Efficacy of Normal Saline Nasal Spray Added to Standard Treatment Regimen of Chronic Rhinosinusitis: A Randomised Controlled Trial.

Chronic Rhinosinusitis is characterized by inflammation of lining of nose and paranasal sinuses leading to nasal blockage/discharge, facial pressure/pain and loss of smell sensation, generally treated with medical therapy initially. Nasal saline irrigation is one of the treatment modalities commonly used to improve symptoms. The aim was to evaluate efficacy of adding normal saline nasal spray to standard treatment regimen of chronic rhinosinusitis. A randomized, controlled, single blinded study with 40 chronic rhinosinusitis patients. Study group was prescribed Normal Saline nasal spray (1 puff in each nostril, thrice daily) along with topical corticosteroids (Mometasone furoate nasal spray, 1 puff in each nostril, twice daily; 1 puff = 50 µg), and oral antibiotics (Amoxicillin + Clavulanic acid, 30 mg/kg, twice daily), and the control group was only prescribed topical corticosteroids and oral antibiotics. Patients were evaluated using Lund-Kennedy endoscopic scores and Sino-Nasal Outcome Test before and after treatment. There was a significant improvement in LKES, with pre-treatment and post-treatment scores for control group being 5.35 ± 2.43 vs 3.70 ± 1.95 respectively (p = 0.0116), whereas for test group, pre-treatment and post-treatment scores were 8.15 ± 2.62 vs 6.05 ± 2.04 respectively (p = 0.0037). Improvement in SNOT-22 scores were observed as well, with pre-treatment and post-treatment scores for control group being 38.90 ± 12.01 vs 25.70 ± 9.21 respectively (p = 0.0002), whereas for test group, pre-treatment and post-treatment scores were 49.85 ± 11.38 vs 31.55 ± 9.91 respectively (p < 0.0001). The study suggests that there is additional benefit in usage of normal saline in form of symptomatic relief as well as clinical improvement.

Effect of Deviated Nasal Septum on Mean Platelet Volume: A Prospective Study.

Nasal obstruction due to Deviated Nasal Septum (DNS) is a commonly encountered condition by the Otorhinolaryngologist. This leads to chronic hypoxia which in turn leads to stimulation of platelets. This change can be assessed by estimation of the Mean Platelet Volume (MPV) which is a commonly available investigation while ordering a haemogram. As there is a lot of conflicting data about the relationship between DNS and MPV, this study was undertaken to evaluate if there is a relationship between these two parameters. A 1-year observational study was done and after adhering to the inclusion and exclusion criteria, there were 50 cases of deviated nasal septum and 50 controls who attended the ENT Out-Patient Department of a tertiary care hospital who were evaluated. Blood was drawn and the Mean Platelet Volume was estimated. It was found that there was no statistical significance between the cases and controls. Contradictory to other studies done in literature, our study did not find any correlation. This could be due to the type of septal deviation cases that were part of our study. Hence, multicentric studies with larger samples need to be studied in order to establish sound conclusions.

Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia.

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in post-tonsillectomy analgesia. Over a period of 1 year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24 h post operatively. Using Mann-Whitney non-parametric statistical test, inter-group analysis was done which showed highly significant p-value (<0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Anaerobic Bacteriological Microbiota in Surface and Core of Tonsils in Chronic Tonsillitis.

INTRODUCTION: Tonsillar infection may stem from bacteria within tonsillar crypts or parenchyma rather than from those on the surface. Pathogens isolated from surface culture may be colonizing the tonsil, but not essentially infecting it. Anaerobes though not often studied, are known to cause chronic tonsillitis. AIM: To study the correlation of anaerobic bacterial isolates in surface and core cultures from recurrently infected and inflamed tonsils. MATERIALS AND METHODS: A cross-sectional study was conducted in Charitable Hospital and Medical Research Centre, Belagavi from January 2014 to December 2014 on 100 patients of chronic tonsillitis who underwent tonsillectomy. Swabs were obtained from tonsil surface and core and analysed for anaerobes as per standard protocol. Chi-square test and Fischer-Exact test were used for statistical analysis. RESULTS: Twenty eight out of 63 (44.4%) patients had anaerobic growth on tonsil surface and 30 out of 62 (48.4%) patients had anaerobic growth in tonsil core. Porphyromonas sp. was the most common anaerobe isolated from the surface as well as from the core. There was no statistical significance between anaerobes isolated in the tonsil surface and core. CONCLUSION: Anaerobic organisms obtained from tonsil surface and core cultures were similar. A throat swab satisfactorily depicts the core organism and is reliable in recognizing the bacteriology of chronic tonsillitis. Anaerobic organisms known to inhabit the surface as well as the core of tonsils may be treated with suitable antibiotic therapy.