An International Journal of Otorhinolaryngology Clinics

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2019 | January-April | Volume 11 | Issue 1

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Editor's Speak

Bachi T Hathiram, Vicky S Khattar

“Rhinology Un-revisited”

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/aijoc-11-1-iv  |  Open Access |  How to cite  | 


Original Article

Lokman Saim

No Difference in Clinical Outcome between Middle Turbinate Resection vs Inferior Turbinoplasty in Patients with Rhinitis

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:4] [Pages No:1 - 4]

   DOI: 10.5005/jp-journals-10003-1324  |  Open Access |  How to cite  | 


Introduction: To date, there is no optimal surgical management for rhinitis. Current techniques include inferior turbinate resection or turbinoplasty (ITP), septoplasty, and submucosal resection. Middle turbinate resection (MTR) at present is used as part of endoscopic sinus surgery to prevent adhesions and recurrent disease. In this study, the outcomes of MTR and ITP were compared via peak nasal inspiratory flow (PNIF), sinonasal outcome test-22 (SNOT-22), and visual analog scale (VAS) in patients with rhinitis. Materials and methods: In a prospective study, 22 consented patients with rhinitis from the otolaryngology head and neck surgery outpatient clinic were selected and underwent surgery. Twelve patients had MTR and 10 patients had ITP with a 6-month follow-up. Patients were evaluated pre- and postoperatively via PNIF, SNOT-22, VAS, and endoscopic examination. Results: Both treatment groups showed statistically significant improvements (p < 0.01) in PNIF, SNOT-22, and VAS scores postoperatively in early and late follow-up when compared preoperatively. There was a median increase of 57–58% in PNIF, a decrease in SNOT-22 scores by 53–80%, and a decrease in 64–78% VAS scores at the 6-month follow-up. There were no significant differences between scores when comparing the MTR and ITP groups. ITP group had more early postoperative bleeding compared to the MTR group (p < 0.05) and a few patients from the ITP group complained of intermittent long-term epistaxis. Conclusion: Middle turbinate resection was observed to be as effective as ITP to reduce the signs and symptoms of rhinitis and has a lower morbidity of postoperative bleeding.



Shruti Tandon, Vijay Giridher, Akash Juneja

Symptomatic Septal Deviation: Its Nasal Endoscopy and Computed Tomography-aided Correlation with Chronic Rhinosinusitis

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:4] [Pages No:5 - 8]

   DOI: 10.5005/jp-journals-10003-1325  |  Open Access |  How to cite  | 


Aim: To evaluate the nasal septal deviation by measuring the angle of deviation and study its relation with sinus diseases and lateral nasal wall anomalies, by diagnostic endoscopy (DNE) and computed tomography (CT), in patients of chronic rhinosinusitis (CRS). Materials and methods: A prospective study was carried out on 90 patients with nasal complaints and deviated septum, attending the Department of Otorhinolaryngology, from January 2015 to August 2016. Patients were diagnosed to have CRS clinically and were subjected to DNE and CT scans. The maximum angle of septal deviation was calculated in coronal cuts. The side and sites of rhinosinusitis and lateral wall anatomical variants were identified. Results: The prevalence of CRS was 73%, with males more affected than females (1.8:1). Left-sided and C-shaped DNS were most common. Fifty-two percent patients suffering from CRS had septal angle of deviation between 7° and 12°, and 46% had more than 12°. Maxillary sinus was the most commonly involved sinus. Concha bullosa (32%) was the most common variant noted. Occurrence of medialized uncinate process was found to be increasing on the ipsilateral side of deviated septum with increasing angle of deviation. Conclusion: In patients with chronic sinusitis, most of the angles were deviated between 7° and 12°. The mean deviation was 12.92°. Majority of patient with chronic rhinosinusitis had a concurrent variation along with the deviated nasal septum. No correlation was found between the side of deviated nasal septum and side of maxillary sinusitis. No correlation was noted between the anatomical variants of lateral nasal wall with increasing angle of deviation. Clinical significance: Our study emphasizes the multifactorial etiology behind CRS with plausible role of genetic factors, environmental influence, allergic factors, and hormonal influence, etc., in its causation.



Dhaneshwor N Singh, Kanwar Sen, Arun K Sharma, Meenakshi Bharadwaj

Sinonasal Teratocarcinosarcoma: Is Minimally Invasive Resection Followed by Adjuvant Histology-directed Chemoradiation a Better Alternative to Radical Excision? A Case Report

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:9 - 11]

   DOI: 10.5005/jp-journals-10003-1320  |  Open Access |  How to cite  | 


Sinonasal teratocarcinosarcoma (SNTCS) is a rare, highly malignant tumor arising from primitive embryonic sinonasal tissue or immature pluripotential cells occurring almost exclusively in the sinonasal tract. It is an aggressive tumor with a high propensity for locoregional recurrence and mortality. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. In view of its aggressive behavior, radical excision with or without chemoradiation is advocated as the optimum treatment. Here we share our experience of SNTCS in a 23-year-old man managed with endoscope assisted craniofacial resection followed by histocytology-directed chemotherapy with external beam radiation. He remains disease-free in the last 3 years of follow-up.



Vishal Vasant Jain, Harish Khatakdhond, Kunzang Bhutia

Nasal Schwannoma Presented as External Nasal Swelling: A Rare Case Presentation

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:12 - 14]

   DOI: 10.5005/jp-journals-10003-1328  |  Open Access |  How to cite  | 


Introduction: Nasal schwannomas are very rare neoplasms. According to the literature, half of the schwannoma cases occur in the head and neck areas and only <4% occur in the sinonasal tract. So far, only a few cases have been reported. Case description: We present the case of a 50-year-old man who had dorsal nasal deformity at the root of nose since 5 months. Complete excision of mass was performed by giving dorsal incision through external approach under local anesthesia. Here, we discuss the clinical and pathological aspects of schwannomas arising at dorsum of nose. Conclusion: Although schwannoma of the nose is extremely rare, the possibility of their existence should be realized and included in the differential diagnosis of any dorsal nasal mass.



Sílvia Alves, Nélia Ferraria, Mário Santos

Surgical Management of Traumatic Cerebrospinal Fluid Fistula in a Child with Recurrent Meningitis

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:4] [Pages No:15 - 18]

   DOI: 10.5005/jp-journals-10003-1332  |  Open Access |  How to cite  | 


Aim: To report a case of a child with recurrent meningitis in which cerebrospinal fluid (CSF) leak diagnosis was established and treated by an extracranial approach. Background: The diagnosis and management of pediatric posttraumatic CSF leak can be challenging. Untreated leaks can be manifested by intermittent rhinorrhea or recurrent meningitis, which can be the only form of presentation. Case description: A 15-year-old girl had a past medical history of a fall from the second floor at the age of 8, which resulted in traumatic frontal sinus fracture. She had her first episode of pneumococcal meningitis at the age of 14 which led to the diagnosis of posttraumatic CSF fistula. External surgery was performed to repair the fistula, with no evidence of CSF rhinorrhea on postoperative examination. She was readmitted at the age of 15 years for a new episode of pneumococcal meningitis. The high-resolution computed tomography scan revealed an anterior and posterior wall defect of the right frontal sinus. An extracranial approach was performed with visualization of CSF trickling through the defect. Dural regeneration matrix and fascial graft were positioned on the defect, and fibrin glue was used. Frontal sinus obliteration was performed using hydroxyapatite with success. Conclusion: The basic principles of pediatric CSF fistulas repair, such as an adequate exposure of the defect, do not differ from those of the adults. The successful repair of CSF leaks results in a preoperative correct identification of the fistula and bone defect site, an accurate knowledge of reconstruction techniques, and their judicious application in the procedure planning. Clinical significance: This report documents a case of a child with recurrent meningitis as the only symptom of a CSF fistula as a consequence of a traumatic fall 7 years earlier. The CSF leaks’ etiology, current diagnostic techniques, and surgical management are discussed.



Vineet Kaul, Biswajyoti Hazarika, Manish Julaha, Nandini Hazarika, Shilpi Modi

Desmoid Fibromatosis of the Right Maxilla in an Infant: A Case Report

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:19 - 21]

   DOI: 10.5005/jp-journals-10003-1321  |  Open Access |  How to cite  | 


Desmoid fibromatoses are rare benign tumors that arise from the musculoaponeurotic tissues. They are locally aggressive and invade surrounding structures. We report a case of desmoid fibromatosis of the right maxilla in a 10-month-old male baby. This site of occurrence of desmoid tumor in an infant has not been reported previously in literature. Using Weber–Ferguson incision, wide excision with right upper alveolectomy was done to remove the tumor. Adjuvant chemotherapy consisting of a weekly regimen of vinblastine and methotrexate was given to achieve locoregional control and prevent disease recurrence.



David Temmermand, Andriy Pavlenko, Tasos Aslanidis

Recurrent Epistaxis: The First Hemorrhagic Chondro-osseous Respiratory Epithelial Adenomatoid Hamartoma (COREAH) Reported in the Literature

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:22 - 23]

   DOI: 10.5005/jp-journals-10003-1326  |  Open Access |  How to cite  | 


Chondro-osseous respiratory epithelial adenomatoid hamartomas (COREAHs) are benign entities that are rarely present within the nasal cavity but to date have only been identified in nasal polyp-like masses. This report represents the first case published with a COREAH causing epistaxis. Although these are benign lesions which are nearly 100% curable with simple surgical excisions, they remain rare and are not commonly thought of in the differential of nasal masses or as hemorrhagic lesions. Further, the patient reported here is the oldest reported and has a unique presentation.



Puneeth S Nayak, Samanvaya Soni, Manasi B Manure, Tejaswini J Suresh

Rhinolithiasis: An Unusual Misdiagnosed Entity

[Year:2019] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:24 - 26]

   DOI: 10.5005/jp-journals-10003-1329  |  Open Access |  How to cite  | 


Aim: To assess the usefulness of endoscopy in the initial visit for nasal obstruction in the outpatient department. Background: Rhinolith as the name suggests is stone formation in the nose. They are formed by gradual deposition of calcium and magnesium salts in a manner to encrust an endogenous (thick mucus, blood clot, and ectopic teeth) or exogenous (seed and cotton fiber) nidus of origin. The first documented case of the pathology was reported by Barthdinin in 1654. Since it is a slow-growing entity, it remains asymptomatic for a long period and often comes to light with presentation of unilateral nasal obstruction, foul smelling nasal discharge, cacosmia, and epistaxis. With its ability to cause rhinosinusitis and bony erosions of septum, lateral nasal wall, and hard palate, they are typically misdiagnosed. Case description: A young patient came with the history of nasal obstruction on the left side for the past 1 year. There was an intermittent history of a yellow, thick, foul-smelling, blood-stained nasal discharge. Nasal endoscopic examination revealed an irregular, dark, stony mass covered with secretions confirming a rhinolith, which was removed piecemeal. Conclusion: Considered as the cause of nasal obstruction and cacosmia, and many a times present in patients who have nasal complaints, delay in the diagnosis and treatment should be avoided. Rigid nasal endoscopy is the most important method to be used in diagnosis and treatment of rhinolith. Clinical significance: Presentation of rhinolith and diagnostic dilemma are discussed in this article so as to enable the attending clinician to be aware of this still prevailing condition and to prevent complications, such as oroantral and oronasal fistulas, septal perforation, palatal perforation, bony destruction of the maxillary sinus, frontal osteomyelitis, and epidural abscess.


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