An International Journal of Otorhinolaryngology Clinics

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2023 | May-August | Volume 15 | Issue 2

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar


[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/aijoc-15-2-iv  |  Open Access | 


Original Article

Iriana Maharani, Monica Intan, Rus Suheryanto, Dhaniel Abdi Wicaksana, Fifin Pradina Duhitatrissari

Comparison of Neutrophil Eosinophil Ratio (NER) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Chronic Rhinosinusitis without Nasal Polyps (CRSsNP)

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:5] [Pages No:59 - 63]

Keywords: Chronic rhinosinusitis with nasal polyps, Chronic rhinosinusitis without nasal polyps, Neutrophil eosinophil ratio

   DOI: 10.5005/jp-journals-10003-1449  |  Open Access |  How to cite  | 


Introduction: Chronic rhinosinusitis is one of the most common world health problems and affects the quality of life. Recent research suggests differences in immunological mechanisms in immunological endotypes between chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). Identifying the neutrophil eosinophil ratio (NER) in CRSwNP and CRSsNP is important to determine the type of inflammation so that pathophysiological differences can be known and appropriate therapy can be given. Materials and methods: Cross-sectional study involved 24 subjects. The subjects are divided into two groups based on the phenotype, 12 CRSwNP and 12 CRSsNP. This research uses maxillary sinus mucosa to identify the levels of neutrophils and eosinophils in the maxillary sinus mucosa using flow cytometry. NER in CRSwNP and CRSsNP was analyzed statistically using student t-test. Results: The mean of neutrophils in CRSwNP: 5.31 ± 0.24% (N:1.1–1.7%) and CRSsNP: 4.29 ± 2.42% (N:1.1–1.7%). The mean of eosinophils in CRSwNP: 4.76 ± 2.55% (N: 0.3–0.7%) and CRSsNP 3.60 ± 2.88% (N: 0.3–0.7%). The average NER in CRSwNP was 1.33 ± 0.71 (N:2.8), and CRSsNP was 2.58 ± 3.07 (N:2.8). The results were not significantly different in the two groups (p = 0.196). In CRSwNP and CRSsNP, as many as 83.33% of the subjects had an eosinophilic type of inflammation. Conclusion: There were no significant differences in NER and type of inflammation between chronic rhinosinusitis with polyps and without polyps.


Original Article

Semridhi Gupta, Sonu Parmar, Paridhi Ahuja

Rhino-orbital-cerebral Mucormycosis and Aspergillosis Post-COVID-19: Contrariety in Terms of Prevalence Severity Management and Prognosis at a Tertiary Care Centre in Western Rajasthan

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:6] [Pages No:64 - 69]

Keywords: Amphotericin B, Aspergillosis, COVID-19, Diabetes mellitus (DM), Diagnostic nasal endoscopy, Maxillary sinus, Mucormycosis, Mycosis, Rajasthan, Rhinocerebral

   DOI: 10.5005/jp-journals-10003-1462  |  Open Access |  How to cite  | 


Aim: To assess the etiopathogenesis and associated morbidity of rhino-orbital fungal infections post-COVID-19. Primary objective: To study the prevalence of mucormycosis vs aspergillosis post-COVID-19 and to collate their similarities and the distinguishing features. Secondary objective: To determine the sensitivity and positive predictive value of KOH fungal staining. Materials and methods: The study was conducted as a retrospective review of 71 patients with rhino-orbital fungal infections post-COVID-19 admitted in our department from “May to August 2021” at M.D.M. Hospital, Jodhpur. The records were assessed and statistically evaluated. Results: The median age was 43 with male: female ratio 3:1. Out of 71 patients, 53 were positive for mucormycosis and 18 diagnosed with aspergillosis. Uncontrolled diabetes was associated with 94% of rhino-orbital cerebral mucormycosis (ROCM) and 77% of aspergillosis. Steroid intake was seen in 68% of ROCM and 47% of aspergillosis. Most common presenting feature was facial paresthesia/pain. Maxillary sinuses were the most involved paranasal sinuses. Orbital involvement was seen in 36% of ROCM and 32% aspergillosis. Intracranial involvement was seen in 9% of ROCM and 5% of aspergillosis. On nasal endoscopy, necrosed middle turbinate seen in 79% of mucormycosis and 11% of aspergillosis. Aggressive surgical intervention was required in 37% of ROCM and 16% of aspergillosis. Revision surgery became necessary in 13% of ROCM and 27% of aspergillosis. ROCM associated mortality was 18% in mucormycosis, whereas 0% in aspergillosis. Sensitivity of the KOH report was 94% and PPV 98%. Conclusion: A male preponderance seen that can be credited to higher smoking habits and hence susceptibility for COVID-19. The patients suffering from rhino-orbital aspergillosis and mucormycosis have almost similar underlying risk factors, clinical and radiological signs and treatment protocol but they differ in the prevalence, disease extension at presentation, aggressive/conservative surgical approach, recurrence, and mortality. Though mucormycosis comes out to be more malignant and common, rhino-orbital aspergillosis is not an unusual entity.



S Sai Manohar, S Siddharth, Gangadhara Somayaji, VG Nayana

Endoscopic and Microdebrider-assisted Partial Inferior Turbinectomy in Chronic Nasal Obstruction

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:6] [Pages No:70 - 75]

Keywords: Endoscopic, Experimental study, Nasal obstruction, Partial turbinectomy

   DOI: 10.5005/jp-journals-10003-1458  |  Open Access |  How to cite  | 


Objectives: • To study the role of endoscopic and microdebrider-assisted partial inferior turbinectomy in inferior turbinate hypertrophy. • To study the improvement in symptoms and quality of life following the procedure. • To study the complications of endoscopic and microdebrider-assisted partial inferior turbinectomy. Materials and methods: A prospective study was conducted on 50 subjects over a period of 18 months. Subjects who presented with long-standing nasal obstruction secondary to hypertrophy of inferior turbinate also not responding to medical therapy were enrolled for the study. They were taken up for endoscopic microdebrider-assisted partial inferior turbinectomy. Saccharine transit test and modified spirometry were done and modified SNOT 10 questionnaire was administered preoperatively as well as in the 1st and 3rd postoperative months. Results: On subjective assessment using SNOT 10 Questionnaire, it was seen that patients with headache, nasal obstruction, and anosmia had the highest benefit post-surgery. Out of 50 subjects reported with nasal obstruction preoperatively, only 16 had mild obstruction in the 3rd postoperative month which was statistically significant. Of 44 subjects with headache, only 17 had mild headache in the 3rd postoperative month. Only 8 of 43 subjects with anosmia still had mild symptoms during the 3rd month. On objective assessment using saccharine transit test, the mean time of 16.02 preoperatively decreased to 14.32 at 3 months after surgery. The rhinospirometry also showed a statistically significant improvement, 3 months after surgery when compared with preoperative values. Conclusion: Endoscopic and microdebrider-assisted partial inferior turbinectomy proved to be a safe and one of the most effective treatments for chronic nasal obstruction secondary to inferior turbinate hypertrophy. The SNOT 10 questionnaire is an effective tool in the subjective assessment of patients undergoing partial inferior turbinectomy. Clinical significance: Symptomatic inferior turbinate hypertrophy can be effectively treated by endoscopic and microdebrider-assisted partial inferior turbinectomy and the SNOT 10 questionnaire may act as an indicator.



Neha Thakur, Dinesh Dutt Sharma, Ramesh K Azad, Surbhi Dadwal, Jagdeep S Thakur

Anxiety and Depression in Chronic Rhinosinusitis

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:76 - 78]

Keywords: Anxiety, Chronic rhinosinusitis, Depression, Mental health

   DOI: 10.5005/jp-journals-10003-1451  |  Open Access |  How to cite  | 


Introduction: Chronic rhinosinusitis (CRS) is a complex disease that affects not only the nose and sinuses but also has broad effects throughout the body. It is associated with a decreased quality of life, affecting the physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety. Studies reported depression in 9–25% of CRS patients. Given the negative impact of depression and anxiety on the clinical outcomes of CRS, better screening for undiagnosed depression and anxiety, and improved understanding of the complex interplay between CRS-associated depression and anxiety are needed. Aim: To find the association of anxiety and depression in chronic rhinosinusitis. Materials and methods: We assessed 36 CRS patients while comparing them with an equal number of chronic otitis media patients using BAI and BDI-II scores. Results: The CRS group showed high BAI and BDI-II scores as compared with the control group, but only BDI-II was found statistically significant. Twenty-five percent of CRS cases were suffering with anxiety as compared to 11.1% of control groups. Similarly, 11.1% of CRS had depression as compared with 5.6%. Conclusion: This is the first Indian study that evaluated mental health problems in CRS patients and found higher BAI and BDI-II scores. These observations require further validation through a large sample study.



Shantanu Tandon

Gossypiboma Mimicking Maxillary Sinusitis: A Unique Case Report

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:2] [Pages No:79 - 80]

Keywords: Case report, Gossypiboma, Foreign body, Maxillary sinus

   DOI: 10.5005/jp-journals-10003-1459  |  Open Access |  How to cite  | 


Background: Gossypiboma (foreign body granuloma) is a rare clinical presentation, especially in the maxillary sinus, and may be seen after transnasal procedures but is an uncommon foreign body in the maxillary sinus after dental procedures. Case description: A 24-year-old female presented with symptoms suggestive of sinonasal disease. Intraoperatively, a foreign body composed of a cotton ball was incidentally found in the left maxillary sinus and intraoperative findings were histopathologically compatible with foreign body reaction around the cotton ball. Conclusion: Gossypibomas are rare and hard to diagnose, and usually asymptomatic. In chronic cases, it does not reveal any specific radiological or clinical signs for diagnosis but must be considered in patients with a history of dental procedures. Clinical significance: Although imaging is suggestive of sinusitis, a localized disease with a history of dental procedures, should raise a high index of suspicion to rule out foreign body granuloma, for desired clinical and surgical outcomes.



Filipa Ferreira, Sílvia Alves, Ricardo Nuno Pestanudo São Pedro, Cristina Marques, Luis Antunes

Inflammatory Pseudotumor of the Nasopharynx: An Unusual Diagnosis of a Destructive Skull Base Lesion

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:81 - 83]

Keywords: Case report, Inflammatory pseudotumor, Nasopharynx, Skull base

   DOI: 10.5005/jp-journals-10003-1481  |  Open Access |  How to cite  | 


Aim: To describe a rare case of nasopharyngeal inflammatory pseudotumor (IPT) with skull base invasion. Background: Inflammatory pseudotumor is a nonneoplastic lesion characterized by fibrosis and inflammation. It can be locally aggressive and resemble malignancy and extranodal lymphoma. It has been described in nearly every anatomic site throughout the body. Although rare, the involvement of the skull base is associated with more aggressive behavior. Case description: The authors present the case of a 63-year-old male with a 3-month history of right otorrhea, headache, and facial pain in the sensitive territory of the right trigeminal nerve (V3). Magnetic resonance imaging (MRI) showed an infiltrative lesion of the posterior wall of the nasopharynx with poorly defined limits, extended deep into the retropharyngeal and prevertebral space, with bone erosion of the occipital clivus and petrous apex. The patient performed three biopsies of the nasopharynx suggestive of a fibroinflammatory process. Inflammatory pseudotumor was diagnosed and the patient did a long course of high-dose systemic corticotherapy with good clinical and radiological response. Conclusion: Biopsy is essential for the diagnosis of IPT, although it usually just shows inflammatory changes. Magnetic resonance imaging features of this entity are ill-defined lesions with local infiltration, hypointensity on T2-weighted sequences, and weak contrast enhancement, usually with an absence of cervical lymphadenopathies. The treatment of IPT involving the skull base has been controversial but can include corticotherapy and radiotherapy. Clinical significance: This case report highlights the relevance of including IPT in the differential diagnosis of infiltrative nasopharyngeal and skull base lesions, especially when biopsies and cultures are negative.



Zheng Hao Loh, Ramiza Ramza Ramli, Zahirruddin Zakaria

Hidden Bone in Prevertebral Space

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:84 - 86]

Keywords: Case report, Fishbone, Migratory, Prevertebral

   DOI: 10.5005/jp-journals-10003-1466  |  Open Access |  How to cite  | 


A 60-year-old lady presented with pain in the throat and odynophagia post-ingestion of fishbone 5 days ago. A computed tomography scan showed linear opacity resembling a fishbone in the prevertebral space. Direct laryngoscopy and esophagoscope revealed only slough and neck exploration showed fishbone in the prevertebral space. Early removal of the fishbone avoided fatal complications.



Ilson Sepulveda, Thomas Wilhelm Schmidt, J Patricio Ulloa, Jorge Hidalgo, Pablo Mucientes, Francisco Rivas-Rodriguez

Extraskeletal Primary Ewing's Sarcoma of the Nasal Cavity: A Case Report and Review of the Literature

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:4] [Pages No:87 - 90]

Keywords: Case report, Computed tomography, Ewing, Magnetic resonance imaging, Nasal cavity, Sarcoma

   DOI: 10.5005/jp-journals-10003-1455  |  Open Access |  How to cite  | 


We report on a patient who presented with nasal obstruction and epistaxis. Computed tomography (CT) and magnetic resonance imaging studies demonstrated a large expansive heterogeneous mass filling the left nasal cavity. Intravenous contrast administration revealed a lesion with moderate enhancement, without paranasal sinuses involvement or intracranial invasion. Patient underwent tumor resection; biopsy confirmed the presence of an extraskeletal Ewing's sarcoma/primitive neuroectodermal tumor (PNET). Currently undergoing treatment in the National Cancer Institute.



Ranvir Singh, Shirish Saheewala, Deepak Verma, Surender Kumar

Nasal Septal Schwannoma: A Rare Case and Review of Literature

[Year:2023] [Month:May-August] [Volume:15] [Number:2] [Pages:3] [Pages No:91 - 93]

Keywords: Case report, Epistaxis, Endoscopy, Nasal schwannoma, Nose block

   DOI: 10.5005/jp-journals-10003-1456  |  Open Access |  How to cite  | 


Introduction: Nasal septal schwannoma is not so common, presenting with unilateral nasal block age, breathing difficulty, and bleeding nose. Nasal schwannoma is a rare diagnosis accounting for 4% of schwannomas. The diagnosis is made by histopathological examination of specimens and is S100 positive on immunohistochemistry (IHC). Case description: We report a 19-year-old female who presented with unilateral nasal block age, bleeding from the same side, and pain. On clinical examination, a polypoidal mass was seen filling the right nasal cavity and deviated nasal septum (DNS) to the left. Contrast-enhanced computed tomography showed soft tissue density in the right nasal cavity pushing the septum. The patient was taken for endoscopic excision of the mass. Histopathology report confirmed nasal schwannoma, S100 positive. Conclusion: Complete surgical excision is the treatment of choice.


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