Montelukast As An Adjunct To Treatment of Chronic Rhinosinusitis With Polyposis: A Prospective Randomized Controlled Trial.

In a prospective, randomized controlled trial, forty consecutive adult patients with bilateral nasal polyps were randomized into two groups. Twenty subjects in Group A were treated with oral prednisolone for 14 days and budenoside nasal spray for 8 weeks while the twenty subjects in Group B received a similar treatment with additional oral montelukast for 8 weeks. Subjects completed a modified nasal ICSD symptom score at the start of treatment and at 8 and 12 weeks after beginning the treatment. Symptom scores improved in both the groups after treatment. Subjects in Group B reported a statistically significant improvement in sense of smell (p = 0.0002), sneezing (p = 0.008) and overall score (p = 0.0006) at 8 weeks than controls. Four weeks after the completion of treatment, a statistically significant improvement was seen in the sense of smell (p = 0.0006), headache (p = 0.03) and overall score (p = 0.003) in patients in Group B when compared to Group A. Montelukast therapy may have clinical benefit as an adjunct to oral and inhaled steroid in chronic nasal polyposis.

Deep Neck Space Infections: A Profile of Fifty Nine Cases.

The present study was undertaken to analyse our experience with deep neck space infections and emphasize the importance of patient presentation, radiologic evaluation and early diagnosis and appropriate management. The records of 59 patients treated for deep neck space infections were evaluated. Odontogenic infections (35.59%) were found to be the most common cause of deep neck space infections followed by tonsillar infections (20.33%). Pain, fever, neck swelling and odynophgia were the most common clinical presentations. Radiological investigations were performed in all the patients (100%) while contrast enhanced CT - scan was performed in 35 patients (59.32%). The most commonly involved sites were the submandibular space and the parapharyngeal space, involving 14 patients and 11 patients respectively. All the patients (100%) were on intravenous antibiotics and fluids. Surgical intervention was done in 47 patients (79.66%) whereas 12 patients (20.33%) improved with conservative medical management alone. Despite the wide use of antibiotics, deep neck space infections are commonly seen. Early clinical and radiological diagnosis and appropriate management help to prevent the development of life threatening complications. Surgical drainage forms the mainstay of treatment, conservative medical therapy is also effective in selective cases.