Orbital and Intracranial Complications of Acute Rhinosinusitis in a Tertiary Center, Saudi Arabia.

Background Rhinosinusitis is an inflammatory condition affecting the nasal cavity's mucosa and paranasal sinuses. In rare cases, acute rhinosinusitis (ARS) might lead to significant orbital and intracranial complications. This study aims to review the patients who presented with orbital or intracranial complications of ARS and to identify the main outcomes of these complications and their prognosis. Methods In this study, a retrospective chart review of patients with orbital or intracranial complications of ARS who presented to the otolaryngology department at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 2016 to 2022 was conducted. Results A total of 43 patients with orbital, intracranial, or both (orbital and intracranial) complications of ARS were included. The most involved sinuses were maxillary sinuses. The most reported orbital complications were subperiosteal abscesses, and the most reported intracranial complications were epidural abscesses. Conclusion Orbital and intracranial complications of ARS are serious and life-threatening if not recognized early and treated effectively. The majority of ARS complications in this study were orbital complications. Fortunately, most of the cases carry a favorable outcome.

Bilateral enlarged concha bullosa: a case report and literature review.

Concha Bullosa (CB) is a common sinonasal anatomical variant, which commonly extends into the middle turbinate. Generally, patients presenting with CB are asymptomatic and often incidentally diagnosed with a non-contrast computed tomography scan of the paranasal sinuses. In cases of extensive pneumatization, large CB may cause significant signs and symptoms-commonly, headaches, nasal obstruction, and hyposmia. With only a few reported cases of large CB in the literature; we herein, report a rare case of an unusually massive bilateral CB that resulted in complete obstruction of the left nasal cavity and partial obstruction of the right nasal cavity, in addition to a review of relevant literature.

Predictors and Time Interval of Chronic Rhinosinusitis Recurrence After Endoscopic Sinus Surgery.

Objective: Chronic rhinosinusitis (CRS) is a common inflammatory disease that significantly impacts the quality of life. Endoscopic sinus surgery (ESS) is indicated for refractory CRS. This study aims to estimate the predictors of CRS recurrence, and the rates with time intervals of recurrent CRS and revision ESS. Methods: A retrospective cohort study included 516 patients who underwent ESS for CRS at King Abdulaziz Medical City in Riyadh between January 2017 and May 2020. Patients were followed up for 12-48 months postoperatively. The study sample was divided into two groups based on the recurrence status and compared using the appropriate statistical tests. Significant variables were included in the logistic regression model to determine the predictors of CRS recurrence. Results: The recurrence rate of CRS following ESS was 14.5%, with a time interval of 28.31 months, and standard deviation (SD) =18.76. On the other hand, the rate of revision ESS for recurrent CRS was 6.8%, with a time interval of 34.18 months, SD =16. In the multivariable logistic regression model, the significant predictors of recurrent CRS were a high Lund-Mackay (LM) score [odds ratio (OR): 1.055, p=0.04] and a high eosinophil count (OR: 3.619, p=0.03). Almost half of the patients who developed recurrent CRS underwent revision surgery (46.7%). Conclusion: CRS has a considerable recurrence rate despite the high success rate of ESS, and nearly half of the recurrent CRS patients need revision surgery. A high LM score and eosinophilic count significantly increase the likelihood of CRS recurrence.

Endoscopic transorbital management of frontal sinus mucocele: a case report and review of the literature.

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

Cerebrospinal fluid leak post COVID-19 nasopharyngeal swab for a patient with idiopathic intracranial hypertension: a case report.

Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 is an infectious disease that led to a global pandemic. In this article, we reported a case of a young women who is known to have idiopathic intracranial hypertension, with iatrogenic skull base injury from a nasopharyngeal swab. Her case was complicated by meningitis.

Concha Bullosa of the Inferior Turbinate: Report of Two Cases.

Concha bullosa (CB) is defined as pneumatization and the presence of air cells within the nasal turbinates. Inferior concha bullosa (ICB) is a rare anatomical variation of the lateral nasal wall, with only a handful of case reports published in the literature to date. In this article, we present two additional cases of ICB and a review of the literature regarding this rare anatomical variation.

Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review.

INTRODUCTION: The middle turbinate (MT) is the most important anatomical structure inside the nasal cavity and a landmark in the identification of skull base, ethmoid cells, and lamina papyracea. Postoperatively, lateralizationof the MT can cause synechia and obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses. OBJECTIVE: To review the current literature about the outcome of different techniques used intraoperatively to prevent lateralization of MT after functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS: This retrospective narrative literature review provides a summary of current and past research publications about different techniques used intraoperatively to prevent MT lateralization after FESS. RESULTS: Many methods have been described to prevent the lateralization of MT and synechiae formation. These methods include controlled synechiae, suture lateralization, metal clips, partial resection of MT, middle meatus implants, and steroid-eluting implants and stents. CONCLUSION: The ideal FESS should include preservation of the MT, reducing its lateralization, and preventing synechia formation.Different techniques have been discovered in an attempt to prevent this complication.

Intranasal lobular capillary hemangioma: A series of five cases.

BACKGROUND: Lobular capillary hemangiomas (LCH) are acquired benign vascular lesions of the skin and mucous membranes mostly affecting the head and neck region. Involvement of the nasal cavity is extremely rare and can manifest as epistaxis and nasal obstruction. CASE SERIES: In this case series, we present five cases of intranasal LCH. Three cases are of pregnant women that presented with epistaxis and nasal obstruction. The first was surgically treated during her pregnancy with preoperative embolization of the tumor for vascular control, while the other two patients were treated after delivery. The two other cases are of a post trauma pediatric patient, and an elderly lady with multiple co-morbidities, both presenting with recurrent nose bleeds and nasal obstruction. Surgical excision was performed with no complications observed post-operatively. DISCUSSION: The etiology of LCH is unknown, but certain predisposing factors have been associated with the development of LCH and include pregnancy and trauma. The anterior portion of the nasal septal mucosa and the tip of the inferior turbinate are commonly involved sites. Computed tomography scans and histopathology are used to diagnose LCH. Treatment is surgical excision with or without pre-operative embolization. CONCLUSION: LCH are rare tumors of the nasal cavity. Treatment of these lesions is surgical with or without preoperative vascular control.

Recurrence Pattern and Complication Rate of Allergic Fungal Sinusitis: A 10-Year Tertiary Center Experience.

BACKGROUND: Allergic fungal rhinosinusitis is a noninvasive form of highly recurrent chronic rhinosinusitis. Despite the advancement in medical and surgical strategies, recurrence in AFRS in general poses another challenging problem with reported incidence that eventually can reach more than 60%. Recognition and understanding the pattern of disease recurrence will lead to greater understanding of the disease response in our population. METHOD: A retrospective cohort study was performed in King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with chronic rhinosinusitis and underwent functional endoscopic sinus surgery from the period of January 2006 to December 2016 were reviewed. RESULTS: 28 patients were found to have AFRS based on clinical, radiological, and microscopic examination suggestive of allergic fungal rhinosinusitis. Among these patients, 53% of them were female and 46% were male. The age ranged from 13 to 55 years, with a mean age of 31.57 years. 28.57% of the patients presented with recurrent allergic fungal sinusitis. The duration between the surgery and symptoms recurrence was around one year. Male and female patients had similar recurrence rate (50%). At first visit, 95% of the patients with nonrecurrent disease presented with nasal obstruction compared to 87.5% of the patients with recurrent disease. On the other hand, patients with recurrent disease had more nasal discharge (87.5%), postnasal drip (37.5%), facial pressure/pain (50%), headache (50%), nasal polyposis (87.5%), hypertrophy of inferior turbinate (37.5%), and proptosis (12.5%). Nasal obstruction (87.5%) and nasal polyps (87.5%) were the most common presenting symptoms for the disease recurrence. The pattern of disease recurrence in the previously unilateral disease was 18% ipsilateral and 27% bilateral. For the patients who had bilateral disease formerly, 17% (n = 3) of them had recurrent bilateral disease. CONCLUSION: Allergic fungal rhinosinusitis is a distinct clinical entity. A high recurrence rate is a pathognomonic feature of the disease, despite all the development in medical and surgical trials. This study demonstrated that recurrence rate is lower in our population. However, more studies with a greater number of patients are needed in the future to clearly recognize the pattern of recurrence in patients with AFRS.

Atropine toxicity caused by erroneous intranasal administration in a pediatric patient: case report.

A 28-month-old boy mistakenly received intranasal atropine sulfate instead of Otrivin (xylometazoline hydrochloride) for the treatment of adenoid hypertrophy. Later on, he came to the emergency department with anticholinergic manifestations after the administration of multiple drops. The child presented with a tonic-clonic seizure lasting for a few minutes, followed by a brief loss of consciousness, vomiting, agitation, and irritability, all of which were stabilized by a dose of intravenous lorazepam. Subsequently, he was admitted to the pediatric intensive care unit for observation. Afterwards, he developed agitation and unsteady gait, both of which resolved after receiving neostigmine. Eventually, the child became asymptomatic and was discharged home. To the best of our knowledge, only one similar case has been reported in the literature. SIMILAR CASES PUBLISHED: 1.

Acute profound sensorineural hearing loss as the initial manifestation of Hairy Cell Leukemia, Case Report and literature review.

INTRODUCTION: Hematologic diseases are rarely present with sudden hearing loss as an initial symptom. Although the precise cause of sudden sensorineural hearing loss has not been identified, several pathophysiological mechanisms have been proposed. However, a variety of hematologic diseases are among the causes of sudden onset deafness. This article represents the first reported case of Hairy cell leukemia (HCL) which presented with acute unilateral profound sensorineural hearing loss as an inital mainfestation. PRESENTATION OF CASE: A 41-year-old man presented with unilateral sudden hearing loss for one day's duration was found to have HCL during a worked up for his hearing loss. The disease worsened, and there was no improvement in his hearing. DISCUSSION: Sudden sensorineural hearing loss can rarely be seen as a paraneoplastic occurrence.Very few cases have been reported in the literature. It has been reported as a presenting symptom of leukemia in numerous clinical and histopathological reports concerning the hearing loss in hematologic diseases. Our case is an example of such a rare incidence. CONCLUSION: The purpose of this study is to draw physicians' attention to the possible association between acute sensorineural hearing loss to HCL, and to highlights permanent deafness as a complication secondary to HCL. Furthermore, it is important to increase awareness on early diagnosis and treatment that may improve treatment outcomes.

Intranasal endoscopic identification of the nasal septal L-strut: a cadaveric study.

BACKGROUND: Preserving the L-shaped strut during septoplasty is a crucial step in the prevention of several types of postoperative nasal deformities. In this study, we aimed to identify the intranasal anatomic landmarks to establish reliable and feasible measurements to preserve an adequate L-strut during an endoscopic septoplasty. METHODS: A prospective study was conducted on 20 cadaver heads. Three measurements were studied within each side of the nasal cavity. The dorsal strut (DS) was measured from the dorsal line to the septal dorsum edge. Then, the caudal strut was measured from 2 different landmarks: the axilla of the inferior turbinate (CSIT) and the pyriform aperture (CSP). RESULTS: We examined a total of 40 nasal cavities from 20 cadavers. The DS showed an average length of 15.1 mm (standard deviation [SD], 3.2 mm). The average lengths of the CSIT and CSP were 23.6 (SD, 3.6) mm and 19.4 (SD, 2.7) mm, respectively. CONCLUSION: Suggested landmarks to identify the dorsal and caudal struts in endoscopic septoplasty are the axilla of the middle turbinate and pyriform aperture bone, respectively. The utilization of the inferior turbinate axilla as a caudal strut landmark showed larger variability and would potentially leave excessive caudal cartilage that could be manipulated if deviated.

Intranasal Lobular Capillary Hemangioma with Multiple Sites of Origin during Pregnancy: A Case Report and Literature Review.

In the present case report, we describe a 33-year-old pregnant woman in the third trimester with a history of recurrent epistaxis leading to frequent visits to the emergency department. Each episode of epistaxis was managed by anterior nasal packing. During endoscopic examination, a left nasal mass was seen. She was admitted and managed conservatively until she delivered her baby without complication. After delivery, a CT scan was taken, which showed an enhancing mass in the middle and lower meatus of the nasal cavity with no bony erosions. For symptomatic relief and tissue diagnosis, endoscopic surgical removal was advised. An intraoperative examination revealed a red, smooth, and well-circumscribed mass occupying the left nasal cavity and originating from the medial surface of the inferior turbinate and the inferior surface of the posterior part of the middle turbinate. A complete en bloc resection of the mass was performed endoscopically. The mass was sent for histologic analysis, which confirmed the diagnosis of lobular capillary hemangioma. Eventually, upon follow-up at two weeks, one month, three months, and six months postsurgery, no evidence of recurrence was detected.

Safety of intranasal corticosteroid sprays during pregnancy: an updated review.

INTRODUCTION: Rhinitis and rhinosinusitis are commonly encountered in pregnant women. Intranasal corticosteroid (INCS) sprays are generally safe and effective in the treatment of these conditions in the general population. However, the use of some of these INCS sprays during pregnancy is still controversial. OBJECTIVE: To review the current literature about the safety of intranasal corticosteroid sprays during pregnancy. METHODOLOGY: Using different search engines, each type of INCS was reviewed separately (triamcinolone, beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, mometasone, and ciclesonide). A total of 51 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, a total of three articles were reviewed. RESULTS: No significant association with congenital organ malformations has been linked to intranasal use of beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, or mometasone. Intranasal triamcinolone, however, has been found to have a significant association with respiratory tract defects. Data about the safety of intranasal ciclesonide during pregnancy are not available. CONCLUSION: Lacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation. Intranasal fluticasone propionate might be a safe option in the absence of other INCS options due to its questionable efficacy during pregnancy. Risk-benefit ratio should always be considered before prescribing any intranasal corticosteroid sprays during pregnancy.

Oronasal fistula post-septoplasty.

Nasal septal surgery is one of the most common otolaryngology procedures performed, with rare occurrences of major postoperative complications. Oronasal fistula is a rare complication of septal surgery, with only few cases being reported in the literature. It is commonly caused by a congenital cleft palate, cleft palate surgery, traumatic injuries, infections, or neoplasms; however, it does not usually occur post-septal surgery. Here, we report the case of a 55-year-old male who presented with a symptomatic oronasal fistula post-septoplasty. Unlike other reported cases, there were no features of underlying palatal pathologies, and no previous history of other nasal or oral procedures. We described a multilayer surgical closure technique that was utilized in this case, with no recurrence seen during a 6-month follow-up period. Additionally, we reviewed the other 3 reported cases of this complication, and discussed the possible etiology in this case.