Endoscopic Resection of Pituitary Macroadenomas Extending Into the Nasal Cavity: A Case Report and Literature Analysis.

Pituitary macroadenomas are benign tumors that typically present with symptoms of hormonal imbalance or visual disturbances due to their location and size. However, in rare instances, these tumors can extend beyond the sellar region into the nasal cavity, leading to unusual clinical presentations. This case report describes a 63-year-old woman who presented with progressive nasal obstruction, episodes of dizziness, and occasional headaches. Physical examination revealed a large, firm mass in the nasopharynx. Nasal endoscopy and computed tomography (CT) imaging confirmed the presence of a pituitary macroadenoma measuring 7.3 x 4 x 4.9 cm, extending from the pituitary gland through the sphenoid sinus into the nasal cavity. The tumor did not affect the optic chiasm despite its significant size, as evidenced by normal visual field tests. The patient underwent successful endoscopic transnasal resection of the tumor, a minimally invasive procedure that allowed for complete removal with minimal morbidity. Postoperative recovery was uneventful, and follow-up imaging showed no residual tumor. The patient reported a significant improvement in symptoms, particularly the resolution of nasal obstruction and headaches. Histopathological examination confirmed the diagnosis of a pituitary macroadenoma. This case highlights the rare presentation of pituitary macroadenomas as nasal masses and emphasizes the importance of considering this diagnosis in patients with atypical nasal symptoms. The successful outcome following endoscopic transnasal surgery demonstrates the effectiveness of this approach in managing complex pituitary adenomas with extensive extracranial extension.

Recent Advances in Allergic Rhinitis: A Narrative Review.

Allergic rhinitis (AR) is a prevalent chronic respiratory condition characterized by nasal inflammation, sneezing, congestion, and itching, significantly impacting quality of life. Over recent years, considerable advancements have been made in understanding the pathophysiology, diagnosis, and management of AR. This narrative review aims to synthesize these recent developments, providing a comprehensive overview of key areas. Emerging insights into AR pathophysiology have elucidated the complex interplay between genetic predisposition, environmental factors, and immune system dysregulation. Notably, the role of the epithelial barrier and the microbiome in AR pathogenesis has garnered increasing attention, offering potential targets for novel therapies. Advances in diagnostic technologies, such as component-resolved diagnostics and molecular allergology, have enhanced the precision of allergy identification, enabling more personalized treatment approaches. In terms of management, significant progress has been made in pharmacological and non-pharmacological treatments. Novel biologics targeting specific pathways involved in AR, including monoclonal antibodies against immunoglobulin (Ig)E and interleukin (IL)-4/13, have shown promise in reducing symptoms in refractory cases. Additionally, there has been a resurgence in interest in non-pharmacological strategies, including allergen avoidance, immunotherapy, and complementary therapies, which offer holistic options for patient care. The integration of digital health tools and mobile applications in AR management has further empowered patients, allowing for real-time symptom tracking and personalized treatment adjustments. Recent guidelines emphasize a multidisciplinary approach to AR management, promoting integrated care models that involve collaboration between allergists, primary care providers, and other specialists. These guidelines also highlight the importance of patient-centered care, advocating for shared decision-making and tailored treatment plans based on individual patient profiles. In conclusion, the landscape of allergic rhinitis management is rapidly evolving, with ongoing research and innovation paving the way for improved outcomes. This review underscores the importance of staying abreast of these advances to optimize the care and quality of life for individuals affected by allergic rhinitis.

Improvement in health-related quality of life questionnaires with biologic treatment in severe asthma and comorbid chronic rhinosinusitis with or without nasal polyposis: a real-life experience.

BACKGROUND: Patients with severe asthma frequently have comorbid chronic rhinosinusitis (CRS) with or without nasal polyps, that can increase the symptom burden and complicate treatment. Real-life clinical data on the impact of biologic treatments on CRS-specific quality-of-life questionnaires are still lacking. MATERIALS AND METHODS: In this retrospective real-life study, we collected data from patients with severe asthma with comorbid CRS with/without nasal polyposis at baseline, and after 3, 6 and 12 months of treatment with omalizumab, mepolizumab, benralizumab or dupilumab. In particular, we evaluated improvements in HRQoL as measured by SinoNasal Outcome Test-22 (SNOT-22, 0 - 110), Visual Analog Scale symptom scores (VAS, 0-10), and Asthma Control Test (ACT, 5-25) and the proportion of patients meeting the minimal clinically important difference (MCID). RESULTS: Disease-specific HRQoL, as measured by SNOT 22 and VAS score improved in all patients at 3, 6, and 12 months of treatment compared with baseline (SNOT-22: 14, IQR: 0-52 vs 10, IQR:0-30 vs 0, IQR:0-15 vs 0, IQR:0-12, p < 0.001, VAS score: 1, IQR: 0-5 vs 0, IQR:0-3 vs 0, IQR:0-2 vs 0, IQR 0-1, p < 0.001). After 3 months of treatment >80% of patients reached the MCID for ACT, while only patients on dupilumab showed to reach a MCID in 100% of cases. The effect size depended upon the symptom burden at baseline. CONCLUSIONS: The study confirms the efficacy of omalizumab, mepolizumab, benralizumab, and dupilumab in a real-life setting, with a rapid improvement in CRS-specific HRQoL and general health status. These data highlight the importance of targeting type 2 inflammation in asthmatic patients with co-existing upper and lower airways disease.The Authors disclose that preliminary data and analysis of the present study have been presented in abstract form during the "X International Workshop on Lung Health - Respiratory Disease and Immune Response", held in Nice on 19-21 January 2023.

S100A9 induces tissue remodeling of human nasal epithelium in chronic rhinosinusitis with nasal polyp.

BACKGROUND: Chronic inflammation triggers tissue remodeling in human nasal epithelial (HNE) cells. S100A9, a protein secreted by inflammatory cells, exhibits potent proinflammatory activity. However, its effect on HNE cell remodeling, such as squamous metaplasia, remains unclear. Therefore, this study aimed to determine the effects and underlying pathways of S100A9 on HNE cell remodeling and investigate its clinical implications in chronic rhinosinusitis (CRS). METHODS: Cultured HNE cells were treated with S100A9. Bulk RNA sequencing was performed to analyze gene ontology (GO). Ingenuity pathway analysis (IPA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were also analyzed. Additionally, immunohistochemistry and multiplex immunofluorescence were performed on tissue samples obtained from 60 patients, whose clinical informations were also reviewed. RESULTS: GO enrichment analysis indicated that S100A9 induced tissue remodeling in HNE cells toward squamous metaplasia. IPA and KEGG commonly showed that S100A9 affected HNE cells associated with the IL-17 signaling pathway, including target molecules such as matrix metalloproteinase 1 (MMP1) and small proline-rich protein 2A (SPRR2A). Squamous metaplasia with a marked expression of S100A9 was observed in 50% of CRS with nasal polyps (CRSwNPs). In addition, in multiplex immunofluorescence, the S100A9 in sub-epithelium was co-expressed with myeloperoxidase, a neutrophil marker, and MMP1 and SPRR2A were strongly expressed in epithelial remodeling. Clinically, the expression of S100A9 correlated with sino-nasal outcome test-22 (r = 0.294, p = 0.022) and Lund-Mackay scores (r = 0.348, p = 0.006). CONCLUSION: S100A9 induces tissue remodeling in HNE cells. Its increased expression in CRSwNP, particularly squamous epithelium, correlates with disease severity. This suggests the clinical potential of S100A9 as a biomarker for CRS severity.

Case Report: "Navigating the Narrow Path: Unveiling a Nasal Septal Abscess in a Neonate".

Nasal septal abscess in a newborn is a rare condition. This case report describes a case of nontraumatic, nasal septal abscess in a newborn baby with no evidence of sinusitis or other localized trauma/ infections. A 15-day-old newborn was admitted to a tertiary care hospital with a history of nasal blockage and swelling of the nasal septum. Physical examination revealed a fusiform swelling involving the nasal septum. The patient underwent Diagnostic Nasal Endoscopy with Incision and Drainage followed by 48-hour nasal packing. Neonates being obligate nasal breathers, after drainage, due to the bilateral nasal packs, the otolaryngology and paediatric team had to find a way to make the neonate breathe and swallow simultaneously. The neonate showed gradual improvement following nasal pack removal and had a normal nasal airway on follow-up at 14 days and one-month post-drainage. Even though the septal abscess in neonates is a rare entity however, it can significantly compromise the nasal airway in an obligatory nasal breather, and with limited space for intervention also poses a challenge in managing the condition.

Comparative Study on Finger Gloves Nasal Packing Vs Merocel Nasal Packing After Intranasal Surgery: Randomized Controlled Trial.

Nasal packing is one of the common procedures done following various intranasal surgeries in order to prevent the various complications that can arise post-operatively. Some of the complications noted include bleeding from the nose, septal hematoma, septal abscess and formation of mucosal adhesions. There are different types of nasal packing materials available. Few of the commonly used nasal packing material are ribbon gauzes impregnated with antibiotics, merocel, gel foam, glove fingers and Vaseline gauze. This study compared the effectiveness of Merocel nasal packing with Glove finger nasal packing after Septoplasty and Polypectomy. Merocel, a widely used expandable non-absorbable material, was compared with conventional ribbon gauze packs inserted into glove fingers. Results showed no significant differences in post-operative bleeding, pain, discomfort, mucociliary clearance, or late complications between the two groups. However, a slightly earlier return of mucociliary clearance in patients packed with Glove finger nasal packs was observed. Therefore, it can be concluded that both Merocel and Glove finger nasal packs are equally effective in managing post-operative complications following these procedures.

Oral and Nasal Myiasis in Two Patients Hospitalized in the Intensive Care Unit: Diagnosis and Clinical Significance of Cases.

Myiasis is a disease caused by fly larvae from the Diptera order settling in various tissues and organs of humans or animals. To report the diagnosis of myiasis larvae invading the oral and nasal cavities of patients in the management of intensive care units and to draw attention to the poor hygiene situation. A 78-year-old male patient diagnosed with cancer and a 93-year-old male patient diagnosed with ischemic cerebrovascular disease were followed up in the intensive care unit. On the 21st day of the cancer patient's hospitalization, eight larvae were removed from the oral cavity. In the first month of the other patient's hospitalization, six larvae were seen in the patient's nasal osteum near the feeding tube. A clinical diagnosis of myiasis was made and the larvae were initially manually removed for treatment, followed by medication. In conclusion, myiasis is a rare condition, but good hygiene, correct diagnosis, and treatment are necessary to prevent further harm to those who have risk factors such as immunosuppression, poor hygiene, malnutrition, diabetes, and peripheral vascular disease, particularly those who are hospitalized. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04767-9.

Angiectatic Polyp-An Unusual Nasal Mass in a Young Adult.

Angiectatic nasal polyps (ANP) are rare pseudo-neoplastic lesions that might raise intriguing pathophysiological issues and present a significant diagnostic challenge. They are also referred to as inflammatory granuloma telangiectaticum, vascular granuloma, pseudo-angioma, and angiomatous/angiectatic polyp. However, the name angiectatic polyp refers to the fact that the lesion is not a true tumour and is clinically distinguished by ectatic vasculature, haemorrhage, and persistent proliferation. The most confusing aspect of this polyp is its clinical appearance, which resembles a juvenile nasal angiofibroma. Despite its typical imaging characteristics, this lesion is difficult to differentiate radiologically. Hence, histopathology is paramount for establishing diagnosis. We report a rare case of a young adult who presented with complaints of nasal block and epistaxis. Examination revealed a vascular nasal mass and CT scan demonstrated the lesion to be epicentred in right nasal cavity extending to multiple sinuses with adjacent bone erosion. Patient underwent endoscopic excision of the mass with JNA as the predominant differential and only following histopathological examination, the final diagnosis was confirmed.

Treatment Outcome Post Endoscopic Sinus Surgery(ESS) in Patients with Chronic Rhinosinusitis (CRS).

Chronic rhinosinusitis (CRS) is one of the most prevalent conditions in medicine causing a considerable amount of healthcare expenditure. This study was performed to clinically diagnose chronic rhinosinusitis with or without polyps and to measure the intensity of patients' symptoms and treatment outcomes. This was a prospective cohort study, which included 70 patients diagnosed with CRS according to the EPOS-2012 and were given SNOT-22 questionnaire preoperatively, which was repeated on 1st, 4th, and 12th weeks post-op to determine the treatment outcome. Patients were divided into three groups according to their predominant histopathological features and the treatment outcomes were assessed based on SNOT-22 scoring system. According to our study, ESS effectively raised the quality of life for CRS patients, and one week after surgery, there was a significant improvement in total symptoms (from 49.01 ± 14.83 to 21.91 ± 8.88). it was noted that there was a decrease in SNOT-22 scores at various intervals from baseline to week 12. The four subscales of the SNOT-22 test (rhinological symptoms, ear and facial symptoms, sleep function, and psychological difficulties) showed significant improvements in quality of life across all groups, and this relationship extended beyond the relationship with rhinological symptoms. These improvements were statistically significant after three months of post operative medical therapy. SNOT-22 is determined to be reliable and convenient to use. After ESS, all of the symptoms in our study showed a drop in SNOT-22 scores from week 1 to week 12, indicating an improvement in overall symptoms. Therefore, it can be used to monitor the success of surgical intervention in addition to medicinal therapy.

Prevalence of Chronic Rhino Sinusitis in Patients with Concha Bullosa.

This study aims to investigate the prevalence of chronic rhino sinusitis in patients with concha bullosa, a common anatomical variation characterised by pneumatization of the middle turbinates. Chronic rhino sinusitis is an inflammatory disorder of the paranasal sinuses and the linings of the nasal passages that lasts for 12 weeks or longer. The incidence of chronic rhino sinusitis was assessed among patients with diagnosed concha bullosa, focusing on the presence of symptoms, and severity. There seems to be a strong relationship between concha bullosa and the development of chronic rhino sinusitis To screen the patients of concha bullosa for chronic rhino sinusitis. To find out of the percentage of chronic rhino sinusitis in patients with concha bullosa. To determine the sinuses affected and their respective sides. This is a retrospective study to investigate the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. The study was conducted at Vydehi institute of medical science and research centre, Whitefield, Bangalore and the data from 01/02/23 to 01/09/23 were analyzed. Medical records of patients with diagnosed concha bullosa were identified through electronic medical records and imaging databases (CT scan paranasal sinuses). Inclusion criteria consisted of patients with a confirmed diagnosis of concha bullosa based on radiological imaging (CT scans) and clinical assessment.Exclusion criteria: patients with previous sinus surgeries and malignancy. The study's methods focused on retrospectively assessing the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. In the above study it is concluded that concha bullosa plays major role in development of chronic rhino sinusitis. Thus after confirming the presence of concha bullosa practitioner should keep in mind the possibility of development of chronic rhino sinusitis.

Nasal Extranodal NK/T Cell Lymphoma with Orbital Involvement: A Rare Entity of Common Presentations.

Nasal Extranodal NK/T Cell Lymphoma is an aggressive tumour affecting the nasal and midline structures, causing surrounding tissue destruction as the result of its progression. The initial presentations are similar to symptoms of benign nasal polyps, such as nasal obstruction, hyposmia and nasal discharge. As the disease progresses, the involvement of the palate, paranasal sinuses, orbit and skin become alarming symptoms. We report a case of a young male with Nasal ENKTL who presented with symptoms similar to acute on chronic rhinosinusitis with orbital complications. The challenges of diagnosing and getting to the correct management pathway are discussed.

Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function.

Endoscopic endonasal Trans-sphenoidal surgery for sellar-suprasellar tumors is considered the preferred route. The ideal instruments in skull base surgery should be able to manipulate adequately through the narrow corridors with effective tissue removal and bleeding control and reduce collateral damage to nearby vital structures. The present study sought to compare the nasal morbidity following transnasal sphenoidal surgery for pituitary macroadenoma using Coblation and Electrocautery. 160 undergoing Endoscopic TSS for non-functioning PAs were enrolled. The patients were randomly allocated into Coblation (n = 80) and electrocautery (n = 80) groups. All operations were performed by the same group of surgeons skilled in their surgical techniques. There were 59 and 53 patients with Knosp grade II tumors in the cautery and coblation group, respectively, while 21 and 27 patients had Knosp grade III tumors. The average duration of surgery using cautery was 96+/-4.5 min, while with coblation, the average time was 83+/-3.5 min, and the difference was statistically significant. Nasal crusting and granulation severity were observed more in the electrocautery group. The coblation group patients had clear surgical fields with few ooze points; the difference between the two groups was significant. Nasal synechiae and decreased nasal patency were common in the electrocautery group. There were no statistical differences in nasal bleeding, nasal deformity, or sense of smell parameters. Advanced medical tools like coblation are safe and effective for the dissection and ablation of the mucosa. They result in better intra-operative visualization and lesser postoperative nasal morbidity, which will help patients achieve a better quality of life.

Adult Thornwalt Cyst: A Rare Case Report.

Nasopharyngeal cysts are rare benign entity, smaller in size and usually asymptomatic. They are mostly diagnosed incidentally on MRI. Larger cysts commonly presents with spasmodic and obstructive symptoms. Thornwaldt cysts are congenital cysts originating from the mid- line of the nasopharynx just above the upper border of the superior constrictor muscle. They represent primitive communication between notochord remnants and the pharyngeal endoderm. We report this case because of its unique presentation in a 35 year old male. Patient presented with nasal blockage, nasal discharge, snoring, ear pain and aural fullness, intermittent neck pain and neck stiffness. Preoperative evaluation included diagnostic nasal endoscopy (DNE) and Magnetic resonance imaging (MRI-scan). A large cystic mass of size 2.8 cm × 3 cm was diagnosed on DNE and MRI. Transnasal Marsupialisation and excision of the cyst was planned using powered instruments. Post operatively, patient noticed marked improvement in the obstructive symptoms. Regular follow up was done 6 monthly for 2 years. No recurrence was noted on DNE. Although a rare pathology in adulthood, it should be kept as a differential diagnosis for cervical pain and neck stiffness.

Clinical Study and Management of Epistaxis.

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion.

The Use of Botulinum Toxin for Nasal Esthetics: A Systematic Review.

Physical attractiveness is commonly evaluated based on facial appearance, with the nose being the most noticeable feature. Botulinum toxin injection is a less invasive method for enhancing nasal esthetics, which can address minor nasal imperfections through relaxing muscles. To fully understand the uses of botulinum toxin in the nose area, a thorough review of the available information is necessary. We aimed to conduct a systematic review of literature to evaluate the effects and clinical application of botulinum toxin for nasal esthetics. We searched PubMed, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up until May 2023 to identify studies investigating the use of botulinum toxin for cosmetic enhancement in the nose area. Data was extracted from the selected studies regarding the baseline characteristics, type of botulinum toxin used, dosage, injection site, and outcomes. Initially, 1139 articles were found and 23 articles were included. The studies showed the usage of botulinum toxin can correct drooping nasal tips, dilated nostrils, minor post-rhinoplasty deformities, and high columellar show. It can also augment nasal dorsum, improve cleft lip-related deformities, and address other disorders related to the function and appearance of the nose. Botulinum toxin injection seems to be a safe and effective treatment option for individuals seeking to correct minor nasal defects. Further large-scale studies are recommended.

Bilateral Choanal Atresia in 24 Years Old Woman: A Case Report.

Background: Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence. Case Presentation: A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana. Conclusion: Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment.

Olfactory Function and Surgery of the Lateral Nasal Wall - Systematic Review.

This study aimed to comprehend the influence of surgery on the lateral nasal wall, primarily focusing on the inferior turbinates, and its impact on olfactory function. A systematic review was carried out utilizing electronic databases like PubMed, Cochrane (including various registers and databases), and Web of Science. No restrictions were imposed on publication year or language. The PRISMA criteria guided study selection, and predefined inclusion and exclusion criteria were employed. Risk of bias assessment for randomized controlled trials (RCTs) utilized the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)," while Hawker et al. scale evaluated the quality of non-RCT studies. The review encompassed nine studies after rigorous selection and bias assessment. All studies unanimously demonstrated improved olfactory function following surgery on the inferior turbinate. Different surgical techniques and olfactory assessment methods were employed across studies. Evaluation encompassed pre- and post-surgery olfactory measurements. Most studies employed the Visual Analogue Scale (VAS) and commercial smell test kits (like Sniffin' Stick Test). The Nasal Obstruction Symptom Evaluation (NOSE) scale was used in two studies, and the butanol threshold test in one. Olfactory improvement was measured through enhanced patient numbers or nasal cavities, often expressed via VAS scores. One study utilized both patient count and VAS scores. A few studies also employed NOSE scale and olfactory threshold measurements. All studies consistently concluded that olfactory function post-surgery was superior to preoperative measures. The collective evidence strongly suggests that surgery on inferior turbinates has a positive impact on olfactory function, as indicated by the studies reviewed. Nonetheless, for a comprehensive understanding of surgical efficacy, future research should incorporate randomized controlled trials featuring control groups. This would facilitate the establishment of optimal surgical techniques for specific indications and the formulation of practical guidelines.

Prevalence of Obstructive Sleep Apnoea in patients with primary nasal and nasopharyngeal pathologies.

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations.

Intraorbital Foreign Body- Endoscope Assisted Removal.

Intraorbital wooden foreign body is uncommon in patients with orbital trauma, and if present its complete surgical removal at the earliest is of utmost importance to avoid significant complications. We report an interesting case of an intraorbital wooden foreign body that was succesfully removed using a nasal endoscope.

A Giant Encephalocele Mimicking Nasal Polyp - A Case Report.

Encephaloceles are most commonly seen in children and rarely in adults. Spontaneous encephaloceles comprises of 3 - 5% of all CSF leaks. A huge encephalocele may be misdiagnosed as Polyp. Here we are sharing our experience of clinical presentation of an 46 year old male adult who was referred to ENT OPD with recent history of seizures, history of intermittent rhinorrhea, and nasal obstruction. On further radiological evaluation spontaneous encephalocele was noted in the left nasal cavity and was managed by Endoscopic CSF leak repair with DRAF 2 procedure.