Therapeutic Efficacy of Diode Laser Turbinoplasty on Nasal Obstruction Estimated with Rhinomanometry

Objective: Diode-assisted laser turbinoplasty is a popular surgical technique that improves airflow during nasal obstruction. In this study, we aimed to evaluate the efficacy of a diode laser for turbinate hypertrophy by using rhinomanometry. Methods: This cross-sectional study included 199 patients for 13 months. Preoperative, intraoperative, and 6-week postoperative rhinomanometry values were measured. Results: The most common intraoperative symptoms were olfactory annoyance (barbecue smell) (76.4%) and a painful burning or stinging sensation (64.3%). The inspiratory and expiratory mean nasal airflow values increased both intraoperatively and postoperatively, illustrating the effect of decongestants and inferior turbinate surgery. Intraoperatively, inspiration improved by 262.73 ± 196.09 (p < 0.01) and expiration by 247.94 ± 180.05 (p < 0.01). Postoperative inspiration improved by 254.03 ± 199.08 (p < 0.01) and expiration by 244.05 ± 194.57 (p < 0.01). Postoperative snoring (22.6%, p = 0.026) and nasal obstruction (20.2%, p = 0.042) were significantly higher in female than in male patients. Conclusions: The therapeutic efficacy of using diode lasers in inferior turbinate resection was established in this study on the basis of rhinomanometric data with a follow-up of 6 weeks. Postoperative nasal obstruction was effectively decreased and the other symptoms displayed a female preponderance.

Septoplasty alone is not suitable for most structural nasal obstructions

Septoplasty is widely used in the treatment of structural nasal obstructions,and it also has a good effect and a high degree of postoperative satisfaction.However,there a large number of structures demonstrate abnormalities related to structural nasal obstruction,including the external nose,maxilla,nasal cavity and paranasal sinus.Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure.Septoplasty is only performed to correct deviations of the nasal septum,which in many cases is obviously insufficient in restoring the symmetry of the nasal structure.Therefore,septoplasty alone is not suitable for the treatment of most structural nasal obstructions.Nasal ventilation expansion surgery,which typically covers more abnormal structural correction procedures than septoplasty,should be used when describing the treatment of structural nasal obstruction.

Unilateral Choanal Atresia in Adults: A Case Series

Choanal atresia (CA) is a rare occlusion of the posterior choanae. Unilateral cases have been reported more than bilaterally, and it’s more often right-sided in those patients. According to the literature, mixed bony-membranous atresia is the most common type. There is a high incidence of craniofacial and visceral anomalies associated with congenital choanal atresia. Therefore, investigation for associated congenital anomalies is an important step before the surgery. We report 2 cases of incidental finding of unilateral choanal atresia in a 21- and 17-year-old with nasal discharge being the only complaint in the former and nasal obstruction with headache in the latter. The patients were then scheduled for day-surgery as a case of choanal atresia for transnasal, endoscopic repair and posterior septectomy. The patients were discharged home on the same day with the absence of restenosis or other complications.

Numerical analysis for the effcacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea-hypopnea syndrome（OSAHS） patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The effcacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram（PSG） test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further,provide a theoretical basis to solve relevant clinical problems.

不同方式下鼻甲手术治疗慢性鼻炎的疗效观察

目的探讨不同方式下鼻甲手术治疗慢性鼻炎的疗效。方法选择我院2011年7月~2018年6月间行下鼻甲手术治疗慢性鼻炎患者235例,分别采用下鼻甲部分切除术、下鼻甲骨折外移术、下鼻甲黏膜下整形术、微钻辅助下鼻甲整形术、低温等离子下鼻甲消融术,术后3个月~1年进行随访,分析5种手术的疗效及并发症。结果5种下鼻甲手术有效率分别为84.8%、94.0%、87.5%、91.2%、92.3%,平均有效率为90.2%;下鼻甲手术常见的并发症为鼻干、鼻干痂和出血,发生率分别为9.8%、4.3%,少见并发症为鼻甲萎缩,发生率为0.9%。结论不同下鼻甲手术方式各有所长,根据不同的患者选择合适的手术方式可能是保证疗效、降低并发症的关键因素之一。

An infrequent cause of neonatal upper airway obstruction:Congenital nasal pyriform aperture stenosis presenting to a remote facility

Introduction:Congenital nasal pyriform aperture stenosis(CNPAS)is a rare congenital condition of structural nasal obstruction.Respiratory distress,stertor,and poor feeding are often presenting features.Case Presentation:We report a case of a newborn diagnosed with CNPAS at 3 weeks of life.The diagnosis was missed on a nasoendoscopy at day 3 of life but was realised following a facial CT when the infant presented with ongoing symptoms of upper airway obstruction.Nasal dilation was performed successfully.Conclusion:CNPAS should be considered in any neonate with upper airway obstruction.A normal nasoendoscopy does not exclude the diagnosis.

Functional nasal surgery in the office-based setting

Objective:Nasal obstruction is a very common problem often addressed by functional nasal surgery.Increasingly,these procedures are being performed in the office setting secondary to decreased down time,cost,and obviation of general anesthesia.Our goal with this review is to discuss how to appropriately select patients for office-based procedures,what procedures may be considered,and current outcomes with in-office functional nasal surgery.Data Sources:PubMed,Scopus,Google Scholar.Methods:Research databases were searched for articles discussing techniques for performing functional nasal surgery in an office setting,and outcomes of various in-office functional nasal procedures.Results:Studies found and included in this review discuss many aspects of office-based functional nasal surgery,including practical points on patient selection and office set-up,what procedures can safely be performed,and outcomes of different techniques to address specific problems.Broadly,procedures amenable to performance in the office address the internal and external nasal valves,the nasal septum,and the inferior turbinates.Conclusion:A wide range of techniques to aaddress the nasal valves,septum,and inferior turbinates can be performed in a safe and effective manner without the need for an operative suite.

Failure Rate of Adenoidectomy and Reasons of Failure in the Short Term

Objectives: The aim of the present study was to analyze the recovery rate of symptoms in patients with adenoid hypertrophy and investigate the role of nasal pathologies, allergy and gastroesophageal reflux (GER) as the reason of failure in patients with persistent symptoms. Patients and Methods: Patients undergoing adenoidectomy were enrolled in this study. There were 58 males and 42 females, aged between 1 - 13 years (mean ± SD: 4.9 ± 2.2 years). The parents of each child were questioned about the following symptoms;apnea, nasal obstruction, mouth breathing, snoring and nasal discharge. Presence or absence of nasal obstruction due to septal deviation and/or chonchal hypertrophy was noted. All children were evaluated for GER by upper gastrointestinal endoscopy or pH monitorization and for allergy by specific IgE analysis or skin prick test. Three months after the operation the children were re-examined and their parents were interviewed about persistent symptoms. Patients with persistent symptoms were re-evaluated with rigid endoscopy for residual adenoid vegetation. Results: Apnea was cleared in the entire group postoperatively. However, 9 patients complained of nasal obstruction, 16 patients had mouth breathing, 9 patients had snoring and 17 patients continued to have nasal discharge two months after the operation. Statistical assessment showed a significant difference for each symptom between the pre- and postoperative level (p Conclusions: Adenoidectomy alone is an effective treatment for nasal obstruction and obstructive sleep symptoms in children. Persistent obstructive symptoms are usually due to nasal pathology and allergy.

Association of allergic rhinitis with hypothyroidism, asthma, and chronic sinusitis: clinical and radiological features

Background: Allergic rhinitis (AR) is characterized by mucosal inflammation that leads to a variety of symptoms, such as nasal congestion, rhinorrhea, and sneezing. This rhinitis is triggered by inhalation of allergens, such as pollen, and this condition has a negative impact on the quality of life. AR was shown to be associated with a number of co-morbidities, including hypothyroidism, asthma, and chronic sinusitis.Objective: This study aimed to assess AR-associated comorbidities in patients presenting symptoms and paranasal sinus computed tomography (CT) scan findings in Taif City, Saudi Arabia.Methods: This cross-sectional study evaluated medical and radiological records of AR patients retrospectively from the period of December 2018 to September 2019 in Al-Hada Armed Forces Military Hospital, Taif City, Saudi Arabia.Results: A total of 103 AR patients with a mean age of 39.0 ± 15.6 years with 55.3% males and 44.7% females. The three most common associated comorbidities in allergic rhinitis patients were chronic sinusitis (28.2%), hypothyroidism (21.4%), and asthma (8.7%). Nasal obstruction (30.1%) was the symptom most frequently presented by all patients. Mucosal thickening occurred most frequently in patients with associated chronic sinusitis, while bilateral osteomeatal complex obliteration was observed mostly in asthmatic patients, and bony boundary thinning was more prevalent among patients with associated hypothyroidism.Conclusion: The gender distribution of AR was 10% more common among males;however, the most common three comorbidites in allergic rhinitis patients were chronic sinusitis, hypothyroidism, and asthma, and most of those patients were females. Hypothyroidism can be a hidden predisposing factor for AR, while chronic sinusitis can be caused by AR due to secretion stasis or immune system activation.