Does Managing Patients With Chronic Rhinosinusitis Improve Their Depression Score? Prospective Study.

BACKGROUND: To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores. METHODS: This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression. RESULTS: Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated (r = .522, P < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (ß = .178, 95% confidence interval 0.12-0.23, P < .0001). CONCLUSION: CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences.

Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.

Endoscopic endonasal retrieval of air gun pellet retained in the frontal sinus: A case report.

INTRODUCTION AND IMPORTANCE: Foreign bodies in paranasal sinuses are rarely encountered and most commonly present in the maxillary sinus. Guidelines for managing paranasal sinus object removal are limited due to its rarity. However, there are three major management options: open surgery, endoscopic sinus surgery, and observation. CASE PRESENTATION: We report a rare case of an 18-year-old boy who underwent extended frontal sinus surgery to retrieve a retained air gun pellet in the right frontal sinus and repair the skull base defect resulting from the air gun pellet. CLINICAL DISCUSSION: Physicians commonly use endoscopic sinus surgery (ESS) for improving sinus drainage in recurrent chronic and acute infective sinusitis. Extended sinus surgery aims to maximize the communication between the paranasal sinuses and the nasal cavity. This extended communication helps improve access to the sinus, enhance drainage, and improve the delivery of topical medications. In addition, the use of ESS with the modified Lothrop procedure allows for better exposure of the skull base, which can help with the repair of a CSF leak. CONCLUSION: Based on our experience with this patient and similar literature, ESS should be considered a treatment option for patients with retained foreign objects in the frontal sinus.

Presence of Two Separate Hairy Polyps with Meningothelial Elements in a 15-Month-Old Child.

Hairy polyps are benign embryological tumors of the head and neck region that are derived from two germinal layers, the ectoderm and mesoderm. At an incidence of 1 : 40000, hairy polyps are considered rare growths. Presenting symptoms of hairy polyps can vary greatly depending on the size and location of the tumor. To the best of our knowledge, our reported case is the first in the literature to highlight an extremely rare occurrence of two separate hairy polyps being simultaneously present in one patient, in the clivus and the nasion, with the presence of meningothelial cells within both tumors, histopathologically. With surgical resection as the management of choice, the approach of surgery differs greatly depending on many factors. Since the patient in our reported case had a cleft palate, we used a combined transnasal and transoral approach to fully release the clival mass and a direct skin incision for the nasion mass. Recurrence after complete surgical resection is rare, and if happens, it should rise suspicion of histopathologically misdiagnosed tumor. We amplified the importance of advanced radiological investigations along with proper multidisciplinary teamwork to exclude CNS connections and other histologically malignant tumors and to early pick up a possible simultaneous lesion.

Seromucinous hamartoma of ethmoid sinus in pediatric patient (case report).

INTRODUCTION AND IMPORTANCE: Seromucinous hamartoma is a rare benign glandular proliferation arising from the respiratory epithelium, which was originally described by Baillie and Batsakis in 1974. Since this time, case reports started to be published on SH, as a middle aged and elderly disease, here we report a case of a pediatric patient who found to have SH. PRESENTATION OF THE CASE: 2-year-old girl, brought by her parent with a complain of a mass at the right medial canthal area for one year. CLINICAL DISCUSSION: As this pediatric patient presented with long standing history of right medial canthal area, we made out differential diagnosis list, with keeping congenital midline nasal masses such as nasal glioma, dermoid, and encephalocele at the top of our differentials, followed by inflammatory disease and lacreimal system disease. After bedside clinical assessment and imaging, patient underwent endoscopic sinus surgery for surgical excision, histopathology analysis came as Seromucinous hamartoma. Postoperative course was unremarkable, patient is disease- free for 18 months, till her most recent follow up. With no additional treatment or recurrence. CONCLUSION: This case report indicates that seromucinous hamartoma should always be considered in the differential diagnosis of pediatric sinonasal disease. According to the literature review we did; this is the first case reported in such an age group.

Endoscopic endonasal repair of a temporal lobe meningoencephalocele in the pterygoid fossa: A case report and literature review.

INTRODUCTION: Meningoceles are defined as herniation of the meninges through a skull base defect. If brain tissue is herniated as well, then it is called meningoencephalocele. The most common locations of meningoceles are the cribriform plate and the lateral recess of the sphenoid sinus, with the most common presentation being CSF leakage. We present a case of temporal lobe meningocele that herniated through a defect in the greater wing of the sphenoid bone to the pterygoid fossa and that was diagnosed incidentally while evaluating the patient for seizures. METHODOLOGY: Case report and literature review. CONCLUSION: The endonasal endoscopic approach is a suitable minimally invasive approach for the management of pterygoid fossa lesions, including meningoceles. In this case, the patient had epilepsy with the surgery resulting in the resolution of the seizures.

Endoscopic Reconstruction of Skull Base Defects Using Tutoplast.

BACKGROUND: Various graft materials that are classified as autografts, xenografts, and allografts based on their origin have been used to endoscopically repair skull base defects. Tutoplast® (Tutogen Medical GmbH), an allogeneic natural collagen matrix, is processed through chemical sterilization that preserves tissue biocompatibility and structural integrity. OBJECTIVE: To study the safety and efficacy of Tutoplast Fascia Lata and Tutoplast Temporalis Fascia® as primary graft materials in the endoscopic reconstruction of skull base defects of different sizes and etiologies and to compare the outcomes with those of other traditional graft materials based on our experience. METHODS: This is a multi-center retrospective chart review of patients who underwent cerebrospinal fluid leak (CSF) endoscopic reconstruction with Tutoplast Fascia Lata or Tutoplast Temporalis Fascia as either a stand-alone reconstruction material or a part of a multilayer reconstruction depending on the defect at Prince Sultan Military Medical City and King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between 2017 and 2020. Our inclusion criteria were CSF leak repair with Tutoplast and a transnasal endoscopic approach. We reviewed demographic data, intraoperative and postoperative complications, repair materials, repair failure, defect size and location. RESULTS: Tutoplast® was used as the primary graft material in 33 cases. Our main outcome was repair success with lack of post operative CSF leak, observed in 30 cases (90.9%). There was no significant association between postoperative CSF leaks and factors including different defect sizes, defect sites, demographic data, hospitalization duration, or postoperative radiation in oncological cases. CONCLUSION: Tutoplast alone or in combination with other materials can be used safely and effectively for skull base defects repair.

Validation and Cross-cultural Adaptation of the Sinonasal Outcome Test (SNOT)-22 for the Arabian Patient Population.

Background and objective Quality of life measurement is an essential element of healthcare evaluation. The Sino-Nasal Outcome Test 22 (SNOT-22) has been validated in different languages, and in this study we validated the SNOT-22 in Arabic language. The objective of this study is to provide a validated, cross-culturally adapted version of the SNOT-22 for the Arabic speaking population. Materials, methods, and main outcome measures This was a prospective cohort study set in a tertiary hospital in Riyadh, Saudi Arabia. The SNOT-22 was translated into Arabic by two native Arabic speakers. A total of 30 patients with chronic rhinosinusitis (CRS) with/without nasal polyps were included in test-retest study. Following that, a prospective study was conducted where the translated SNOT-22 was distributed to a different set of 30 CRS patients before and three months after endoscopic sinus surgery. Another 50 healthy individuals were included as a control group. The main outcome measure was the translation and validation of the SNOT-22 in Arabic. Results Internal consistency was assessed by performing a test-retest study. Cronbach's alpha was 0.803 at both the initial examination and at the retest, showing good internal consistency. There was a statistically significant difference between the results of the control group and the preoperative results of the CRS group (p<.001). The preoperative mean (SD) SNOT-22 score for the CRS group was 64.8 (20.3) and it dropped to 29.2 (11.8) postoperatively showing statistically significant change (p<.001), indicating the responsiveness of the SNOT-22. Conclusion The Arabic version of the SNOT-22 has internal consistency, reliability, and reproducibility that is needed for it to be a valid instrument to be used in research and clinical practice.

Endoscopic Resection of Sinonasal and Ventral Skull Base Malignancies.

The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base malignancies in carefully selected cases. The goal of surgery is complete removal of all tumor with negative resection margins while maintaining the key oncological principles. Careful selection of cases along with the presence of an experienced surgeon and a fully involved multidisciplinary skull base team trained in the management of ventral skull base neoplasm are essential for excellent outcomes.

Extradural dermoid cyst of mastoid bone: a case report.

Dermoid cysts of the head and neck are rare congenital benign tumors. According to the literature they represent about seven percent of all dermoids and less than one percent of all intracranial neoplasms. Extradural dermoid cysts are very rare. We report a case of intracranial extradural dermoid cyst of mastoid bone. We believe that this is the second documented extradural dermoid cyst, the first case reported in the literature (Ammirati et al., 2007) was in close relation to the petrous apex but ours is in close relation to mastoid antrum. Hearing loss was the only clinical presentation in this case, while neurological symptoms were the main presenting symptoms in the first reported case. We present our management of this rare case with respect to the clinical, radiological, histopathological, and surgical aspects and conclude that dermoid tumors, though rare, need to be included in differential diagnosis of middle ear lesions.