Retained foreign body in nose following eye injury.

A man in his 60s presented with diminution of vision of the left eye with nasal bleeding after accidental fall. On examination his left upper eyelid was lacerated and left temporal sclera was punctured which was repaired under local anaesthesia after which he was discharged by ophthalmologists but continued to complain of pain and left nasal obstruction. A non-contrast CT of paranasal sinuses revealed fracture of medial wall of left orbit, left ethmoid haemosinus and a metallic foreign body (FB) in the septum and anterior face of sphenoid. Diagnostic nasal endoscopy performed to remove the metallic FB showed plastic splinters embedded in the mucosa of nasal cavity which was unexpected. Hence, the FB was removed in two sittings because of diagnostic dilemma.

Evaluating post-rhinoplasty nasal obstruction treatment: The efficacy of VivAer radiofrequency ablation.

PURPOSE: Nasal obstruction is a prevalent issue affecting up to one-third of adults, often requiring surgical intervention. Low-temperature radiofrequency (RF) treatment, specifically VivAer, has emerged as a promising alternative, especially for the treatment of nasal valve collapse (NVC). However, its efficacy in patients with a history of rhinoplasty or nasal valve repair remains unexplored. METHODS: A single-center retrospective chart review was conducted on 37 patients with a history of rhinoplasty or nasal valve repair who underwent VivAer RF treatment. Treatment outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale. The primary outcome was defined as a decrease in NOSE score by at least one severity category or a 20 % reduction in total NOSE score. RESULTS: The study found a statistically significant average reduction in NOSE score of 22.4 points or 36.6 %. Among patients with a positive treatment response (21 patients or 56.8 %), the average NOSE score reduction was 34.7 points or 55.6 %. Repeat RF treatment in non-responders resulted in a 50 % response rate. No significant difference was observed in treatment outcomes based on the type of prior rhinoplasty or NVC. CONCLUSIONS: Temperature-controlled RF treatment with VivAer can effectively alleviate nasal obstruction in patients with a history of rhinoplasty or nasal valve repair, offering a viable alternative to revision surgery. The study also highlights the potential benefit of repeat RF treatment in non-responders. Further research, including randomized controlled trials, is needed to validate these promising results and expand the treatment options for this complex patient population.

Surgery is better than nasal sprays for people with severely blocked airways caused by septal deviation.

The studyCarrie S, O'Hara J, Fouweather T, et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 2023;383:e075445.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/surgery-is-better-than-nasal-sprays-for-people-with-severely-blocked-airways/.

Juvenile trabecular ossifying fibroma of the inferior turbinate.

Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT scan of the nose and paranasal sinuses further identified a bony hyperdense lesion with ground glass attenuation, confined to the right inferior turbinate. Subsequent biopsy confirmed juvenile trabecular ossifying fibroma (JTOF). The patient underwent endoscopic right medial maxillectomy, and the final histology affirmed the diagnosis of JTOF.

Quantification of Heavy Metals in the Nasal Turbines of Smokers and Nonsmokers.

OBJECTIVES: Cigarette smoke is known to contain toxic heavy metals. In this study, heavy metal levels in the nasal turbinate tissues of smokers and nonsmokers were measured and compared with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). METHODS: Forty patients who come to the Otorhinolaryngology outpatient clinic due to nasal obstruction and are given an appointment for partial turbinate reduction operation due to inferior turbinate hypertrophy, according to their smoking status, were divided into two groups: those who had smoked one pack/day for at least 10 years and those who had never smoked. The levels of heavy metals (Al, As, Ba, Cd, Cr, Co, Cu, Pb, Mn, Hg, Ni, Se, and Ag) were compared by ICP-MS in nasal turbinate tissues. RESULTS: Al (p = 0.002), Cr (p < 0.001), Co (p < 0.001), Ni (p = 0.001), Cu (p < 0.001), As (p < 0.001), Se (p < 0.001), Ag (p < 0.001), Cd (p = 0.001), Ba (p = 0.008), Hg (p < 0.001), and Pb (p < 0.001) values in the smoker group were found to be significantly higher than the values of nonsmokers. Although the Mn level was high in smokers, no significant difference was observed (p = 0.299). CONCLUSIONS: Smoking can cause nasal and sinus problems. In this study, we observed that the smoking group had significantly higher levels of almost all the heavy metals investigated in the nasal turbinate tissues. As smoking damages, the mucociliary system and the mucosa, heavy metals from cigarettes may accumulate further and cause harm to the nasal tissues. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3562-3567, 2024.

Intravascular papillary endothelial hyperplasia of the maxillary sinus extending into the contralateral nasal cavity.

INTRODUCTION: Intravascular papillary endothelial hyperplasia (IPEH) predominantly occurs in the subcutaneous and dermal regions and rarely originates from the sinonasal mucosa. CASE PRESENTATION: We report on the case of a 58-year-old male patient who presented with progressive bilateral nasal obstruction, left-sided epiphora, and intermittent epistaxis. Computed tomography revealed a soft tissue opacity in the left maxillary sinus with intersinusoidal nasal wall demineralization, extending into the surrounding ethmoid cells and the right nasal cavity through a contralateral deviation of the nasal septum. Contrast-enhanced T1-weighted magnetic resonance imaging further confirmed these findings. The IPEH originating from the maxillary sinus extended into the contralateral nasal cavity, and it was successfully removed using an endoscopic endonasal approach, avoiding overly aggressive treatment. CONCLUSION: This case report highlights the diagnostic challenges of IPEH in the sinonasal region and the importance of considering IPEH as a differential diagnosis in patients presenting with nasal obstruction, epiphora, and intermittent epistaxis.

Nasal airway obstruction in patients with cleft lip nasal deformity: A systematic review.

BACKGROUND: Cleft lip nasal deformity (CLND)-associated nasal airway obstruction (CL-NAO) may be inadequately characterized, with its functional implications subsequently underappreciated and neglected. The purpose of this systematic review is to (1) summarize the available assessment results in CL-NAO, (2) evaluate the reliability of current assessment tools, and (3) identify ongoing gaps and inconsistencies for future study. METHODS: A systematic search of the MEDLINE, EMBASE, and Scopus databases was performed for articles studying CL-NAO. Articles focusing on noncleft populations or surgical techniques were excluded. Extracted data included information about study design, patient demographics, medical history, and assessment scores. RESULTS: Twenty-six articles met criteria for inclusion. Assessments included patient-reported outcome measures (PROMs), anatomic characterizations of CLND, and nasal airflow and resistance studies. Objective assessments were generally more reliable than subjective assessments in CLND. Unilateral CLND was better represented in the literature than bilateral CLND. For unilateral CLND, the cleft side was more obstructed than the noncleft side, with stereotyped patterns of anterior nasal deformity but varied middle and posterior deformity patterns. Overall, there was considerable heterogeneity in study design regarding stratification of CLND cohorts by age, cleft phenotype and laterality, and surgical history. CONCLUSIONS: A wide range of subjective and objective assessment tools were used to characterize CL-NAO, including PROMs, anatomic measurements, and airflow and resistance metrics. Overall, objective assessments of CL-NAO were more reliable than subjective surveys, which may have resulted from variable expectations regarding nasal patency in the CLND population combined with large heterogeneity in study design.

Nasal Disorders.

Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.

Validated Symptom Outcomes Following Septal Perforation Repair: Application of the NOSE-Perf Scale.

OBJECTIVE: The Nasal Obstruction Symptom Evaluation (NOSE)-Perf scale was developed and validated to measure symptoms associated with nasal septal perforations. This study reports the application of the NOSE-Perf scale to evaluate symptom change following septal perforation repair. METHODS: Patients with NOSE-Perf evaluations ≥6 months following attempted perforation closure from July 2018 to December 2021 utilizing bilateral nasal mucosal flaps with an interposition graft were eligible for study inclusion. Change in NOSE-Perf scores were noted. Patient demographics, perforation size, and concurrent functional procedures were analyzed for impact on symptom outcomes. RESULTS: One-hundred and seventeen patients met the study criteria. Seventy-nine (67.5%) of the patients were female and the mean (range) age at surgery was 47.3 (14-78) years. Repair failure was noted in 7 (6.0%) patients. Mean (SD) preoperative NOSE-Perf score was 25.3 (95% CI, 23.5-27.1) and postoperative score was 7.9 (95% CI, 6.5-9.3). Minimal clinically important difference (MCID) was estimated and greater than 91% of patients had improvement above this threshold. Patient age, perforation size, or concurrent functional procedures did not impact outcomes. Postoperative scores at short (2-4 months), intermediate (5-8 months), and long-term (≥9 months) time periods showed significant improvement (all p < 0.001) compared to preoperative NOSE-Perf scores. CONCLUSION: Significant reduction in nasal symptoms as measured by the NOSE-Perf scale is noted following bilateral mucosal flap repair. Although the nose does not completely normalize following repair, clinically important improvement was noted in at least 91% of patients. The NOSE-Perf scale is positioned to play a role in the standardization of septal perforation evaluation and outcomes assessment. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3067-3072, 2024.

Bilateral Concha Bullosa Within Concha Bullosa: Unique Middle Concha Variation.

The middle nasal turbinate is an important anatomical formation located on the lateral nasal wall. Concha bullosa can be defined as the presence of an air gap inside the turbinate. It is the most common middle nasal turbinate variation. It is often asymptomatic, but can sometimes cause nasal obstruction. In this study, an asymptomatic patient with concha bullosa within concha bullosa in both middle turbinates, which has not been reported before in the literature, is presented. Laryngoscope, 134:3516-3518, 2024.

Misdiagnosed long-standing unilateral nasal obstruction: ossifying fibroma of the inferior turbinate.

A man in his 20s presented with complaints of unilateral nasal obstruction for the past 6 years that progressively worsened leading to irrational use of over-the-counter nasal decongestants. With the worsening of symptoms, a non-contrast CT was done. It showed a dense expansile sclerotic lesion of the right inferior turbinate, which was excised endoscopically. Cemento-ossifying fibromas of the inferior turbinate are rare and require assessment and surgical excision to relieve the symptom of nasal obstruction. It derives its name from the variable proportions of fibrous and mineralised tissue present in it and exclusively develops in the craniofacial region. It can be surgically managed by an endoscopic, an endonasal non-endoscopic (with a speculum) or an open approach (lateral rhinotomy, sublabial approach or mid-facial degloving). Here, we present how such a case was detected and managed surgically by the endoscopic approach, which is a minimally invasive option with shorter hospital stay and early recovery.

Nasal spindle cell tumor: A case report and literature review.

BACKGROUND: Spindle cell tumors are rare and can occur in any organ or tissue. Due to their rarity the clinicopathological features and diagnostic protocols have not been adequately studied. However, it has become necessary to develop differential diagnosis of spindle cell tumors. Here, we report a case of a nasal spindle cell tumor diagnosed at our hospital in attempt to contribute to this gap in literature. KEY POINTS FROM THE CASE: A male in his 30s was admitted to our hospital with nasal obstruction that had persisted for several years. Electronic fibrolaryngoscopy revealed a smooth neoplasm within the nasal cavity. MAIN LESSONS TO BE LEARNED FROM THIS CASE REPORT: The results of this case emphasize that spindle cell tumors have large morphological variations, and it is difficult to determine the origin of tumor cells using hematoxylin and eosin staining alone. Therefore, it is necessary to improve the immunohistochemistry and combine it with clinical symptoms to diagnose the disease.

Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings?

OBJECTIVE(S): To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS: This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS: A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION: OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT: Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS: • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.

The Association Between Transverse Maxillary Deficiency and Septal Deviation in Adults with Obstructive Sleep Apnea.

OBJECTIVES: Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation. METHODS: A prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high-arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height-to-width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing. RESULTS: Ninety-three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter-premolar palatal height and the degree of septal deviation at the inter-molar region. No significant correlation was observed between palatal dimensions and NOSE score. CONCLUSION: This study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2464-2470, 2024.

Effectiveness of Radiofrequency Device Treatment for Nasal Valve Collapse in Patients With Nasal Obstruction.

OBJECTIVE: Internal nasal valve dysfunction is a prevalent cause of nasal obstruction. This systematic review, along with a Meta-analysis, evaluated the efficacy of temperature-controlled radiofrequency device (RFD) treatment in alleviating nasal obstruction by rectifying nasal valve collapse. DATA SOURCES: A comprehensive review of studies retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases (up to December 2022) was conducted. REVIEW METHODS: We included studies that evaluated the quality of life and nasal obstruction scores before and after RFD treatment. In addition, sham-controlled studies were analyzed. RESULTS: In total, 451 patients across 8 studies were included in the analysis. Patients who underwent RFD treatment reported a significantly enhanced quality of life 24 months after treatment compared to pretreatment scores. The rates of clinically improved states and positive responses regarding quality of life after treatment were 82% and 91%, respectively. Moreover, the disease-specific quality of life, as assessed by the Nasal Obstruction Symptom Evaluation score, significantly improved. CONCLUSION: RFD may help improve nasal obstruction symptoms. Further randomized clinical studies on larger cohorts are essential to substantiate its efficacy in enhancing nasal valve function.

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study.

OBJECTIVE: Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. METHODS: This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). RESULTS: The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. CONCLUSION: 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1970-1977, 2024.

Impact of different fracture types in the pyriform buttress area on nasal airway function.

INTRODUCTION: Fractures in the pyriform buttress area adversely affect facial appearance and nasal airway patency. Nasal airway function has received less attention than aesthetic problems in the literature. This retrospective study classified the different fracture types in this area and determined their impact on nasal airway function. MATHODS: Three-dimensional computed tomography images of patients with fractures in the pyriform buttress area were analyzed to identify the exact fracture pattern. The nasal airway functions were evaluated and compared between patients with different fracture patterns using acoustic rhinometry, rhinomanometry, and the nasal obstruction symptom evaluation scale. RESULTS: Overall, 47 patients, including 16 with type I fractures (high fracture line; group I), 16 with type II fractures (intermediate fracture line; group II), and 15 with type III fractures (low fracture line; group III), were included in the study. The mean minimal cross-sectional area (MCA), total nasal inspiratory resistance (Tri) and total nasal expiratory resistance (Tre) of group I were 0.51 ± 0.06 cm2, 1.67 ± 0.11 kPa L-1 s-1, and 1.66 ± 0.12 kPa L-1 s-1, respectively; those of group II were 0.48 ± 0.07 cm2, 1.89 ± 0.15 kPa L-1 s-1, and 1.88 ± 0.14 kPa L-1 s-1, respectively; and those of group III were 0.36 ± 0.04 cm2, 1.94 ± 0.21 kPa L-1 s-1, and 2.01 ± 0.34 kPa L-1 s-1, respectively. The nasal obstruction symptom evaluation (NOSE) scale scores for groups I, II, and III were 7.188, 9.813, and 13.27, respectively. CONCLUSION: Therefore, the severity of the nasal airway obstruction depends on the displacement of the fractured bones in patients with fractures in the pyriform buttress area. The most profound nasal obstruction occurs in patients with the lowest fracture line.