Paranasal Sinus Fungus Ball, Anatomical Variations and Dental Pathologies: Is There Any Relation?

Objective: The purpose of this study was to investigate the relationship between anatomical variations and the fungus ball (FB), and the association between odontogenic etiologies and the maxillary sinus FB. Methods: We analyzed the clinical records of 66 patients who underwent endoscopic sinus surgery for FB. The anatomical variations determined were nasal septal deviation (NSD) and direction, presence of Onodi and Haller cell, concha bullosa and lateral recess of the sphenoid sinus. Further, dental X-ray records were reviewed to detect any possible odontogenic etiologies in patients with maxillary sinus FBs. Results: There were 41 female and 25 male patients. Positive fungal culture was found in 60 patients (91%) and the causative fungus was Aspergillus species in all cases. The correlation between NSD and localization of the maxillary sinus FB was statistically significant (p=0.0409). Maxillary sinus FB was more common on the concave side of the NSD. Presence of dental pathologies was significantly associated with maxillary sinus FB compared to the healthy side (p=0.0011). For sphenoid sinus FB, NSD was detected in a similar number for both the affected and unaffected side and there were no significant correlations (p>0.05). However, the relationship between sphenoid sinus FB and presence of lateral recess was significant (p=0.0262). Conclusion: Our study revealed that the maxillary sinus FB was more common on the concave side of the deviated septum. Also, dental pathologies or a presence of dental treatment history were associated with maxillary sinus FB.

Evaluation of the factors affecting the necessity for revision surgery in choanal atresia.

OBJECTIVE: This study aims to compare the effects of different surgical techniques for congenital choanal atresia (CCA), and particular emphasis is given to the analysis of the factors affecting the surgical outcome. The necessity for revision surgery and surgical outcomes were retrospectively investigated in patients undergoing revision surgery according to a recently proposed classification system. MATERIAL AND METHOD: A retrospective study was conducted on patients operated for CCA between January 2007 and December 2018 at a university hospital. Data in the medical records, including patient age when the initial surgery was performed, gender, additional anomalies and medical conditions, the duration of gestation, side and type of atresia, type of surgery and need for revision surgery were reviewed. RESULTS: Forty-five patients treated for CCA in our university hospital were screened. The mean follow-up duration was 82.16 months. Revision surgery was required in 9 of 26 cases, which are included in the study (34.6%). Fourteen patients presented with bilateral CCA, while 12 were unilateral cases. Sixteen patients (61.5%) had comorbid medical conditions. While the removal of vomer and mucoperiosteal flap use affects successful surgical repair, no differences were observed in choanal atresia type, laterality, use of stent and the presence of additional medical conditions. CONCLUSION: The most important factors affecting surgical success for CCA are the removal of the vomer and closure of all bare bone tissues using a mucoperiosteal flap. Use of stents provides no additional benefit, apart from preventing synechiae formation.

The Simplified Nasal Septal Deviation Evaluation System and Nasal Obstruction Symptom Evaluation Scale Correlation.

Nasal septal deviation (NSD) is a common condition in otorhinolaryngology practice. The aim of this study was to investigate the possible relationship between localization and severity of NSD, and related complaints as well as to suggest a simplified assessment method for NSD. Seventy-five patients who complaint nasal obstruction were enrolled this study. The affected nasal cavity was divided into 4 separate sections as follows: antero-superior (AS), antero-inferior (AI), postero-superior (PS), and postero-inferior (PI). Each section was determined according to its relationship to the both superior edge and head of the inferior turbinate. The NSD score was calculated separately for each section according to its relationship with lateral nasal wall. The NSD-related complaints were assessed via the Nasal Obstruction Symptom Evaluation (NOSE) scale. There were 42 male and 33 female patients, with an age range of 18 to 44 years. The mean NSD score was 2.18 ±â€Š0.63 for AS section, 1.92 ±â€Š0.67 for AI section, 1.54 ±â€Š0.70 for PS section, and 1.18 ±â€Š0.60 for PI section. The mean total NSD score was 6.84 ±â€Š1.97 while the mean NOSE score was 12.5 ±â€Š5.11. There was a strong positive correlation between total NSD and NOSE scores when the NSD score was 6 or more (r = 0.9556). This correlation was also present when each section was evaluated separately. The strongest correlation was detected for AS section deviations. Our septal classification system provides a simple and effective evaluation of NSDs. The NSDs which affect internal valve are more related with nasal obstruction and patients' discomfort.

Paranasal sinus volumes and headache: is there a relation?

PURPOSE: The aim of the study is to investigate the relation between paranasal sinus volumes and headache in patients with no other rhinologic causes. METHODS: Two hundred patients with chronic headache and 99 subjects with no headache or facial pain history in the last 6 months were included in the study. Paranasal computed tomography (CT) scans of both patient and control groups were evaluated. Sixty one patients were excluded from the study due to possible rhinogenic headache CT findings such as secretions and contact points. Sinus volume index (SVI) formula created by Barghouth et al. in 2002 was used to calculate paranasal sinus volumes: SVI = ½. A × B × C. Mann-Whitney U test was used to compare an independent continuous variable and a continuous variable with non-normal distribution. RESULTS: In the patient group, the total sinus, frontal sinus, and maxillary sinus volumes were found to be significantly lower than those of the control group (p < 0.001). Although the total sphenoid sinus volume was found to be lower in the patient group, there was no significant difference between the two groups (p = 0.013). CONCLUSION: Although rhinogenic findings are often related to secondary headache, the relation between paranasal sinus volume and headache is scarcely investigated in the literature. Our study showed that paranasal sinus volumes might have a role in secondary headaches. Furthermore, in contrast to the literature, our study showed a significant relation between headache and smaller paranasal sinus volumes.