSTRACT FROM AUTHOR]

Objectives: Conebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment. CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery. We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons. Design: The RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria. Setting: A virtual panel of 13 international experts in ESS. Participants: The expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision‐making processes. Main outcome measures: To define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT. Results: Patients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus. For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered. Conclusions: This study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes.Methods: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests.Results: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001.Conclusions: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway. [ABSTRACT FROM AUTHOR]