Postoperative Comfort Score after Septoplasty among Patients Undergoing Nasal Packing versus Suturing of the Septal Flap by Modified Technique without Packing : A Randomized Controlled Trial

Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.

Management of coexistent sinonasal pathology in patients undergoing endoscopic cerebrospinal fluid rhinorrhea repair / Manejo de doenças nasossinusais coexistentes em pacientes submetidos a tratamento cirúrgico endoscópico de fístula liquórica

Abstract Introduction Patients who undergo endoscopic cerebrospinal fluid rhinorrhea repair may occasionally present with coexistent sinonasal pathology which may or may not need to be addressed prior to surgical repair. Some patients may develop new onset nasal morbidity related to endoscopic repair. Objective To study the prevalence and management of additional sinonasal pathology in patients who undergo endoscopic repair of cerebrospinal fluid rhinorrhea Methods A retrospective review of patients who underwent endoscopic cerebrospinal fluid leak repair was conducted to note the presence of coexistent sinonasal morbidity preoperatively and in the followup period. Results Of a total of 153 patients who underwent endoscopic closure of cerebrospinal fluid leak, 97 (63.4%) were female and 56 (36.6%) males. Most patients (90.2%) were aged between 21 and 60 years, with a mean of 40.8 years. Sixty-four patients (41.8%) were found to have coexistent sinonasal morbidity preoperatively, the commonest being symptomatic deviated nasal septum (17.6%), chronic rhinosinusitis without polyps (11.1%) and chronic rhinosinusitis with polyps (3.3%). Rare instances of septal hemangioma (0.7%) and inverting papilloma (0.7%) were also seen. Postoperatively, there was cessation of cerebrospinal fluid rhinorrhea in 96.7% which rose to 100% after revision surgery in those with recurrence. Resolution of coexistent sinonasal pathology occurred in all patients with followup ranging from 10 to 192 months. New onset sinonasal morbidity which developed postoperatively included synechiae between middle turbinate and lateral nasal wall (5.9%) and sinonasal polyposis (1.3%). Conclusion Patients who undergo endoscopic cerebrospinal fluid leak repair may have coexistent sinonasal pathology which needs to be addressed prior to or along with repair of the dural defect. New onset sinonasal morbidity, which may arise in a few patients postoperatively, may require additional treatment. A protocol for the management of coexistent sinonasal conditions ensures a successful outcome.

Resumo Introdução Pacientes submetidos a tratamento cirúrgico endoscópico de fístula liquórica podem ocasionalmente apresentar coexistência de outras doenças comuns que podem ou não precisar ser tratadas antes do procedimento. Alguns pacientes podem desenvolver nova morbidade nasal relacionada ao tratamento da fístula. Objetivo Estudar a prevalência e o manejo de doenças nasossinusais adicionais em pacientes submetidos ao reparo endoscópico de fístula liquórica. Método Uma revisão retrospectiva de pacientes submetidos ao reparo endoscópico de fistula liquórica foi feita para avaliar a presença de outras morbidades nasossinusais coexistentes no pré‐operatório e no período de seguimento. Resultados De 153 pacientes submetidos ao tratamento endoscópico do fistula liquórica, 97 (63,4%) eram do sexo feminino e 56 (36,6%) do masculino. A maioria dos pacientes (90,2%) tinha entre 21 e 60 anos, com média de 40,8. Verificou‐se que 64 pacientes (41,8%) apresentavam coexistência de morbidade nasossinusal no pré‐operatório, as mais comuns eram desvio de septo nasal sintomático (17,6%), rinossinusite crônica sem pólipos (11,1%) e rinossinusite crônica com pólipos (3,3%). Casos raros de hemangioma septal (0,7%) e papiloma invertido (0,7%) também foram observados. No pós‐operatório, inicialmente obteve‐se fechamento da fístula liquórica em 96,7%, que aumentou para 100% após a cirurgia de revisão nos pacientes com recorrência. A resolução das outras doenças nasossinusais coexistentes foi obtida em todos os pacientes, o seguimento variou de 10 a 192 meses. A ocorrência de uma nova morbidade nasossinusal no pós‐operatório incluiu sinéquias entre a concha média e a parede lateral do nariz (5,9%) e polipose nasossinusal (1,3%). Conclusão Pacientes submetidos a tratamento endoscópico de fistula liquórica podem apresentar coexistência de outras doenças nasossinusais que necessitam de tratamento prévio ou concomitante ao reparo do defeito dural. Outras morbidades nasossinusais que surgem durante o pós‐operatório podem exigir tratamento adicional. Um protocolo para o manejo das condições nasossinusais coexistentes garante um desfecho bem‐sucedido.

A comparative study of endoscopic and conventional septoplasty

Objective: Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologist. The standard surgical treatment for symptomatic deviated septum is septoplasty which has gone through several modifications since its inception. Study objectives were to compare the endoscopic and conventional septoplasty and to evaluate the advantage, disadvantage and complication of both the procedures. Materials and Methods: Prospective observational study was conducted in department of ENT and Head-Neck-Surgery of a tertiary care teaching hospital. Sixty patients undergoing either endoscopic septoplasty or conventional septoplasty were studied prospectively for a period of 3 months to compare the efficacy of both the techniques. Objective assessment was done by doing nasal endoscopy 90 days after the operation to note the following points- (1) Persistence of deviation (2) Spur (3) Formation of synechiae (4) Septal perforation. Result: In this study the endoscopic approach showed better overall clinical result as compared to conventional technique with lesser complication. It was noted that endoscopic septoplasty group had minimum blood loss and shorter operative time than conventional method, but difference was not statistically significant. Conclusion: Endoscopic septoplasty was founded with distinct advantage over conventional method due to better illumination, improve accessibility to remote area was founded. Further surgical experience and larger similar studies will help in coming to a greater consensus.

A Comparative Study of Conventional Septoplasty Verses Endoscopic Septoplasty

Introduction: A deviated septum can be asymptomatic or cancause functional and cosmetic abnormality. Different studieshave been proposed for correction of deviated septum butseptoplasty has been the treatment of choice. Septoplasty is amore conservative surgery and endoscopic septoplasty hasbecome increasingly popular over the last few decades.Methods: The study was carried out to compare thepostoperative results among patients of conventional andendoscopic septoplasty and to assess the efficacy ofendoscopic septoplasty with other surgeries. The present studywas conducted among 40 patients of deviated nasal septumadmitted in the department of otolaryngology of Adesh Instituteof Medical Sciences and Research, Bathinda. Patients wereselected by simple random sampling and were divided intogroup A and B, with 20 patients in each group. Group Aunderwent conventional septoplasty and group B underwentendoscopic septoplasty.Results: The male to female ratio in the present study was 3:1.Deviated nasal septum was commonly associated with inferiorturbinate hypertrophy (45%) and concha bullosa (27.5%).Postoperatively, a significant relief from the symptoms ofnasal obstruction (85%), nasal discharge (25%), headache(30%) and post nasal drip (55%) was observed in endoscopicseptoplasty. Complication rate was higher in conventionalseptoplasty. The endoscopic approach facilitates properalignment by limited and precise resection of pathologicalareas.Conclusion: Endoscopic Septoplasty provides preciseresection of the pathological areas and better illumination withlimited flap dissection and exposure.

A Prospective Study on Association Between Deviated Nasal Septum and Sinusitis in a Tertiary Care Teaching Hospital

Background: Chronic sinusitis (CS) is an extremely prevalent disorder. It affects up to two percent of the world population. It has a significant impact on the quality of life of people [2]. Basically, the word “sinusitis‟ refers to a group of disorders characterized by inflammation of mucosa of nose and paranasal sinuses. Deviated Nasal septum is one of the most common disorder that presents up to 62% of the population. Its role in the pathogenesis of chronic sinusitis remains uncertain. Methods: Two groups were included in this study .Each group had 30 cases with Midline nasal septum & Deviated nasal septum. This study conducted in the Department. of ENT, Saraswathi Institute of Medical Sciences, Hapur. The duration of the study was over a period of six month. Results: We were studied two groups, 30 cases involved in group I of Midline nasal septum and in group II 30 cases involved with Deviated nasal septum. In this study we showed symptom & sign of rhinoscopy. In the group I, 14 cases had congested nasal mucosa followed by 10 cases of nasal discharge, 4 cases of inferior turbinate hypertrophy & 2 cases of Middle turbinate hypertrophy. Conclusions: that management of chronic maxillary sinusitis should include simultaneous treatment of any anatomical variation. For treating chronic sinusitis along with deviated nasal septum, nowadays treatment of choice is Septoplasty along with Functional Endoscopic Sinus Surgery (FESS). FESS technique is used for managing sinus infection and ostial obstruction.

Conventional septoplasty verses endoscopic septoplasty: A comparative study.

The study was carried out to compare the postoperative morbidity among patients of conventional and endoscopic septoplasty and to assess the efficacy and use of endoscopic septoplasty with other endoscopic surgeries. The present prospective study was conducted among 100 patients of deviated nasal septum, admitted in the department of Otorhinolaryngology, of Sawai Man Singh Medical College and hospital, Jaipur, Rajasthan. Patients were selected by simple random sampling procedure and were divided into group A and B, with 50 cases in each group. Group A underwent conventional septoplasty and group B underwent endoscopic septoplasty. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (75%) and concha bullosa (26%). Postoperatively, a significant relief from the symptoms of nasal obstruction (96%), nasal discharge (88%), headache (100%) and post nasal drip (67%) was observed in endoscopic septoplasty. Posterior deviations were best corrected by endoscopic septoplasty. Complication rate was higher in conventional septoplasty. The endoscopic approach to septoplasty facilitates accurate identification of the pathology. It facilitates realignment by limited and precise resection of the pathological areas.

Preoperative computed tomographic evaluation of inferior nasal concha hypertrophy and its role in deciding surgical treatment modality in patients with deviated nasal septum / Evaluación preoperatoria con tomografía computada de la hipertrofia de la concha nasal inferior y su rol en la decisión de la modalidad de tratamiento quirúrgico en pacientes con tabique nasal desviado

Deviated nasal septum is associated with compensatory hypertrophy of the inferior nasal concha on the contralateral side. In the past conventional septoplasty was done for the deviated septum, which would improve the patency on the side of deviation but would worsen it on the opposite side due to reallocation of the septum to the midline. The present study of 50 patients unfolds the anatomical composition of the inferior nasal concha based on the computed tomographic scan and help the otolaryngologist to determine whether to add turbinoplasty to standard septoplasty procedure or not.

Un tabique nasal desviado está asociado con una hipertrofia compensatoria de la concha nasal inferior del lado contra lateral. En el pasado se realizaba septoplastía convencional para el tabique desviado, lo que mejoraraba la permeabilidad en el lado de la desviación, pero agravaba ésta en el lado opuesto, debido a la reacomodación del tabique en el plano mediano. En el presente estudio se evaluó en 50 pacientes la composición anatómica de las conchas nasales inferiores, basado en la exploración a través de tomografía computarizada, y de esta manera ayudar al otorrinolaringólogo a determinar si es necesario o no, añadir la plastía de la concha nasal inferior al procedimiento de septoplastía estándar.

Etiologia, manifestações clínicas e alterações presentes nas crianças respiradoras orais / Etiology, clinical manifestations and concurrent findings in mouth-breathing children

OBJETIVO: Investigar a etiologia, as principais manifestações clínicas e as alterações presentes em crianças de 3 a 9 anos, respiradoras orais, residentes na região urbana de Abaeté (MG). MÉTODOS: Estudo com amostra aleatória representativa da população do município de 23.596 habitantes. Clinicamente, foram consideradas respiradoras orais as crianças que roncavam, dormiam com a boca aberta, babavam no travesseiro e apresentavam queixas de obstrução nasal freqüente ou intermitente. As crianças com diagnóstico clínico de respirador oral foram submetidas a endoscopia nasal, teste alérgico cutâneo e raio X do cavum, hemograma, contagem de eosinófilos, dosagem de IgE total e parasitológico de fezes. Os dados foram analisados utilizando o programa SPSS® versão 10.5. RESULTADOS: As principais causas da respiração oral foram: rinite alérgica (81,4 por cento), hipertrofia de adenóides (79,2 por cento), hipertrofia de amígdalas (12,6 por cento) e desvio obstrutivo do septo nasal (1,0 por cento). As principais manifestações clínicas do respirador oral foram: dormir com a boca aberta (86 por cento), roncar (79 por cento), coçar o nariz (77 por cento), babar no travesseiro (62 por cento), dificuldade respiratória noturna ou sono agitado (62 por cento), obstrução nasal (49 por cento) e irritabilidade durante o dia (43 por cento). CONCLUSÃO: Algumas manifestações clínicas são muito freqüentes na criança respiradora oral. Essas manifestações devem ser reconhecidas e consideradas no diagnóstico clínico da respiração oral.

OBJECTIVE: To investigate the etiology, main clinical manifestations and other concurrent findings in mouth-breathing children aged 3 to 9 years and resident in the urban area of Abaeté (MG), Brazil. METHODS: This study was based on a representative random sample of the town population, of 23,596 inhabitants. Clinical diagnosis of mouth-breathing was defined as a combination of snoring, sleeping with mouth open, drooling on the pillow and frequent or intermittent nasal obstruction. Children with a clinical diagnosis of mouth breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS® version 10.5. RESULTS: The main causes of mouth breathing were: allergic rhinitis (81.4 percent), enlarged adenoids (79.2 percent), enlarged tonsils (12.6 percent), and obstructive deviation of the nasal septum (1.0 percent). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86 percent), snoring (79 percent), itchy nose (77 percent), drooling on the pillow (62 percent), nocturnal sleep problems or agitated sleep (62 percent), nasal obstruction (49 percent), and irritability during the day (43 percent). CONCLUSION: Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth breathing.

The relationship between deviated nasal septum and middle ear pressure.

The Nose/Ear Distress Syndrome is defined as the combination of nasal septal deformity and eustachian dysfunction in the absence of any other pathology (McNicoll and Scanlan,1979). Until now, there have been few literatures strongly mentioned about it in the scientific role, and this relationship has not been studied in Thai people. The relationship between deviated nasal septum (DNS) and middle ear pressure (MEP) was then studied with the audiometry, tympanometry, rhinomanometry, and acoustic rhinometry. A total of 80 patients with DNS was recruited and divided into 2 groups; The allergic rhinitis group (n = 40) and the control group (n = 40). Each group could be further divided into 2 subcategories: (a) DNS to Right (nasal airflow: right side< left side) (n = 44) (b) DNS to left (nasal airflow: left side< right side) (n = 36). The mean of patient's age was 33.5 years (range: 11-56 years). The mean of minimal cross-sectional area in patients with DNS and its length from anterior nostril (after decongestion) were 0.7 cm2; 1.6 cm on the left side and 0.7 cm2;1.4 cm on the right side, respectively. The mean of MEP (n = 80) was - 17.3 daPa (S.D.=13.4) on the left side and - 18.7 daPa (S.D.=14.3) on the right side. In each subcategory of both groups, there were no significant differences in MEP between both sides (p > 0.05) although there were significant differences in airflow and resistance (p < 0.05). Furthermore, the difference of nasal airflow or nasal resistance between both sides did not significantly correlate with the difference of MEP (p > 0.05). The number of patients who had auditory symptom was 9 (22.5%) in the control group and 4 (10%) in the allergic rhinitis group. There were no significant differences in incidence of auditory symptom between both groups (p > 0.05). Between the patients who had auditory symptom (n = 13) and had no auditory symptom (n = 67), the difference of nasal airflow, nasal resistance, and MEP between both sides did not differ significantly (p > 0.05). In summary, we found no relationship between DNS and MEP in this study.