Background: Chronic rhinosinusitis (CRS) is a prevalent health problem that results in a large costly burden in society is often associated with the role of the microbiome that seems to maintain a healthy state and stability of the sinonasal environment often viewed as a symbiotic system. Aim and objective: This study aimed to identify a microbiome profile in chronic rhinosinusitis with and without nasal polyps of Indonesian population. Materials and methods: This study was conducted using the case-control technique on 20 patients divided into two groups. The first group is CRS without nasal polyps consisted of 10 patients and the second group is CRS with nasal polyps consisted of 10 patients. All of the samples were examined by next-generation sequencing techniques. Results: Microbes were detected in all samples. Actinobacteria, Bacteroidetes, Cyanobacteria, Firmicutes, Fusobacteria, and Proteobacteria were the dominant phylum in both groups with a variable number of percentages. Conclusion: This study highlights alteration of the commensal microbe may lead to dysbiosis conditions of the sinonasal environment.

Background: The fungal ball is a common type of fungal rhinosinusitis. The fungal ball appears to be unstructured caseous masses revealed during the surgical treatment. Aim and objective: To analyze the contents of the paranasal sinuses in 168 patients with the clinically suspected fungal ball who had undergone functional endoscopic sinus surgery (FESS). Study design: A total of 168 patients aged between 19 and 63 with fungal ball clinical diagnosis admitted to the ENT Department of Rostov State Medical University, Russia, were involved in the study between January 2009 and July 2018. Materials and methods: Tissue samples obtained from the affected sinuses underwent microscopic, microbiological, and histopathological examination. Results: Fungi presence was confirmed in 148 out of 168 patients. In 20 cases, the presence of fungi in the caseous masses, obtained during the operation, was not revealed by any diagnostic method, and in 19 out of 20 patients, different types of bacteria were detected in diagnostically significant titers, most often Bacteroides spp.—in five patients, Staphylococcus spp.—in five patients, Pseudomonas aeruginosa—in three patients, two cases of Klebsiella pneumoniae, and two cases of Actinomyces spp. To characterize such findings, the term “bacterial ball” by analogy with the “fungal ball” was earlier suggested. Conclusion: Caseous masses found during sinus surgery is often considered to be a clinical diagnosis validation. Meanwhile, the said caseous masses may not only manifest a fungal disease, but also bacterial colonization, which determines the postoperative treatment.

Aim and objective: A case report with review of the literature. Background: Pott's puffy tumor is an uncommon complication of frontal sinusitis. Nevertheless, an increase in the frequency of cases has been reported over the last 10 years. The presence of both frontal sinuses in the production of Pott's puffy tumor has never been described before. Case description: A 15-year-old boy was evaluated in the emergency department by tumor and pruritus at the right frontal level. A computed tomography (CT) scan revealed a disruption of the right frontal sinus with a subperiosteal abscess. During surgery, it was discovered the involvement of both frontal sinuses. A combined bilateral functional endoscopic sinus surgery and external approach were used. Conclusion: This pathology must be kept in mind in the case of an adolescent patient with a frontal tumor. Surgery is the most important factor in the treatment of this pathology together with a targeted antibiotic treatment.

The world of rhinology has smelt and dealt with a steadily increasing number of allergic fungal rhinosinusitis cases that were initially mistaken for chronic rhinosinusitis. Although both group of patients present similarly, the allergic fungal counterpart does not respond to conventional medical therapy. We report a case of a young gentleman who combated chronic rhinosinusitis for years before undergoing functional endoscopic sinus surgery which yielded an extremely rare fungal pathogen, Nodulisporium species, clinching the diagnosis of allergic fungal rhinosinusitis. Operative intervention was key to definitive diagnosis and treatment for this case. We discuss the challenges and methods used in identifying Nodulisporium, the surgical approach, and procedures performed in treating this condition.

Actinomycosis is a gradually evolving infection caused by bacteria of genus Actinomyces. Cervicofacial involvement is the most common presentation and palatal involvement is very rare. Presented below is the case report of a 79-year-old diabetic and hypertensive female who presented with nonhealing ulcer over the hard palate for 10 months, which enlarged and formed a large oroantral fistula within 4 months. Following the diagnosis of actinomycosis by histology, complete debridement and removal of necrotic tissue was done. She was treated with intravenous crystalline penicillin 6th hourly for 4 weeks and was discharged on oral amoxicillin for 12 months with regular follow-up. Only four cases of actinomycosis hard palate have been reported in English literature so far.

Aim and objective: To report a case of multiple epidermoid cysts of the tonsil with actinomycosis in a 56-year-old female patient who presented with discomfort in the throat. Background: The Actinomyces spp. are common saprophytic microorganisms, which are found in the oral cavity, pharynx, and palatine tonsils. The actinomycotic infections can be responsible for recurrent chronic tonsillitis. Epidermoid cysts are benign lesions that can be encountered anywhere in the body, usually seen in neck, chest, or trunk. Case description: This study reports a case of multiple epidermoid cysts of the tonsil with actinomycosis in a 56-year-old female patient presented to our ENT outpatient department with discomfort in the throat and presence of a few whitish masses over her right tonsil, which was her major concern. She underwent a tonsillectomy followed by a course of antibiotic for 3 weeks; the diagnosis was confirmed by histology. Conclusion: Though tonsillitis is the commonest lesion diagnosed in all age groups, histopathology plays an important role in diagnosis of various other non-neoplastic and neoplastic lesions of tonsil. There might be existence of two separate clinical entities in a single case, one being the causative factor of another. Clinical significance: Our results indicate that actinomycetes may play an active role in the etiology of the epidermoid cyst of the tonsillar tissue. The clinical importance of recognizing this organism lies in the fact that definitive treatment requires a long course of penicillin group antibiotics even after surgical excision. To the best of our knowledge, this is the first case report in the English-indexed literature.