Impact of habitual marijuana and tobacco smoke on severity of chronic rhinosinusitis.

PURPOSE: Health concerns around cannabis (marijuana) use have focused on the possible relationship with psychosis and lower airway health, however; the effect of cannabis smoking on upper airway health has received less attention. The aim of this study is to investigate difference between exclusive tobacco cigarettes smoking compared with tobacco plus cannabis smoking regarding severity of chronic rhinosinusitis (CRS). MATERIAL AND METHODS: A prospective cross-sectional study with two groups of CRS patients recruited (Group 1: tobacco cigarettes smokers; 100 patients and group 2: tobacco cigarettes smokers and also cannabis users; 100 patients). Recruitment occurred in a general practice in Egypt. Cannabis use was recorded by self-report. Severity of CRS was assessed and compared between 2 groups using SNOT-20 questionnaire, Lund-Mackay CT score and Lund-Kennedy (LK) endoscopy Score. RESULTS: Group 2 patients (tobacco plus cannabis smokers) had significantly higher mean of assessment cores (SNOT-20 (P = 0.005), Lund-Mackay CT score (P = 0.006) and Lund-Kennedy (LK) endoscopy Score (P = 0.005)). Group 2 patients also had significantly higher mean of facial pain/pressure, difficulty sleep, and wake at night, lack of sleep, wake up tired, fatigue, reduced productivity, reduced concentration, frustration/restless/irritable, sad and embarrassed compared to patients in group 1. CONCLUSION: Adult patients who smoked tobacco cigarettes plus cannabis mixed with tobacco had greater health related quality of life burden and more severe CRS compared to patients who smoked tobacco cigarettes only.

Pulmonary Function of Patients with Chronic Rhinosinusitis and the Impact of Endoscopic Sinus Surgery.

OBJECTIVE: The aim of this study was to compare pulmonary function tests (PFTs) among control subjects and patients with chronic rhinosinusitis (CRS) and to investigate the outcomes of endoscopic sinus surgery (ESS) on PFTs among patients with CRS. STUDY DESIGN: Prospective study conducted from June 2015 to June 2016. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: The study is based on 2 groups: adult control subjects (group 1, n = 25) and adult patients with medically resistant CRS (group 2, n = 25). PFTs were used to compare the lower airway condition between the groups. Another comparison in PFTs was made among patients with CRS at 1 week preoperatively and 1 month postoperatively to evaluate the effectiveness of ESS. RESULTS: In group 1, all subjects had an FEV1/FVC ratio ≥80% (forced expiratory volume in 1 second / forced vital capacity) with a mean of 0.84 ± 0.07, as compared with group 2, from 61% to 70% for 5 (20%) patients, 71% to 79% for 10 (40%), and ≥80% for 10 (40%). FEV1/FVC was significantly lower in group 2 than group 1 (P = .04). At 1 month postoperatively, the FEV1/FVC values of group 2 was from 61% to 70% for 2 (8%) patients, 71% to 79% for 13 (52%), and ≥80% for 10 (40%). The mean FEV1/FVC was 0.9 ± 0.50, and these values were significantly higher (P = .02) when compared with preoperative values. CONCLUSION: This study provides objective evidence that patients with CRS may have nonmanifest lower airway affection when compared with control subjects and that ESS is efficacious in the improvement of such affection.

Topical mitomycin C as an adjunct to surgical debulking and medical treatment in rhinoscleroma.

BACKGROUND: Rhinoscleroma is a chronic granuloma that is endemic in Egypt and is caused by gram-negative bacilli (Klebsiella rhinoscleromatis). The nasal mucosa is affected in almost all cases, which causes nasal obstruction, anosmia, and epistaxis. The disease usually passes through an atrophic stage (atrophic rhinitis) and a granulomatous stage before ending in the fibrotic stage, with possible bone destruction. OBJECTIVE: This study assessed the effect of topical mitomycin C (MMC) on reducing the recurrence of granulation tissue and intranasal adhesions after endoscopic debulking and continuous medical treatment of nasal rhinoscleroma. MATERIALS AND METHODS: This double-blind randomized clinical trial was performed with 30 patients who had rhinoscleroma (granulomatous and fibrotic stages). At the end of endoscopic debulking, meshes impregnated with MMC was placed in one nasal cavity for 5 minutes, while another meshes impregnated with saline solution were placed in the opposite side. Repeated meshes with MMC were placed in the same side during the follow-up period. Patients were followed up for 1 year. The recurrence of granulation tissue and the degree of intranasal adhesions were recorded and compared according to the Lund-Kennedy score. RESULTS: At 12 months' follow-up, among the total 30 patients, 30 MMC sides were compared with 30 control sides: 69% of MMC sides versus 32% of control sides had no recurrence of granulation tissue (p = 0.01) and 65% of MMC sides versus 24% of control sides had no recurrence of intranasal adhesions (p = 0.03). The Lund-Kennedy score decreased from 2.1 ± 0.64 to 0.8 ± 0.41 and from 2.3 ± 0.33 to 1.9 ± 0.20 in the MMC sides and control sides, respectively, with a nonstatistically significant lower incidence of intranasal adhesions in the MMC sides. CONCLUSION: Topical MMC may reduce granulation tissue and intranasal adhesion formation in patients with rhinoscleroma. Further studies with a larger number of samples and longer follow-up periods are recommended.

Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage.

IMPORTANCE: The main objective in the treatment of chronic otitis media is to relieve drainage and to rehabilitate hearing. Various materials can be used to repair the tympanic membrane (TM) through different tympanoplasty techniques. OBJECTIVE: To assess the results of endoscopic type I tympanoplasty in pediatric patients using tragal cartilage as a grafting material. DESIGN, SETTING, AND PARTICIPANTS: In this prospective study, we studied 80 ears in 80 pediatric patients (ages, 5-17 years) who had undergone type I tympanoplasty from January 2011 to December 2013 at a tertiary referral hospital. We classified our patients into a younger group (≤10 years; n = 40) and an older group (>10 years; n = 40). Patients were followed for up to 6 months. INTERVENTIONS: Endoscopic type I tympanoplasty using split-thickness tragal cartilage. MAIN OUTCOMES AND MEASURES: We identified the following criteria for success: (1) healing of the TM (anatomical success) and (2) improvement in hearing by assessing the change in the air-bone gap (ABG). We also assessed the mean operation duration and the different prognostic factors. RESULTS: Healing of the TM healing occurred in 34 patients (85%) in the younger group vs 36 patients (90%) in the older group. Both groups had notable improvement compared with the preoperative measurements, with no significant differences between the 2 groups. Thirty patients (75%) in the younger group had improvement in their ABG vs 32 patients (80%) in the older group, with a mean ABG of 8.0 dB and 10.5 dB in the younger and older groups, respectively. Both groups had significant functional success with no significant differences between the 2 groups. Sixty patients (75%) displayed a type A tympanogram at their 6-month postoperative audiometric testing (28 patients in the younger group vs 32 patients in the older group). There were no statistically significant differences regarding the anatomical and functional success between the patients who had previously undergone adenotonsillectomy and the other patients. The mean (SD) operation duration was 55.03 (2.50) minutes. CONCLUSIONS AND RELEVANCE: In pediatric patients undergoing type I tympanoplasty, the endoscopic approach using the tragal cartilage as a grafting material resulted in successful anatomical and functional outcomes that are in comparable to other techniques but with a shorter operation duration. Age of the patient, auditory tube dysfunction, and previous adenotonsillectomy were not prognostic factors for this procedure.

The value of intranasal splints after partial inferior turbinectomy.

To assess the value of using the intranasal septal splint after partial inferior turbinectomy (PIT) surgery. Prospective, randomized comparative study. The study was conducted over a period of 2 years from January 2012 to January 2014 at Minia University hospital, Minia, Egypt. A total of 100 patients underwent bilateral PIT. They were randomly divided into 2 groups. Group A included 50 patients had PIT with intranasal splints and group B included 50 patients had PIT without splints. A comparison was made between the 2 groups regarding the postoperative pain, degree of nasal obstruction and the degree of tissue healing and adhesions formation at 2 time points (2 and 4 weeks postoperatively). At 2 weeks postoperatively: visual analogue score (VAS) for the pain was 5 in group A versus 2.1 in group B (P = 0.01), VAS for nasal obstruction was 6 in group A versus 5 in group B (P = 0.328), 70 % of patients had good healing in group A versus 24 % in group B (P = 0.02). At 4 weeks postoperatively: VAS for the pain was 1.5 in group A versus 1.8 in group B (P = 0.423), VAS for nasal obstruction was 7 in group A versus 6 in group B (P = 0.353), 80 % of patients had good healing in group A versus 54 % in group B (P = 0.03). The use intranasal septal splints after PIT without septal surgery can cause increased postoperative pain in the short term follow-up period with significant evidence of decreasing rates of intranasal adhesions.

Topical mitomycin C as an adjunct to surgical debulking and medical treatment in rhinoscleroma.

BACKGROUND: Rhinoscleroma is a chronic granuloma that is endemic in Egypt and is caused by gram-negative bacilli (Klebsiella rhinoscleromatis). The nasal mucosa is affected in almost all cases, which causes nasal obstruction, anosmia, and epistaxis. The disease usually passes through an atrophic stage (atrophic rhinitis) and a granulomatous stage before ending in the fibrotic stage, with possible bone destruction. OBJECTIVE: This study assessed the effect of topical mitomycin C (MMC) on reducing the recurrence of granulation tissue and intranasal adhesions after endoscopic debulking and continuous medical treatment of nasal rhinoscleroma. MATERIALS AND METHODS: This double-blind randomized clinical trial was performed with 30 patients who had rhinoscleroma (granulomatous and fibrotic stages). At the end of endoscopic debulking, meshes impregnated with MMC was placed in one nasal cavity for 5 minutes, while another meshes impregnated with saline solution were placed in the opposite side. Repeated meshes with MMC were placed in the same side during the follow-up period. Patients were followed up for 1 year. The recurrence of granulation tissue and the degree of intranasal adhesions were recorded and compared according to the Lund-Kennedy score. RESULTS: At 12 months' follow-up, among the total 30 patients, 30 MMC sides were compared with 30 control sides: 69% of MMC sides versus 32% of control sides had no recurrence of granulation tissue (p = 0.01) and 65% of MMC sides versus 24% of control sides had no recurrence of intranasal adhesions (p = 0.03). The Lund-Kennedy score decreased from 2.1 ± 0.64 to 0.8 ± 0.41 and from 2.3 ± 0.33 to 1.9 ± 0.20 in the MMC sides and control sides, respectively, with a nonstatistically significant lower incidence of intranasal adhesions in the MMC sides. CONCLUSION: Topical MMC may reduce granulation tissue and intranasal adhesion formation in patients with rhinoscleroma. Further studies with a larger number of samples and longer follow-up periods are recommended.