Clinically significant anatomical variants of the paranasal sinuses

Anatomic structural variations of the paranasal sinuses have a practical significance during surgical procedures conducted on the sinuses by otolaryngologists. This study aims to evaluate the prevalence of clinically significant anatomical variations of the paranasal sinuses. A prospective analysis of 435 computed tomography [CT] examinations of adult Omani patients was conducted to determine the prevalence of clinically significant anatomical variations of the paranasal sinuses. A total of 360 CT scans were included from January 2009 to January 2010. The findings showed abnormal Agger nasi cells in 49% of cases [95% CI: 44-54%], concha bullosa in 49% [95% CI: 44-54%], Haller cells in 24% [95% CI: 18-31%], asymmetry in anterior ethmoidal roof 32% [CI: 29-37%], Onodi cells in 8% [CI: 5%-10%]. The type of skull base were as follows; Type 1 was 30% [n=107; 95% CI: 25-35%], Type 2 was 34% [n=123; 95% CI: 29-39], and Type 3 was 36% [n=130; 95% CI: 31-41%]. Many other surgically significant anatomical variations in small numbers [1-3] were incidentally identified. Knowledge of the presence of anatomical variations of the sinuses has a clinical significance as it minimizes the potential for surgical complications. There is an ethnical difference in the prevalence of anatomical variations. Further studies of anatomical variations with clinical disease correlations are needed.

novel V- silicone vestibular stent: preventing vestibular stenosis and preserving nasal valves

This report presents a novel style of placing nasal stents. Patients undergoing surgical procedures in the region of nasal vestibule and nasal valves are at risk of developing vestibular stenosis and lifelong problems with the external and internal nasal valves; sequels of the repair. The objective of the report is to demonstrate a simple and successful method of an inverted V- Stent placement to prevent potential complication of vestibular stenosis and nasal valve compromise later in life. Following a fall on a sharp edge of a metallic bed, a sixteen month old child with a deep lacerated nasal wound extending from the collumellar base toward the tip of the nose underwent surgical exploration and repair of the nasal vestibule and nasal cavity. A soft silicone stent fashioned as inverted V was placed bilaterally. The child made a remarkable recovery with no evidence of vestibular stenosis or nasal valve abnormalities. In patients with nasal trauma involving the nasal vestibule and internal and external nasal valves stent placement avoids sequels, adhesions, contractures, synechia vestibular stenosis and fibrosis involving these anatomical structures. The advantages of the described V- stents over the traditional readymade ridged nasal stents, tubing's and composite aural grafts are: a] technical simplicity of use, b] safety, c] less morbidity, d] more comfortable, and e] economical. To our knowledge, this is the first report of such a stent for prevention of vestibular stenosis and preserving nasal valves

Non allergic rhinitis: prevalence, clinical profile and knowledge gaps in literature

Although Nasal symptoms induced by Non-allergic rhinitis| [NAR] are a cause of wide spread morbidity; the disease is trivialized. There is a lack of Epidemiological studies on the prevalence of non-allergic rhinitis. In spite of being one of the commonest conditions presenting to the General practitioner and otolaryngologists, the clinical profile, diagnosis, and management outcomes are unknown. The objectives of the study were to examine the prevalence and clinical profile of non-allergic rhinitis in Oman. Secondary objective was to identify Knowledge gaps in literature with the aim of directing future research. A cross sectional study of 610 consecutive adult patients presenting to the Ear, Nose and Throat clinic at Sultan Qaboos University Hospital is presented in this paper. The diagnosis of NAR was mainly based on step wise fashion; including a thorough clinical history and exclusion of other causes of rhinitis; all consecutive patients diagnosed with rhinitis [n=113] had a detailed history, nasal endoscopy, nasal smears, CT scans and an antihistamine response trial. The prevalence of NAR with its clinical profile was subsequently determined. Primary research articles and meta-analysis evaluated for the knowledge gap study were identified through MEDLINE search of English language literature published between 2000-2011. A total of 610 consecutive patients were studied. The overall prevalence of rhinitis was 18.5% [n=113]. The prevalence of NAR was 7.5% [n=46]. Cases of allergic rhinitis [5.7%; n=35], Chronic rhinosinusitis [1.8%; n=11], and miscellaneous causes [3.4%; n=21] were excluded. Among the rhinitis population [n=113], the prevalence of NAR was 57% [n=46]. The major presenting symptoms included nasal obstruction [93%; n=43], postnasal drainage [78%; n=36], and rhinorrhea [62%; n=29]. For the knowledge gap study; 115 Medline titles were reviewed, four systematic reviews, and 34 research papers were reviewed. The text of two recent otolaryngology text books was also reviewed, and the main results of the study revealed the prevalence of NAR had not previously been studied in Oman. Although the recent text now clearly defines NAR, there is scant literature on the prevalence, diagnosis and management outcomes of NAR in the literature. The study found that more than half of rhinitis patients suffered from NAR. There are no specific diagnostic tests for NAR; a thorough case history is the best diagnostic tool to date. A substantial knowledge gap exists in literature with relations to pathogenesis, clinical and laboratory diagnosis, as well as in reference to medical and surgical outcomes. Larger studies are required and management outcomes need to be studied