An International Journal of Otorhinolaryngology Clinics

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2022 | May-August | Volume 14 | Issue 2

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar

Editors' Speak

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/aijoc-14-2-iv  |  Open Access |  How to cite  | 



Chander Pal, Jagdeep S Thakur, Ravinder S Minhas, Madhuri Dadwal, Ramesh K Azad, Anamika Thakur

Advantageous Hyaluronic Acid in Endoscopic Dacryocystorhinostomy

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:47 - 49]

Keywords: Chronic dacryocystitis, Endonasal dacryocystorhinostomy, Hyaluronic acid, Success rate

   DOI: 10.5005/jp-journals-10003-1428  |  Open Access |  How to cite  | 


Background: Endoscopic dacryocystorhinostomy (Endo-DCR) is a standard care for chronic dacryocystitis; however, wound adhesion and granulation affect its optimal outcome. Surgical technique modification, stents, and chemicals are used to achieve better results. Hyaluronic acid has beneficial effects on mucosa which encouraged us to perform a study to find its role in Endo-DCR. Materials and methods: The study had a hyaluronic acid case group and a control group consisting of thirteen subjects each. Standard Endo-DCR was performed in all while the case group had hyaluronic acid application around the ostium. Results: The hyaluronic acid group showed a statistically significant difference in ostium patency as compared to the control group. Granulation and adhesions formation were significantly lower in the case group. Conclusion: Hyaluronic acid increased the surgical success rate of Endo-DCR in this study. Further research in a large sample size randomized control study with a longer follow-up period is warranted.



Sudhir M Naik, J Sarah Bai, BR Prajwal Gowda

“Gypsum Plaster Sandwich”: A Novel Method of Splinting of Fractured Nasal Bones after Closed Reduction

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:50 - 52]

Keywords: Closed reduction, Gypsum plaster sandwich, Gypsum plaster splint, Nasal fracture

   DOI: 10.5005/jp-journals-10003-1406  |  Open Access |  How to cite  | 


External nasal dressing as splints provides stability and splints the reduced nasal fractured bones and also after open rhinoplasty surgeries. As gypsum plaster splints are more cumbersome, fastening them to the facial skeleton is difficult with adhesive plasters and the compliance factor reduces their overall performance. So, we have devised a way of fastening the splint to the facial skeleton. The compliance is better with this splint and the splint can be placed in its place as a masquerade with fastening tags to the frontal as well as nasal ends. This splint has the added advantage of no adhesive plaster being used and the patient him/herself can handle the splint without assistance.



Deepak Verma, Uma Garg, Ranvir Singh, Shirish Saheewala

Modified Endoscopic Denker's Approach for Benign Sinonasal Tumors: Our Surgical Experience at a Tertiary Care Center

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Endoscopic medial maxillectomy, Inverted papilloma, Sinonasal tumors

   DOI: 10.5005/jp-journals-10003-1429  |  Open Access |  How to cite  | 


Objective: To study the benefits of modified endoscopic Denker's approach for benign sinonasal tumors. Methods: The study includes prospective analysis of six histopathologically diagnosed patients of sinonasal inverted Papilloma with special emphasis on our experience with modified endoscopic Denker procedure. All patients underwent detailed preoperative evaluation with clinical history, nasal endoscopic examination, and contrast-enhanced computed tomography scan to see the origin and extent of disease. All the relevant findings including patient demographic profile, tumor staging, and surgical outcomes including recurrence were studied. Patients with intracranial or intraorbital extension, extensive frontal sinus involvement, or with sinus malignancy were excluded for this endoscopic approach. All patients were called for periodic endoscopic evaluations in the follow-up period. Results: All six patients operated in the study were in stage III of Krouse staging system. All patients underwent endoscopic surgical resection using modified Denker's approach and endoscopic dacryocystorhinostomy were done as an adjunctive surgical procedure. Intraoperative period was uneventful and no complication was encountered in any of the patients. No recurrence was noted in any of them at the end of follow-up of 18 months. Conclusions: Preoperative evaluation including histopathological biopsy and radiological examination if rules out malignancy, surgical resection using modified endoscopic Denker's approach is an excellent option and could be helpful in achieving complete resection of benign sinonasal tumor such as inverted papilloma. Subperiosteal dissection at the site of involved areas and regular endoscopic evaluation in the follow-up period are the keys for success and thus chances of recurrence can be reduced.



Prakhar Goel, Anjan K Sahoo, Praveen K Rathore

Olfactory and Taste Dysfunctions and Their Implications in Cases of Severe Acute Respiratory Syndrome Coronavirus 2: A Single-institute Study of 58 Cases

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:56 - 59]

Keywords: Ageusia, Anosmia, COVID-19, Otorhinolaryngology, Pandemic

   DOI: 10.5005/jp-journals-10003-1427  |  Open Access |  How to cite  | 


Importance: There is a need to identify the implications of the loss of smell and taste in cases of coronavirus disease-2019 (COVID-19). Objective: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing isolated anosmia in adult population and whether there is a role of intranasal corticosteroids (INCs) in cases of olfactory dysfunctions (ODs). Design: This was a prospective, cross-sectional, questionnaire-based study of 416 patients diagnosed with COVID-19 in a single institute. Setting: Dedicated COVID-19 facility. Participants: All patients had been tested for COVID-19 using a reverse transcription–polymerase chain reaction (RT-PCR)-based test. Patients who were hospitalized were approached in person. All patients who were discharged were then contacted by telephone up to two times to complete the study. Patients who were not reachable with two telephone calls were excluded. Demographic characteristics of the participants—age, sex, and smoking history—were collected. A standardized questionnaire was given to participants. Result: Olfactory dysfunctions (ODs) was observed in 58 patients and isolated anosmia in 3.6% of patients; 82.7% showed complete recovery of smell, and 6.9% had partial recovery following INCs. Conclusion: Patients reporting recent onset of anosmia should be considered positive for SARS-CoV-2 infection until proven otherwise by a screening polymerase chain reaction test. Also, ear, nose, and throat (ENT) surgeons in particular who see patients with new-onset anosmia during the COVID-19 pandemic must take safety measures to reduce the risk of exposure and infection of healthcare workers and recommend such patients for RT-PCR test. Females and young adults are more prone to SARS-CoV-2 infection. Early intervention by INCs could be beneficial in improving olfactory and taste dysfunctions (OTDs) and other post-viral neurological manifestations. It could be beneficial in improving the quality of life of elderly patients who are at a higher risk of permanent OTDs. Smokers are at a higher risk of OTDs, but this could be reversible after smoking cessation. There is a need to put SARS-CoV-2 as a differential diagnosis in cases of sudden isolated OTDs.


Original Article

Yussy A Dewi, Alfira Ulfa, Nur A Aroeman, Ongka M Saiffudin, Bethy S Hernowo

Distant Metastases of Nasopharyngeal Carcinoma

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:60 - 64]

Keywords: Case-control study, Distant metastases, Nasopharyngeal carcinoma, Risk factors

   DOI: 10.5005/jp-journals-10003-1402  |  Open Access |  How to cite  | 


Aim: This study aims to review the nasopharyngeal carcinoma patients with distant metastases. Materials and methods: This is an analytic case-control study. The populations of this study are patients with distant metastases of nasopharyngeal carcinoma as the case group and patients without distant metastases as the control group. The data, such as general characteristics and risk factors, were taken from medical records of two cancer referral hospitals in West Java between 2016 and 2020 with a consecutive sampling method. Categorical data will be analyzed with Chi-square or exact Fisher's test. While numerical data will be analyzed using unpaired t test. Results: Forty-two patients showed distant metastases based on biopsy and imaging studies. Most of both case and control groups were male (73.8 and 81.0%), aged more than 45 years old (69.0 and 64.3%). The most frequently found risk factors in the case group were salted fish (85.7%) and instant noodle (83.3%) consumption. The age of salted fish consumption started, the usage of mosquito coils, and family history are significantly associated with distant metastases of nasopharyngeal carcinoma. Conclusion: The initiation age of salted fish consumption, usage of mosquito coils, and family history are significantly associated with distant metastases of nasopharyngeal carcinoma. Special attention should be given to these populations to decrease the incidence of distant metastases and improve the outcome. Clinical significance: The knowledge of general characteristics may increase the awareness of distant metastases and decrease the mortality rate due to metastases.


Original Article

Hany MA Riad, Mostafa G Sobhy, Samah M Eldsouky, Abdelrahman A Abdelalim

Maxillary Pain in Correlation to Changes in Intramaxillary Sinus Pressure

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:65 - 68]

Keywords: Facial pain, Headache, Intramaxillary pressure, Sinogenic headache, Sinusitis

   DOI: 10.5005/jp-journals-10003-1405  |  Open Access |  How to cite  | 


Aim: To find out the role of intramaxillary sinus pressure changes in the pathogenesis of headache and facial pain in cases of rhinosinusitis, in order to improve our understanding to the nature of rhinogenic or sinogenic headache. Materials and methods: A cross-sectional controlled study was carried out on 195 patients with maxillary sinusitis (study group) and 12 control normal volunteers. The study group then divided based on the presence of sinus pain. Under local anesthesia, all participants were subjected to anterior antral puncture and intramaxillary sinus pressure measurement using the manometer used in central venous pressure measuring. The value of intramaxillary pressure was measured and recorded. Results: The intramaxillary pressure median and range were 0 (−7.1 to 8) in the study group and 0 (−0.5 to 0.4) in the control group. In the study group, we had found 77 out of 195 patients (39.5%) were with negative intramaxillary pressure values and 62 patients (31.8%) were with positive intramaxillary pressure values. In subgroup A (pain), the median and ranges were −3.8 (−7.1 to 8) compared to 0 (−1.9 to 2.7) in subgroup B (no pain) (p = 0.002). There was no one in the subgroup A with 0 cm water intramaxillary pressure, while in subgroup B, 56 patients (54.9%) were with 0 cm water intramaxillary pressure. Conclusion: The changes in the intramaxillary pressure play a significant role in producing facial pain in cases of sinusitis. Pain was significantly related to both positive and negative pressure values. Clinical significance: Sinusitis may cause headache and facial pain, and in this case, intramaxillary pressure change is one of the main mechanisms causing this sinogenic headache or facial pain.



Henrique Rodrigues Teixeira, Mariana Branco Lopes, Anita Paupério Abreu, Maria Helena Rosa

Transnasal Marsupialization of Nasolabial Cyst: A Case Report

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:2] [Pages No:69 - 70]

Keywords: Case report, Nasolabial cyst, Non-odontogenic cyst, Sublabial approach, Transnasal marsupialization

   DOI: 10.5005/jp-journals-10003-1404  |  Open Access |  How to cite  | 


Aim: Report a case of a nasolabial cyst treated through a transnasal approach with marsupialization of the lesion. Background: Nasolabial cysts are rare non-odontogenic lesions of the alar nasal region. The classic surgical treatment is the excision of the cyst through a sublabial transoral approach; however, a transnasal endoscopic approach has been increasingly described. Case description: We report a case of a 72-year-old female patient who presented with a nasal swelling in the left alar region, with associated asymmetry of the nasolabial fold and partial obstruction of the left nasal vestibule. The computed tomography showed an expansile cystic lesion with regular contours, accompanied by bone remodeling without destruction. The patient was submitted to transnasal marsupialization of the lesion, which was performed under local anesthesia. The postoperative period was uneventful, with complete resolution of complaints. Conclusion and clinical significance: Marsupialization of the nasolabial cyst via a transnasal route is an effective therapeutic approach. The conventional and still most commonly used technique in many centers is the intraoral sublabial excision, but when comparing both techniques, the transnasal marsupialization seems to be less invasive, have a shorter surgical time and overall fewer postoperative complications. Otorhinolaryngologists must be aware of this rare lesion and the possible treatment modalities to best manage their patients.



Laura Sofia Thomas, Andres R Latorre, Viviana Leticia Arias, Bernarda Jinett Acosta, Andres Leonardo Fuentes Francia

Solitary Fibrous Tumor Involving the Nasal Cavity and Paranasal Sinuses with Intracranial and Dural Compromise: A Case Report and Literature Review

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:5] [Pages No:71 - 75]

Keywords: Fibrous tissue neoplasms, Nasal neoplasms, Paranasal sinuses, Skull neoplasms, Solitary fibrous tumor

   DOI: 10.5005/jp-journals-10003-1403  |  Open Access |  How to cite  | 


Introduction: Solitary fibrous tumors (SFTs) are rare neoplasms, with a mesenchymal origin that mainly affects the pleura. The SFTs from extrapleural sites are uncommon. This tumor in the nasal cavity is initially asymptomatic, and due to its growth, the patients may present nasal obstruction and epistaxis; due to compression also visual and neurological disturbances. Methods: In this report, we present a 40-year-old male patient with a diagnosis of SFTs of the paranasal sinus with intracranial and dural invasion. Results: This patient has no medical history and presented with bilateral nose blocked. Contrast-enhanced computed tomorgrahic scan showed a mass involving the right nasal cavity, causing deviation of the nasal septum and compromised anterior and posterior sinus. The magnetic resonance revealed the involvement of the right muscle superior oblique, and the intracranial component moves toward superior the right frontal lobe, with adjacent dural enhancement areas. The lesion was removed completely with an endoscopic approach with no recurrences two years after. Conclusion: The SFTs of the nasal cavity and paranasal sinus are rare, with 38 cases reported in the literature, and only one case presents intracranial and dural invasion. They present mainly in the fourth and fifth decades of life and occur equally between men and women. To our knowledge this is the second case of SFTs involving the nasal cavity and paranasal sinuses with intracranial and dural compromise worldwide, and the first in Latin America. Solitary fibrous tumors (SFTs) should be a potential differential diagnosis in tumors with clinical as well as pathological complicated characterization due to the rarity of presentation at this location.



Lourdes Albina Siluvai Arulappan, Aarthi Sundararajan, Amalu Thomas

Co-existence of Schwannoma and Ancient Neurofibroma of Nasal Cavity: A Case Report

[Year:2022] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:76 - 78]

Keywords: CT, Endoscopic approach, Histopathological examination, Neurofibroma, Schwannoma

   DOI: 10.5005/jp-journals-10003-1400  |  Open Access |  How to cite  | 


A thirty-year-old female presented with complaints of left-sided nasal obstruction for 1 year and pain over left side of nose on touch. Diagnostic nasal endoscopy of left nasal cavity showed a well-defined polypoidal lesion attached to the anterior end of middle turbinate and another polypoidal lesion near left middle meatus. CT showed well-defined soft-tissue density in the anterosuperior aspect of left nasal cavity. MRI showed a lesion which was isointense lesion on T1 and hyperintense on T2 in the left nasal cavity. Both the lesions were removed by endoscopic approach. Histopathological report of the lesions came out to be ancient schwannoma and neurofibroma, respectively.


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