The serum squamous cell carcinoma antigen level in inverted sinonasal papilloma and nasal polyps patients.

OBJECTIVE: To clarify whether the serum squamous cell carcinoma antigen (SCCA) levels of patients with inverted papilloma (IP) are different from patients with nasal polyps (NP) and rhinitis. MATERIALS AND METHODS: Serum SCCA levels were measured in 30 patients with IP and 30 patients with NP at one day before surgery and seven days after surgery and measured in 28 patients with rhinitis. RESULTS: Elevated serum SCCA levels (>1.5 ng/ml) were found in 80.0% of patients in the IP group, 6.7% of patients in the NP group and 14.3% of patients in the rhinitis group, which was a significant difference. The medians of serum SCCA levels in the IP, NP and rhinitis groups were 3.9, 0.8 and 1.1 ng/ml, respectively, which was a significant difference. The SCCA level in IP group was not significantly correlated according to Krouse Staging. There was a significant difference in serum SCCA levels between the pre- and postoperative stages in the IP group, at 3.9 and 0.8 ng/ml, respectively, while in the NP group the levels were 0.8 and 1.0 ng/ml, not significantly different. With regard to the IP diagnosis in the IP and NP group based on the SCCA level (>1.5 ng/ml), sensitivity and specificity was 80.0% and 93.3%, respectively. CONCLUSIONS: The serum SCCA level in patients with IP was elevated and then it decreased after surgery. This was different from NP and rhinitis patients who mostly had normal levels, which did not change.

Complications of Isolated Fungal Sphenoiditis: Patient Clinical Characteristics.

OBJECTIVE: To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis. MATERIALS AND METHODS: The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected. RESULTS: Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41-84) vs. 57.43 (36-81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis. CONCLUSION: This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.

Removal of intraconal bullet through endoscopic transnasal surgery with image-guided navigation system 8 months after injury: a case report.

BACKGROUND: Lodgment of a bullet within the orbit is uncommon. The decision to remove these objects poses a challenge to surgeons due to a high risk of complications. Currently, endoscopic transnasal surgery with navigator assistance facilitates the localization of foreign bodies allowing their safe removal with minimal surrounding tissue damage or optic nerve injury. CASE PRESENTATION: We describe a case of a 26-year-old Thai woman with a chronic intraorbital foreign body located within her medial intraconal space. The chronic intraorbital foreign body was successfully removed by endoscopic transnasal surgery, combined with assistance from a navigation system, 8 months after injury without any damage to her eye or disturbance in vision. CONCLUSION: Intraconal foreign bodies, such as bullets, are a chronic problem and should be observed in the long term; prompt surgical removal should be performed if indicated.

Septochoanal polyp with osseous metaplasia: a case report.

BACKGROUND: Polyps originating from the posterior septum with choanal extension, also known as "septochoanal polyps," are uncommon, and septochoanal polyps with central calcification are extremely rare. We report the second case of septochoanal polyps with central calcification in the English literature. CASE PRESENTATION: A 55-year-old Thai woman presented with a progressive left-side nasal obstruction. An examination of her nose revealed an irregular lobulated mass, yellow in color, with a smooth surface that arose from her posterior nasal septum and extended down to her nasopharynx. Computed tomography revealed a large choanal mass with a central ossified structure. A punch biopsy was performed and microscopic examination showed an inflammatory polyp. The mass was removed using an endoscopic surgery technique, and the histology of this lesion confirmed a typical presentation of choanal polyps. CONCLUSIONS: Although septochoanal polyps with osseous metaplasia are known to be very rare, physicians should be aware of them and include them in the differential diagnosis of choanal mass with central calcification lesions.

Prevalence of confirmed asthma varies in chronic rhinosinusitis subtypes.

BACKGROUND: Chronic rhinosinusitis (CRS) and asthma describe inflammation of the upper and lower airway, respectively. Not surprisingly, the prevalence of CRS and asthma has been linked, with up to 50% asthma prevalence in CRS with nasal polyposis (CRSwNP) patients. However, these prevalence rates do not address subtypes of CRSwNP including allergic fungal rhinosinusitis (AFRS). This study sets out to objectively determine asthma prevalence in CRS subtypes prospectively. METHODS: A prospective prevalence study of adult CRS patients was conducted over a 1-year period at a tertiary care center. Patients were grouped into CRSwNP, CRS without nasal polyposis (CRSsNP), or AFRS. Patients were administered the Asthma Screening Questionnaire (ASQ) and asthma was confirmed by pulmonary function testing (PFT) if positive on the ASQ. Chi square analysis was performed to compare the asthma prevalence among the CRS subtypes. RESULTS: A total of 410 patients (age 48.1 ± 16.4; 53.5% male) were included. Of these, 178 (43.4%) had CRSwNP, 166 (40.5%) had CRSsNP, and 66 (16.1%) met criteria for AFRS. Analysis revealed that 48.3% of CRSwNP patients, 16.5% of CRSsNP patients, and 23.6% of AFRS patients had asthma confirmed by PFTs. Chi square analysis showed a significant difference in asthma prevalence between CRSwNP and AFRS (p = 0.0016) and CRSwNP and CRSsNP (p = 0.0000), but no significant difference between CRSsNP and AFRS (p = 0.2380). CONCLUSION: There is a significant difference in the prevalence of asthma between CRSwNP and AFRS, suggesting a fundamental distinction in their etiologies despite similar immunologic profiles. Further efforts to delineate these biological disparities are underway.

Surgical Outcomes of Sinonasal Inverted Papillomas in Songklanagarind Hospital.

OBJECTIVE: To evaluate the surgical outcomes and recurrence rate of inverted papillomas (IPs). MATERIAL AND METHOD: The medical records of patients diagnosed as IPs at Songklanagarind Hospital between January 2004 and December 2012 were retrospectively reviewed. Demographic data, clinical presentation, type of surgical approach, complications, and recurrence status were collected. RESULTS: From 64 patients, 75% were male. The average age was 55 years. IPs were classified in Krouse's classification system as followed: stage I = 6.3%, stage II = 21.9%, stage III = 70.3%, and stage IV = 1.5%. The surgical approaches were divided into endoscopic endonasal approach (EEA) 60.9%, EEA combined with external approach 35.9%, and external approach 3.2%. Complications such as synechea and maxillary sinus ostium stenosis occurred in 29.7% of patients. Thirty-seven point five percent had disease recurrence after surgery, most commonly at the frontal sinus 82.4%, and sphenoid sinus 60%. CONCLUSION: EEA is an effective treatment for IPs, especially in Krouse's classification stage I, II. The external approach combined with E A could be useful when the tumor extends to the anterolateral wall of the maxillary sinus. Finally, the surgeon must pay particular attention to the frontal and sphenoid sinus because of the high local recurrence rate.