Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms

Abstract Objective: To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. Methods: Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. Results: Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. Conclusion: Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms. Level of evidence: 4.

Efficacy of Guanqiao Zhengqi holistic therapy for chronic rhinosinusitis / 中国基层医药

Objective:To investigate the efficacy of Guanqiao Zhengqi holistic therapy in the treatment of chronic rhinosinusitis. Methods:A total of 200 patients with chronic rhinosinusitis who received treatment in the Department of Otolaryngology, Shanxi Provincial Integrated Traditional Chinese Medicine and Western Medicine Hospital ( n = 72) and Shanxi Yishengtang Traditional Chinese Medicine Center ( n = 128) from January 2021 to January 2022 were included in this study. These patients were randomly assigned to undergo treatment either with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (control group, n = 100) or Guanqiao Zhengqi holistic therapy combined with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (observation group). All patients were treated for 4 weeks and followed up for 3 months. Clinical efficacy, modified Visual Analogue Scale score, Lund-Kennedy endoscopy scoring system score, and duration of glucocorticoid and anti-leukotriene use were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group [92.00% (92/100) vs. 73.00% (73/100), χ2 = 18.45, P < 0.001). There was no significant difference in the modified Visual Analogue Scale score between the two groups before treatment ( Z = 1.37, P = 0.170). There was a significant difference in the modified Visual Analogue Scale score between the two groups after treatment ( Z = -5.27, P < 0.001). Before treatment, there was no significant difference in the Lund-Kennedy endoscopy scoring system score between the two groups ( Z = -1.65, P = 0.098) and the Lund-Kennedy endoscopy scoring system score differed significantly between the two groups after treatment ( Z = -6.03, P < 0.001). The duration of glucocorticoid and anti-leukotriene use in the observation group was significantly shorter than that in the control group [10.00 (10.00, 14.00) days vs. 42.00 (28.00, 70.00) days, 7.00 (7.00, 7.00) days vs. 21.00 (14.00, 26.25) days, Z = -11.27, P < 0.001, Z = -12.31, P < 0.001). Conclusion:Based on the conventional treatment with western medicine, Guanqiao Zhengqi holistic therapy for the treatment of chronic rhinosinusitis can effectively reduce clinical symptoms, reduce the dose of hormones and anti-leukotriene used, shorten the use cycle, and improve the therapeutic efficacy.

Surgical approach analysis of endoscopic resection of juvenile nasopharyngeal angiofibroma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the surgical approach for the resection of juvenile nasopharyngeal angiofibroma（JNA） under nasal endoscopy. Methods:The clinical data of 87 patients undergoing endoscopic resection of nasopharyngeal fibroangioma were retrospectively analyzed. We classified JNA according to tumor site, size, invasion scope and anatomic position relationship between tumor and midline of pupil. Three endoscopic surgical approaches were selected according to the classification, and the postoperative symptoms, complications and recurrence were investigated and analyzed. Results:The tumor resection rate of 87 cases by nasal endoscopic surgery was 100%. Thirty-five cases were approached through the middle nasal passage（small tumors located in the nasal sinuses and pterygopalatine fossa）, forty-five cases were approached through the lateral wall of the nasal cavity（tumor invaded the pterygopalatine fossa but did not exceed the midline of the pupil） , and seven cases were approached via the lateral wall of nasal cavity + ipsilateral anterior wall of maxillary sinus（tumor invaded the infratemporal fossa beyond the midline of pupil or invaded the cavernous sinus and the middle cranial fossa epidural）, Postoperative patients with nasal congestion, nasal bleeding, headache, dizziness, vision loss and other symptoms showed varying degrees of improvement. No surgical death or intracranial infection occurred. The postoperative follow-up was 6-78 months, and the recurrence rate was 3.44%. Conclusion:Endoscopic resection of nasopharyngeal fibroangioma is the main treatment method for JNA. Selecting suitable endoscopic approach to resect JNA, To maximize the advantage of nasal endoscopic equipment according to the inherent anatomical space of the human nasal cavity, In order to achieve the purpose of JNA resection, reduce intraoperative and postoperative complications, reduce the recurrence rate and improve the prognosis.

Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.

SPECIAL ARTICLE COVID-19: Safety for the Rhinologist in the Age of COVID-19: Mask Use, Nasal Corticosteroids, Saline Irrigation, and Endoscopic Procedures - Literature Review

Abstract Introduction Coronavirus disease 2019 (COVID-19) has claimed millions of lives. Adequate protection of the professionals involved in patient care is essential in the battle against this disease. However, there is much uncertainty involving safety-relarted topics that are of particular interest to the rhinologist in the context of COVID-19. Objective To evaluate the current evidence regarding three safety-related topics: mask and respirator use, performance of nasal endoscopic procedures, and use of topical nasal and intranasal medications (saline irrigation and nasal corticosteroids). Methods A literature review was performed on the PubMed, Scopus, and Cochrane databases, with standardized search queries for each of the three topics of interest. Results In total, 13 articles on mask use, 6 articles on the safety of nasal corticosteroids, 6 articles on the safety of nasal endoscopic procedures, and 1 article on nasal irrigation with saline solution were included in the final analysis. Conclusion N95 respirators are essential for the adequate protection of otolaryngologists. If reuse is necessary, physical methods of sterilization must be employed. No evidence was found to contraindicate the use of nasal corticosteroids, whether acute (in the management of sinonasal inflammatory conditions) or continued (in patients who use them chronically). Nasal irrigation with saline solution apparently does not increase the risk in the context of COVID-19. Nasal endoscopic procedures should only be performed after testing the patient for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the surgical team must wear full personal protective equipment to prevent aerosol exposure.

Experiencia en cirugía endoscópica de angiofibroma nasofaríngeo juvenil / Endoscopic surgery experience of juvenile nasopharyngeal angiofibroma

Resumen Introducción: El angiofibroma nasofaríngeo juvenil (ANJ) es un tumor benigno poco frecuente, altamente vascularizado y localmente agresivo, encontrado casi exclusivamente en pacientes masculinos adolescentes. Se presentan con epistaxis recurrente y obstrucción nasal. Objetivo: Presentar la experiencia en el tratamiento quirúrgico endoscópico exclusivo para los ANJ del equipo de rinología del Hospital del Salvador. Material y Método: Estudio descriptivo retrospectivo de corte transversal con revisión de fichas clínicas entre enero de 2011 a junio de 2017 con tratamiento quirúrgico endoscópico exclusivo para ANJ. Resultados: 16 pacientes con edad promedio de 17,2 años, 81% se presentó con obstrucción nasal y epistaxis. Todos fueron embolizados 48 o 24 horas previo a la cirugía. El tiempo quirúrgico promedio fue de 199 minutos. El sangrado estimado fue de 831 ml en promedio, con sólo un paciente con requerimientos de transfusión. El 71% no requirió taponamiento nasal anterior. El requerimiento de hospitalización fue de 4,6 días. Sólo un paciente ha tenido recurrencia al año de control. Conclusión: Los resultados en pacientes con ANJ tratados en el Hospital del Salvador reafirman el éxito de la técnica endoscópica exclusiva versus abordajes abiertos convencional, ya que presentan mejores resultados.

Abstract Introduction: The juvenile nasopharyngeal angiofibroma (ANJ) is a benign, infrequent and highly vascularized tumor. It is locally aggressive, found almost only in adolescent male patients. The classical clinical presentation is recurrent epistaxis and nasal obstruction. Aim: To review the experience of exclusive endoscopic surgery for patients with ANJ by the rhinology team of Hospital del Salvador. Material and Method: Retrospective, cross sectional, descriptive study with research of medical records of patients with exclusive endoscopic surgery treatment between January 2011 and June 2017. Results: 16 patients with a mean age of 17.2 years, 81% had nasal obstruction and epistaxis. All of them were embolized 48 to 24 hours prior surgery. Mean surgical time was 199 minutes. Estimated bleeding was 831 ml among all patients, with only one requiring blood transfusions, while 71% did not need nasal packing. Average length of hospital stay was 4.6 days. Only one patient had a recurrence after one year of surgery. Conclusion: Results of patients with ANJ treated in Hospital del Salvador reassert the success of the exclusive endoscopic surgery versus traditional open approaches, showing better results.

Effect of dexamethasone combined with oxybuprocaine hydrochloride gel on prevention of postoperative sore throat after nasal endoscopy / 北京大学学报(医学版)

OBJECTIVE@#To explore the effectiveness and feasibility of dexamethasone combined with oxybuprocaine hydrochloride gel on the prevention of postoperative sore throat after nasal endoscopy.@*METHODS@#In the study, 60 patients with American Society of Anesthesiologist (ASA) physical statuses Ⅰ to Ⅱ, aged 18 to 72 years, scheduled for elective nasal endoscope surgery under general anesthesia requiring endotracheal intubation were randomly divided into dexamethasone combined with oxybuprocaine hydrochloride gel group (G group, n=30) and control group (C group, n=30). The patients in the G group received dexamethasone 0.1 mg/kg before induction and the oxybuprocaine gel was applied to the endotracheal catheter cuff and the front end within 15 cm. The patients in the C group received the same dose of saline and the saline was applied to the endotracheal catheter cuff and the front end within 15 cm. Then, all the patients in the two groups received the same induction and anesthesia maintainance. The operation time, anesthesia time, emergence time, extubation time and departure time were recorded. The intraoperative infusion volume, blood loss volume, propofol, remifentanil, rocuronium dosage were also recorded. The adverse reactions such as intraoperative hypotension, bradycardia and postoperative agitation were recorded. The postoperative sore throat score was recorded at the end of operation and 4 h, 8 h, 12 h, and 24 h after operation.@*RESULTS@#Compared with the C group, the emergence time [(8.4±3.9) min vs. (10.8±4.7) min], extubation time [(8.8±3.7) min vs. (11.9±4.8) min], and departure time [(20.0±5.3) min vs. (23.0±5.8) min] were significantly shorter, and the propofol dosage [(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg], remifentanil dosage [(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg] were significantly less in the G group, and there was no difference of rocuronium dosage in the two groups. Compared with the C group the incidence of intraoperative hypotension [10%(3/30) vs. 30%(9/30)], bradycardia [16.7%(5/30) vs. 20%(6/30)] and postoperative agitation [6.7%(2/30) vs. 23.3%(7/30)] were significantly lower in the C group. The postoperative sore throat score at the end of operation, 4 h, 8 h, 12 h and 24 h after operation in the G group were significantly lower than in the C group respectively [0 (0, 1) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (0.75, 1), 0 (0, 0) vs. 1 (0, 1)].@*CONCLUSION@#Dexamethasone combined with oxybuprocaine hydrochloride gel was effective and feasible on the prevention of postoperative sore throat after nasal endoscopy.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review / Procedimentos endonasais de rinologia diagnósticos e terapêuticos geradores de aerossóis durante a pandemia de Covid-19: uma revisão sistematizada,

Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.

Clinical analysis of endoscopic-assisted RS silicone intubation for congenital nasolacrimal duct obstruction in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect and safety of endoscopic-assisted RS silicone intubation for congenital nasolacrimal duct obstruction after failed probing in children, in order to guide the clinical application.<p>METHODS: Retrospective case series. Totally 158 children(158 eyes)with congenital nasolacrimal duct obstruction who were failed probing in our hospital from September 2016 to September 2019 were selected as the research subjects. All patients underwent endoscopic-assisted RS silicone intubation. Regular follow-up was performed 1, 3, and 6mo after surgery. Observe the children's gender, age, treatment history, presence or absence of discharge before surgery; treatment effect; complications; types of nasolacrimal duct obstruction. Spearman's correlation coefficient calculation and analysis of the relationship between ages, times of probing and operation efficiency, Fisher's exact probability test for the operation efficiency of different types of nasolacrimal duct obstruction, and chi square test for the operation efficiency of presence or absence of discharge.<p>RESULTS: The total effective rate was 89.9%(142/158). The effective rate of surgery tends to decrease with age(Spearman's correlation coefficient <i>rs</i>= -1.000, <i>P</i><0.01). The effective rate of surgery showed a downward trend with the increase of the times of probing(Spearman's correlation coefficient <i>rs</i>= -1.000, <i>P</i><0.01). The efficiency of membranous nasolacrimal duct obstruction surgery is higher than that of complex nasolacrimal duct obstruction, and the difference is statistically significant(<i>P</i><0.05). It cannot be considered that there is a statistically significant difference in the effectiveness of the operation between the two symptoms with or without discharge(<i>P</i>>0.05). The main complications were: false passage formation(16 eyes, 10.1%), loss of tube(14 eyes, 8.9%), red eyes and irritated tears(18 eyes, 11.4%), punctums tissue adhesion(3 eyes, 1.9%), punctum granuloma formation(1 eye, 0.6%).<p>CONCLUSION: Endoscopic-assisted RS silicone intubation has a higher effective rate and better safety in the treatment of congenital nasolacrimal duct obstruction after failed probing in children. The effective rate of surgery decreases with age, and decreases with the increase of the times of probing. Membranous nasolacrimal duct obstruction is more effective than complicated nasolacrimal duct obstruction.

Short-Term Effect of Modified Kaijie Huatantang on Chronic Rhinosinusitis with Nasal Polyp Due to Qi Stagnation Phlegm Syndrome / 中国实验方剂学杂志

Objective:To observe the short-term effect of modified Kaijie Huatantang on chronic rhinosinusitis with nasal polyp due to qi stagnation phlegm syndrome. Method:A total of 90 cases were divided into control group and observation group，with 45 cases in each group. The control group was given mometasone furoate，and the observation group was given modified Kaijie Huatantang after nasal endoscopy surgery for 4 weeks. After treatment and follow-up for 1 years，the sino-nasal outcome test-20（SNOT-20），Lund-Kennedy and traditional Chinese medicine（TCM） syndrome were observed. The serum and nasal secretions tumor necrosis factor-alpha（TNF-<italic>α</italic>），interleukin（IL）-1<italic>β</italic>，IL-8，IL-17，eosinophilic cationic protein（ECP） and immunoglobulin E（IgE） were detected before and after treatment. The safety，clinical efficacy after treatment and follow-up for 1 years were compared between two groups. Result:After treatment and follow-up for 1 years，the total control rates were 97.7%，93.0% in observation group， which were higher than 87.8%，75.6% in control group（<italic>P</italic><0.05）. Compared with the control group after treatment and follow-up for 1 years，SNOT-20，Lund-Kennedy and TCM syndrome scores in the observation group decreased in the same period（<italic>P</italic><0.05）. Compared with the control group after treatment，the serum and nasal secretions TNF-<italic>α</italic>，IL-1<italic>β</italic>，IL-8，IL-17，ECP and IgE in the observation group were significantly decreased（<italic>P</italic><0.05）. The incidence of postoperative complications was 2.3% in the observation group， which was lower than 17.1% in the control group（<italic>P</italic><0.05）. The incidence of adverse reactions was 4.7% in the observation group， which was lower than 41.5% in the control group（<italic>P</italic><0.05）. Conclusion:Modified Kaijie Huatantang can significantly improve the short-term clinical efficacy of patients with chronic rhinosinusitis and nasal polyp due to Qi stagnation phlegm obstruction，with a low incidence of adverse reactions.

Nasal Endoscopy and Computed Tomography for Epistaxis of Clinically Inapparent Aetiology.

Epistaxis is one of the common otorhinolaryngological emergencies that are encountered in daily practice. Aetiology of epistaxis may range from benign conditions like septal spur, infected nasal polyps etc to serious causes like malignancies. Many a times, the cause for epistaxis is not found on anterior and posterior rhinoscopy. We wanted to assess the role of nasal endoscopy and computed tomography of paranasal sinuses (CT scan of PNS) among patients with epistaxis in whom the cause is not evident after history taking and clinical examination. MethodsThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. For patients included in the study, diagnostic nasal endoscopy under local anaesthesia was done and findings were noted. If any bleeding point was visualised on endoscopy, it was cauterised. In selected cases, endoscopic biopsy from nasal mass was done, and sent for histopathological examination. CT scan of PNS was done and findings were noted. ResultsIn the evaluation of patients with epistaxis of inapparent aetiology, nasal endoscopy could aid the diagnosis in 61.8% of patients, and CT scan of PNS in 81.8 % of patients. Statistical comparison of measure of agreement between nasal endoscopy and CT scan of PNS for diagnosis of epistaxis of clinically inapparent aetiology yielded a kappa value of 0.187 which can be interpreted as slight agreement. Sensitivity of nasal endoscopy and CT scan for diagnosing sinonasal neoplasms as compared to histopathological examination (gold standard) was 83.3% and 100% respectively. Both had an accuracy of 66.7% as compared to histopathological examination. Statistical comparison of measure of agreement between nasal endoscopy and CT PNS for diagnosing sinonasal inflammation yielded a kappa value of 0.391 which can be interpreted as fair agreement. ConclusionsFor evaluation of sinonasal neoplasm causing epistaxis, CT scan of PNS has higher sensitivity than nasal endoscopy. Subclinical sinonasal infection could be a triggering factor for epistaxis in older patients. Nasal endoscopy and CT scan of paranasal sinuses are important and complementary tools in the evaluation of epistaxis.

Clinicopathological Correlation of Sinonasal Masses with Pre-operative Computed Tomography Findings

Aim of the Study: The aim of the study was to study the clinical, radiological, and histopathological correlation of sinonasalmasses.Materials and Methods: This was a descriptive study conducted on 72 patients with sinonasal masses at Government T DMedical College, Alappuzha, over a period of 18 months from January 01, 2014, to June 30, 2015.Results: Age group was from 13 to 85 years with a male to female ratio of 1.3:1. Nasal obstruction was the most commonsymptom followed by nasal discharge and headache. Of the 72 cases, 59 belonged to the non-neoplastic group and 13 to theneoplastic group of sinonasal masses. Clinically, nasal polyp was the most common presentation. Sinonasal polyps (65.3%)formed the majority of the non-neoplastic lesions, vascular lesion (6.9%) was the most common benign neoplastic mass, andmalignancy was seen in 6.9% of cases. After clinical examination and computed tomography scan of the nose and paranasalsinuses, patients underwent surgery. Finally, clinical, radiological, and histopathology correlation of all the sinonasal masseswere done. The clinical diagnosis with computed tomography (CT) scan correlation was the same except in three cases andin one case with histopathology. Histopathology and CT scan result correlated well except in three cases. It was found thatthere was a significant association between the clinical, radiological, and histopathological diagnoses (P < 0.05) and that thesemodalities were complementary to each other. It was also possible to classify the lesions as non-neoplastic, neoplastic benign,and malignant using these modalities. This was important because even though initial presentation of these masses was similar,management of each of them varied significantly.Conclusion: Histopathology still remains the gold standard in the diagnosis of sinonasal masses, while CT scan is indispensablein studying the anatomical variants and providing the route map before and during endoscopic sinus surgeries.

Mucocele de cavidades paranasales / Sinus mucocele

Los mucoceles son quistes expansivos e indolentes de las cavidades paranasales. A pesar de ser lesiones benignas, tienen potencial destructivo local por su expansión crónica y cambios óseos. Su ubicación más frecuente es frontoetmoidal. Se postula que su origen es por alteración de la vía de drenaje de los senos. La clínica es dependiente de su ubicación: los mucoceles frontoetmoidales presentan aumento de volumen, cefalea o proptosis. Las imágenes juegan un rol importante en el diagnóstico, siendo la tomografía computarizada y la resonancia magnética los exámenes que detectan patrones sugerentes de mucoceles. El tratamiento es quirúrgico, donde el abordaje endoscópico ha desplazado al abierto por ser mínimamente invasivo, presentar menos comorbilidades y tener menor tasa de recurrencia.

Mucoceles are expansive and indolent cyst of the paranasal cavities. Despite being benign lesions, they have local destructive potential because of its chronic expansion and bony changes. Its most common location is frontoethmoidal. Alterations in the drainage pathway of sinus is thought to be the origin of mucoceles. The clinical features depend on the location. Frontoethmoidal often presents frontal swelling, headache or proptosis. Imaging plays an important part of diagnosis. Tomography and magnetic resonance have patterns that can suggest the presence of a mucocele. Paranasal sinus mucoceles are primarily treated surgically. The endoscopic surgical management has replaced the open resection because of its minimally invasive treatment, less morbidity and low recurrence rates.

Effect of Modified Huading Loulutang on Postoperative Recovery of Chronic Rhinosinusitis with Secretory Otitis Media Due to Toxic Heat Syndromes / 中国实验方剂学杂志

Objective:To observe the efficacy of modified Huading Loulutang on postoperative recovery of chronic rhinosinusitis with secretory otitis media due to toxic heat syndromes and the effect of eosinophil cationic protein (ECP), immunoglobulin E (IgE) and intercellular adhesion molecule-1 (ICAM-1) in serum, nasal secretion and otitis media. Method:According to the random number table method, 90 cases were divided into control group and observation group, with 45 cases in each group. All patients were given ceftriaxone sodium + hydroxymezoline after nasal endoscopy. In addition, control group was given Biyuan Tongqiao granule, while observation group was given modified Huading Loulutang for 6 weeks. Lund-Kennedy nasal assessment scale, traditional Chinese medicine symptoms and threshold of hearing at different frequencies were observed in two groups before and after treatment and during 6-week and 18-week follow-up visits. The levels of ECP, IgE and ICAM-1 in serum, nasal and ear secretions were detected before and after treatment. Clinical symptoms, adverse reactions and 12-month recurrence rate were compared. Result:Total control rate was 97.7% (43/44, 95%CI [95.6，98.6]) in observation group, which was higher than 78.6% (33/42, 95%CI [72.4，83.5]) in control group (χ2=6.946, P<0.05). During the 12-month follow-up visit, the recurrence rate was 4.5% (2/44, 95%CI [3.7，5.8]) in observation group, which was lower than 19.0% (8/42, 95%CI[16.8，21.3]) in control group (P<0.05). After treatment, Lund-Kennedy and traditional Chinese medicine symptoms score during 6-week and 18-week follow-up visits in observation group were significantly lower than those in control group (P<0.05). Hearing threshold in observation group at different frequencies was significantly lower than that in control group (P<0.05). ECP, IgE and ICAM-1 levels in serum, nasal and auricular secretions in observation group were significantly lower than those in control group (P<0.05). The incidence of adverse reactions was 6.8% (3/44, 95%CI [5.3，8.1]) in observation group, which was lower than 28.6% (12/42,95%CI [25.3，30.2]) in control group (P<0.05). Conclusion:Modified Huading Loulutang can significantly improve postoperative clinical symptoms of chronic rhinosinusitis and otitis media due to toxic heat syndromes with secretion, with a low recurrence rate and fewer complications.

Avoidance Of Nasal Pack By Routine Use Of Nasal Endoscope In Initial Management Of Epistaxis

Introduction - This study was undertaken with the objective to know whether routine use of nasal endoscope in initial management of epistaxis can help to control bleeding without the need of nasal pack so as to achieve targeted haemostasis with minimal discomfort. Material and methods- We conducted a cross sectional study enrolling 21 patients who were treated with nasal pack in other centers within less than 6 hours from onset of bleeding but were still bleeding and were referred to ENTdepartment of our hospital with nasal pack in situ. Deliberate search for bleeding point was made and tried to control bleeding by direct methods. Result- In 19 patients bleeding point was localized precisely whereas in 2 patients it was not. We controlled bleeding in 17 patients by chemical cautery or bipolar diathermy. In 2 patients repacking was done with medicated ribbon gauge as bleeding point could not be localized and bleeding was diffuse. Miniature pack of gelfoam was used to pack the inferior meatus in one patient. One patient had a bleeding polyp which was excised endoscopically and haemostasis achieved. Overall 19 patients (90.47 percent) were managed by various direct therapies in our study. Conclusion- It is expected that routine use of nasal endoscope in initial management of epistaxis will help in accurate identication and good control of bleeding avoiding discomfort and complication of nasal packing.

Clinical study of Medpor Titan implantation for orbital blowout fracture with nasal endoscopy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of reconstruction of orbital blowout fracture by conjunctival incision combined with Medpor Titan implantation under nasal endoscopy. <p>METHODS: Sixteen patients(16 eyes)diagnosed with orbital blowout fracture, include medial fractures, floor fractures and extended fractures, were performed reconstruction by transconjunctival approach with implant material- Medpor Titan under nasal endoscopic-assisted; observation of postoperative visual acuity, eyeball protrusion, extraocular movement limitations, diplopia, orbital CT, occurrence of implanted material rejection was taken. <p>RESULTS: A 3-month follow-up was performed and the therapeutic efficacies of anatomic and functional recovery were evaluated. No further vision loss or infection occurred postoperatively. In the 16 patients, the average postoperative observation was 3mo, enophthalmos were fully corrected, diplopia disappeared. Orbital(CT)did not reveal implant displacement and rejection postoperatively. <p>CONCLUSION: Endoscopic-assisted reconstruction of orbital blowout fracture by conjunctival incision combined with Medpor Titan implantation is a safe and effective surgical method with the characteristics of with direct operation, clear range of fracture exposure and safe and reliable operation, not only restores the patient's visual function and appearance, but also reduces the incidence of complications, avoiding postoperative facial scar.

Application of minimally invasive endoscopic optic nerve decompression in patients with traumatic optic neuropathy / 眼科新进展

Objective To analyze the application effects of endoscopic optic nerve decompression in patients with traumatic optic neuropathy and its effect on visual acuity.Methods From January 2014 to January 2016,100 patients (100 eyes) with traumatic optic neuropathy in our hospital were selected as observation objects.According to different treatment methods,the patients were divided into observation group and control group,50 cases in each group.The control group was treated with drugs,and the observation group with endoscopic sinus decompression of optic nerve on the basis of the control group after the stability of the disease.The patients in two groups were followed up at least 1 year.The clinical efficacy,visual acuity,VEP findings and incidence of adverse reactions were compared between the two groups.Results The effective rates in the observation group and control group were 76.0％ and 36.0％,there was significant difference between two groups (P ＜ O.05).In the observation group,the visual acuity of 16 eyes were improved in 22 eyes with no light perception,9 eyes in 13 eyes with light perception,9 eyes in 11 eyes with hand movement,and 4 eyes with finger counting were all improved;In the control group,the visual acuity of 6 eyes were improved in 20 eyes with no light perception,6 eyes in 14 eyes with light perception,5 eyes in 12 eyes with hand movement,1 eye in 4 eyes with finger counting.After treatment,the incubation period and amplitude of P1O0 in the observation group were (116.85 ±7.96) ms and (5.11 ± 1.16) μV,which were better than the control group (105.62 ±6.82) ms,(4.31 ± 1.25) μV.The incidence of adverse reaction in the observation group was significantly lower than that in the control group (P =O.000).Conclusion The endoscopic optic nerve decompression has a good application effect and safety in patients with traumatic optic neuropathy,can effectively improve the patient's visual acuity,help to improve the quality of life of patients,is worthy of clinical application.

Low temperature controlled plasma technology by nasal endoscopy in treatment of nasal vestibular cyst / 中国内镜杂志

Objective To compare the efficacy of low temperature controlled plasma technology by nasal endoscopy and cystectomy via labiogingival groove approach in treatment of nasal vestibular cyst. Methods 38 patients with nasal vestibular cyst from Jan 2013 to Nov 2016 were selected and randomly divided into control group (n = 20) and observation group (n = 18). The control group received cystectomy via labiogingival groove approach and the observation group received low temperature controlled plasma technology by nasal endoscopy. The time of surgery, bleeding volume in surgery, hospitalization, postoperative complications and relapse were collected and compared between the two groups. Results We found that the observation group have less surgery time than that in control group [(65.45 ± 27.51) vs (34.72 ± 17.61) min, P = 0.000], less bleeding volume in surgery [(22.35 ± 18.41) vs (3.17 ± 1.69) ml, P = 0.000), less postoperative complications [(6.35 ± 0.75) vs (3.61 ± 1.19) d, P = 0.000] and less postoperative complications (16 vs 1, P = 0.000), but relapse of the two groups have no statistical difference (1 vs 0, P = 0.783). Conclusions Low temperature controlled plasma technology by nasal endoscopy in treatment of nasal vestibular cyst have many advantages than cystectomy via labiogingival groove approach such as shorter time of surgery, less bleeding volume in surgery, shorter hospitalization and less postoperative complications. Therefore it's worth of applying clinically.

Comparison of two combined surgical methods in treatment of chronic dacryocystitis with upper lacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of two combined surgical methods in treatment of chronic dacryocystitis with upper lacrimal duct obstruction. <p>METHODS: Totally 68 cases(68 eyes)of chronic dacryocystitis with upper lacrimal duct obstruction were enrolled. They were randomly divided into Group A and Group B through random number table method, each group of 34 cases, Group A was treated with nasal endoscopic dacryocystorhinostomy combined with silicone tube implantation. Group B was treated with traditional dacryocystorhinostomy combined with silicone tube implantation. All patients were followed up for 1a. <p>RESULTS: In Group A, the total success rate was 82%, that in Group B was 79%. There were no significant difference between two groups' total success rate(<i>P</i>>0.05). The incidence of postoperative facial swelling in Group A was 6%. The facial scar incidence rate was 0. Those of Group B were 47% and 100%. The incidence of complications in Group A was significantly lower than that in Group B with significantly difference(<i>P</i><0.05). Rate of patients' satisfaction was 82% in Group A, and 59% in Group B, which of Group A was significantly better than group B(<i>P</i><0.05). <p>CONCLUSION: Canalicular intubation combined dacryocystorhinostomy using endoscopy is an ideal method in treatment of chronic dacryocystitis with upper lacrimal duct obstruction. It is safe, effective with less injury and less complication.

Effect of tympanostomy tube insertion or tympanocentesis on transnasal endoscopic adenoidectomy in the treatment of pediatric patients with secretory otitis media / 重庆医学

Objective To discuss the tympanic membrane puncture or tympanostomy tube under endotoscope combined with adenoidectomy under nasal endoscopy on the influence of invalid conservative treatment of pediatric secretory otitis media.Methods A total of 112 cases of secretory otitis media with invalid conservative treatment were selected in the department of otorhinolaryngology of children′s hospital of Nanjing Medical University from July 2013 to August 2015.They were divided into three groups,the group A of 38 cases(68 ears)underwent transnasal endoscopic pure adenoidectomy;the group B of 37 cases(60 ears)underwent transnasal endoscopic adenoidectomy combined with tympanocentesis;the group C of 37 cases(59 ears)underwent tympanostomy tube insertion.The clinical treatment effect,the period of middle ear effusion,postoperative recurrence and complication were observed and compared.Results The total effective rate of the 3 groups was improved after 3 months(P<0.05);the total effective rate in group B and group C at one week and 3 months after operation were higher than those of group A(P<0.05);and the total effective rate in group C at 3 months after operation was significantly higher than that of group B(P<0.05).The level of auditory brainstem evoked potential(ABR)and the latency of ABR wave Ⅰ latency were decreased at 1 year after operation(P<0.05);the ABR changes in group B and group C at 1 week and 1 year after operation were lower than those in group A(P<0.05).The incidence of recurrence rate and the period of middle ear effusion in group C were lower than those in group A and B(P<0.05).The incidence of complication of group A was lower than those of group B and group C(P<0.05).Conclusion Using tympanostomy tube combined with adenoidectomy under endoscope can improve the children with hearing,which not only can shorten the time of the middle ear effusion,but also effectively reduce the recurrence rate.