Search

Extra Nasopharyngeal Angiofibromas are rare benign vascular tumors typically affecting adolescent males. They have variable sites of origin. Only five cases of extra nasopharyngeal angiofibroma originating from the middle turbinate have been reported in the literature, here we present the sixth such case. A 44-year-old female presented with a history of left-sided nasal obstruction and spontaneous, profuse and recurrent epistaxis. A contrast-enhanced computed tomography (CT) scan showed a hyper vascular mass arising from the left middle turbinate. A provisional diagnosis of extra nasopharyngeal angiofibroma was made and it was successfully surgically excised using a midfacial degloving approach under general anaesthesia. The diagnosis was confirmed with post-operative histopathological analysis. Due to the extremely rare occurrence of Extra Nasopharyngeal Angiofibromas originating from the middle turbinate and their infrequent presentation in female patients, misdiagnosis poses a greater risk of complications. The surgeon must exercise caution before conducting misguided biopsies, which are contraindicated. [ABSTRACT FROM AUTHOR]

Pneumatisation of the maxillary sinus (MS) is variable. The archived cone-beam computed tomography file of a 54-year-old female was retrospectively evaluated anatomically. Nasal or retrobullar recesses of the MSs (NRMS) were found. The MSs were bicameral. NRMSs extended from the postero-lateral chambers of the MSs into the lateral nasal walls. The right NRMS was reached superior to the middle turbinate and the ethmoidal bulla was applied on its anterior side. The left NRMS had two medial pouch-like ends, one beneath the ethmoidal bulla and the other on the anterior side of the basal lamella of the middle turbinate. Additional anatomical findings were the uncinate bulla, infraorbital recesses of the MS, maxillary recess of the sphenoidal sinus, and atypical posterior insertions of the superior nasal turbinates, maxillo-ethmoidosphenoidal and ethmoido-sphenoidal. The NRMS is a novel finding and could lead to erroneous endoscopic corridors if not documented before the interventions. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to compare the applicability of classic lateral lamellectomy versus submucosal conchoplasty techniques in managing concha bullosa during and after functional endoscopic sinus surgery. Methods: The study randomly divided 56 patients with bilateral concha bullosa into two groups. One group of patients underwent the submucosal conchoplasty technique and the other group underwent the lateral lamellectomy technique. The study compared the intra-operative findings, including the time required for each technique, the amount of intra-operative bleeding and the post-operative endoscopic outcome of the middle meatus and middle turbinate stability. Results: Submucosal conchoplasty was significantly more time-consuming than the lateral lamellectomy technique (p = 0.001*). The difference in the intra-operative amount of bleeding was (p = 0.086*). The lateral lamellectomy group showed a higher rate of synechia formation in the middle meatus (p = 0.012*). Conclusion: Submucosal conchoplasty is a valid technique for managing concha bullosa with better post-operative endoscopic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Objectives: Cigarette smoke is known to contain toxic heavy metals. In this study, heavy metal levels in the nasal turbinate tissues of smokers and nonsmokers were measured and compared with Inductively Coupled Plasma‐Mass Spectrometry (ICP‐MS). Methods: Forty patients who come to the Otorhinolaryngology outpatient clinic due to nasal obstruction and are given an appointment for partial turbinate reduction operation due to inferior turbinate hypertrophy, according to their smoking status, were divided into two groups: those who had smoked one pack/day for at least 10 years and those who had never smoked. The levels of heavy metals (Al, As, Ba, Cd, Cr, Co, Cu, Pb, Mn, Hg, Ni, Se, and Ag) were compared by ICP‐MS in nasal turbinate tissues. Results: Al (p = 0.002), Cr (p < 0.001), Co (p < 0.001), Ni (p = 0.001), Cu (p < 0.001), As (p < 0.001), Se (p < 0.001), Ag (p < 0.001), Cd (p = 0.001), Ba (p = 0.008), Hg (p < 0.001), and Pb (p < 0.001) values in the smoker group were found to be significantly higher than the values of nonsmokers. Although the Mn level was high in smokers, no significant difference was observed (p = 0.299). Conclusions: Smoking can cause nasal and sinus problems. In this study, we observed that the smoking group had significantly higher levels of almost all the heavy metals investigated in the nasal turbinate tissues. As smoking damages, the mucociliary system and the mucosa, heavy metals from cigarettes may accumulate further and cause harm to the nasal tissues. Level of Evidence: 3 Laryngoscope, 134:3562–3567, 2024 [ABSTRACT FROM AUTHOR]

Objective: Surgery is frequently used to treat inferior turbinate hypertrophy, and post-surgical bleeding is the most common complication. This study aims to evaluate the whole turbinate in terms of the vascular structures histologifically from the anterior to posterior and to determine regional diferences and, if any, clinical implications. Methods: Eight fresh-frozen cadavers were examined macroscopically. Thirteen selected turbinates were divided into 7 right and 6 left inferior turbinates. Ten randomized sections were obtained from each one-third section. On a light microscope, these sections were counted along the entire section with the artery and vein structures at high magnification. In the calculation of arterial cross-sectional area, vessel diameters were measured in the transverse plane and grouped as anterior, middle, and posterior. Results: In the anterior one-third, the mean value for arterial sections was 33.25, and the mean value for venous sections was 308. In the middle one-third, the mean values for arterial sections were 56.13, and the mean values for the venous sections were 663.63. In the posterior one-third, the mean values for arterial sections were 35.63, and the mean values for venous sections were 445.88. Statistical analysis with one-way ANOVA showed that the difference between the regions for venous structures was P = .202, and for arterial structures was P = .449. Conclusion: According to the outcomes of our study, contrary to what was previously known about surgical techniques applied to inferior turbinate hypertrophies, bleeding can occur, whichever part of the turbinate is operated on. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the presence and severity of inferior turbinate hypertrophy (ITH) in patients with hypertrophic scars (HTS). Methods: This case-control study was conducted with patients diagnosed with HTS during dermatologic examination and a control group without HTS. An otolaryngologist evaluated the presence and severity of inferior turbinate hypertrophy by anterior rhinoscopy. Results: ITH was more common in patients with HTS compared to the control group (64%, and 34%, respectively) (p=0.014). In the HTS group, 48% of patients had grade 2, and 16% had grade 3 ITH; in the control group, 24% had grade 2, and 10% had grade 3 ITH (p=0.046). Also, ITH was higher in patients who complained of pruritus or pain (83%, and 80%, respectively) in the HTS than in asymptomatic HTS patients (p=0.020). Conclusion: A higher number of patients with HTS had ITH compared to the control group, especially those who reported pruritus or pain associated with scar. Given the limited understanding of the full pathogenesis and treatment of HTS and ITH, their association potentially provides new insights into these related conditions. [ABSTRACT FROM AUTHOR]

This video article presents a 47-year-old male patient who presented to the emergency department after a cleaver bounced off the grinding wheel and lodged between his eyebrows. The patient complained of clear nasal drainage since the trauma. Computed tomography showed a comminuted displaced fracture starting from the right frontonasal recess and extending along the right ethmoid roof. The patient underwent surgery. The skull base defect was reconstructed with a free fascia lata graft in the first operation. In the second session, the reconstruction of the skull base was reinforced with a flap that was prepared from the middle turbinate with the concha bullosa. The patient was followed for eight months. The patient's symptoms resolved completely and there was no evidence of rhinorrhoea or any other complication at the control examination. No complications were seen on control magnetic resonance imaging.

Dr. M. Brock Fenton has been intrigued by the diversity of bats throughout his long career, and has combined his research and photography skills to capture the extensive morphological diversity found across the order Chiroptera. In this paper, we honour Brock's fascination with diversity by conducting a review of the external and internal characteristics of the bat nose, a morphological feature that Brock's photographs have beautifully captured in many bat species. Specifically, we explore variation in form and function of the bat rostrum and its role in respiration, echolocation, and olfaction in bats, with an emphasis on the noseleaves of nasal-emitting echolocators, as well as how turbinate morphology may be impacted by nasophonation. While our review is not an extensive dive into all that is known about bat noses, our goal is to highlight the diversity we see in form across the order Chiroptera while exploring how function has been shaped by selection, particularly in relation to mode of echolocation signal emission. [ABSTRACT FROM AUTHOR]

Purpose: The techniques to be performed for bullous middle turbinates are well-defined and widely accepted in the literature. However, in the case of solid middle turbinate hypertrophy, information on surgical techniques that take into account function and sense of smell is very limited in the literature. The aim of this study was to compare the airway patency and olfaction results of patients diagnosed with solid middle turbinate hypertrophy, who underwent subtotal (transverse) resection or medial flap turbinoplasty of the middle turbinates. Methods: Thirty-five adult patients who were diagnosed with solid middle turbinate hypertrophy were divided into two groups, namely medial flap middle turbinoplasty (study group = 17) and transverse resection to the middle turbinate (control group = 18). Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test, and n-butanol threshold measurements were performed before and 3 months after the surgery. In addition, preoperative and postoperative nasal obstruction and olfactory senses of the patients were evaluated with visual analog scale and nasal obstruction symptom evaluation scale. Results: Visual analog scores for olfaction were significantly higher in the study group compared to the control group. In odor identification test, a significant improvement was observed in the study group, while a decrease was observed in the control group. While there was a decrease in the n-butanol thresholds values in the study group, there was an increase in the control group. Conclusions: Medial mucosal flap technique is an effective and functional turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of enhanced airway healing and olfactory results. [ABSTRACT FROM AUTHOR]

Demonstrate the histological remodeling changes in the turbinates, identify the frequency of the two forms of rhinitis in the samples studied and determine the remodeling differences found in the two variants. Patients attended an otolaryngology service at the Social Security Hospital of city Sangolqui-Ecuador from February 2016 to June 2017. The allergic variant was determined when eosinophils were found by higher magnification field and non-allergic when they were not found in the submucosal segment. Epithelial, inflammatory, and stromal markers were analyzed. One hundred twenty histopathological samples were analyzed, 75% presented allergic rhinitis, the age averaged 36.2 years. When we compared between the allergic and non-allergic variants: epithelial and stromal markers we had significant differences, as well as between each of its components; except fibrosis. In relation to the inflammatory pattern, there were significant differences between the number of mast cells and stromal markers with eosinophils > 10 by field. The allergic type corresponded to 75% of patients with persistent severe rhinitis who underwent turbinectomy. Regarding remodeling, there was a statistically significant difference in favor of the allergic variant. Eosinophilia greater than 10 was directly related to mastocytosis and subepithelial edema. [ABSTRACT FROM AUTHOR]

Background and Objectives Turbinoplasty may be an option in patients with persistent symptoms of allergic rhinitis (AR) despite adequate medication. The two most frequently used surgical techniques for turbinoplasty are radiofrequency ablation and microdebriderassisted turbinoplasty. This study compared the outcomes of these two surgical techniques and assessed the long-term treatment effects. Methods This study included patients with AR who underwent turbinoplasty between January 2010 and June 2017. We examined the medication scores, overall treatment satisfaction scores, and medical records. Based on the type of surgery, patients were classified into microdebrider and coblator groups. A telephone survey was conducted to collect data on the 5-year post-treatment efficacy parameters. Scores for allergic symptoms, prescription medicines taken after surgery, and general satisfaction were compared. Results Of the total 241 patients, 192 (79.7%) and 49 (20.3%) underwent microdebrider-assisted turbinoplasty and radiofrequency ablation turbinoplasty, respectively. Both the microdebrider and coblator groups showed remarkable improvements in AR symptoms at the 5-year follow-up (p

This video article presents a 47-year-old male patient who presented to the emergency department after a cleaver bounced off the grinding wheel and lodged between his eyebrows. The patient complained of clear nasal drainage since the trauma. Computed tomography showed a comminuted displaced fracture starting from the right frontonasal recess and extending along the right ethmoid roof. The patient underwent surgery. The skull base defect was reconstructed with a free fascia lata graft in the first operation. In the second session, the reconstruction of the skull base was reinforced with a flap that was prepared from the middle turbinate with the concha bullosa. The patient was followed for eight months. The patient's symptoms resolved completely and there was no evidence of rhinorrhoea or any other complication at the control examination. No complications were seen on control magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

This study investigated the influence of hypoxic culture conditions on human nasal inferior turbinate-derived stem cells (hNTSCs), a subtype of mesenchymal stem cells (MSCs). It aimed to discern how hypoxia affected hNTSC characteristics, proliferation, and differentiation potential compared to hNTSCs cultured under normal oxygen levels. After obtaining hNTSCs from five patients, the samples were divided into hypoxic and normoxic groups. The investigation utilized fluorescence-activated cell sorting (FACS) for surface marker analysis, cell counting kit-8 assays for proliferation assessment, and multiplex immunoassays for cytokine secretion study. Differentiation potential—osteogenic, chondrogenic, and adipogenic—was evaluated via histological examination and gene expression analysis. Results indicated that hNTSCs under hypoxic conditions preserved their characteristic MSC phenotype, as confirmed by FACS analysis demonstrating the absence of hematopoietic markers and presence of MSC markers. Proliferation of hNTSCs remained unaffected by hypoxia. Cytokine expression showed similarity between hypoxic and normoxic groups throughout cultivation. Nevertheless, hypoxic conditions reduced the osteogenic and promoted adipogenic differentiation potential, while chondrogenic differentiation was relatively unchanged. These insights contribute to understanding hNTSC behavior in hypoxic environments, advancing the development of protocols for stem cell therapies and tissue engineering. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study is to evaluate the effectiveness of the surgical and nonsurgical treatment of headache caused by contact points (CPs) between the nasal septum and inferior or middle turbinate. Methods: The research was designed as a prospective clinical case-series study. The patients with CP headaches were offered to choose between 2 treatment options, surgery and medical treatment. Two groups of surgically treated patients (surgery groups 1 and 2, depending on whether there is a contact between nasal septum and inferior turbinate or middle turbinate) were evaluated and compared for headache intensity and frequency. Headache intensity was measured using a visual analog scale value from 0 to 10; the frequency of headache was expressed as the number of days during 1 month with a headache (before surgery, 1 month, and 6 months after surgery). A comparison was also made between surgically and nonsurgically treated patients. Results: We found more intensive and frequent headache in patients who had CP between the nasal septum and the middle turbinate (P =.038 and P =.003, respectively). A significant reduction in headache intensity and frequency was found in both groups of surgically treated patients 6 months after surgery; however, this reduction was more significant in patients with mucosal contact between nasal septum and middle turbinate. The nonsurgical treatment made a significant reduction of headache intensity and frequency at 1-month follow-up (P =.012 and P =.031, respectively), but not at 6-month follow-up (P =.114 and P =.088, respectively). Conclusion: Surgery gave a statistically significant reduction in the intensity and frequency of headache, which was assessed 6 months after surgery. Surgery was found as superior to nonsurgical treatment in the therapy of CP headache. [ABSTRACT FROM AUTHOR]

Background and objectivesTemperature-controlled radiofrequency inferior turbinate ablation (TCRFA) uses a feedback system to control thermal injury and achieve precise volumetric heating to induce specific scar formation. However, it requires costly single-use proprietary consumables. Comparable volumetric tissue heating may be achieved for a fraction of the cost by adjusting the power settings on traditional monopolar electrosurgery devices that use low-cost needle tips. This pre-clinical study aims to determine the optimized power parameters to achieve electrosurgical coagulum volume similar to that of TCRFA.Study design/materials and methodsAn electrosurgery submucosal diathermy (SMD) system (cut mode, 4-32 W, 5-120 seconds) and a temperature-controlled radiofrequency ablation system (standard clinical parameters for treating inferior turbinate hypertrophy) were used to coagulate egg white and chicken breast. Coagulum major and minor axis were measured, and lesion volume was approximated as prolate spheroid.ResultsNo significant difference in volume was found between the temperature-controlled system and the electrosurgery system at 8 W for 30 seconds, 8 W for 60 seconds, 16 W for 30 seconds, 32 W for 5 seconds, and 32 W for 15 seconds. The time to achieve equivalent lesion size was significantly less in the SMD system when compared to the temperature-controlled system (P

Objectives To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) therapy with coblation for the treatment of inferior turbinate hypertrophy (ITH). Methods In this randomized controlled clinical trial, 20 patients underwent inferior turbinate surgery, which consisted of either HIFU or coblation therapy. Efficacy, safety, and tolerability were evaluated by subjective symptom scores, acoustic rhinometry, and nasal endoscopy. Results The modified nasal obstruction symptom evaluation (NOSE) score and nasal obstruction visual analog scale (NO-VAS) significantly decreased in both groups 12 weeks postoperatively. The between-group differences in the evaluation scores were not statistically significant. On nasal endoscopy, the HIFU patients showed improvements in mucosal swelling sooner than the patients undergoing coblation therapy. Nasal crusting significantly increased in the patients undergoing coblation compared to the patients undergoing HIFU therapy until postoperative week 4. Mucosal preservation was superior in the HIFU patients. Although HIFU was less painful than coblation therapy during the procedure, the difference was not significant (4.9 vs. 6.3, P=0.143). The difference in global satisfaction between the two groups was not statistically significant, although satisfaction was slightly higher among the HIFU patients than among the coblation patients (4.6 vs. 4.1, P=0.393). Conclusion HIFU provided results similar to those of coblation therapy for patients with nasal obstruction due to ITH, but HIFU therapy caused less discomfort during the procedure. HIFU therapy appears to be a good noninvasive alternative to the current surgical modalities for ITH.

Introduction:To evaluate the effect of submucosal platelet-rich plasma (PRP) therapy on intraoperative bleeding and early postoperative pain and crusting in patients undergoing inferior turbinate radiofrequency.Methods:A total of 70 adult patients with isolated inferior turbinate hypertrophy were included in this prospective study and randomized to the PRP or control groups. PRP was prepared for all patients. After applying submucosal radiofrequency to the inferior turbinates under local anesthesia, submucosal PRP was injected into the study group, and submucosal saline was injected into the control group. Patient controls were performed by another specialist. The patients and the specialist who performed the controls were blinded to which group they were in. All patients were evaluated endoscopically 1, 7, and 21 days after the operation.Results:The mean age of the patients was 33.37±11.92 years (range: 18 to 54). The two groups had no significant differences in intraoperative bleeding and mucociliary clearance values (p>0.05). The amount of crusting and the visual analog scale pain values were significantly lower in the submucosal PRP -injected group (p

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide; a simple diagnostic test is becoming increasingly important. Polymerase chain reaction tests of nasal swab samples are expensive and time-consuming. Detailed observation of the nasal cavity is required. No nasal endoscopic study regarding patients with SARS-CoV-2 has been published. Here, we compared endoscopic images of normal subjects and patients with allergic rhinitis (AR) to images from a patient with confirmed SARS-CoV-2 infection. Nasal cavity endoscopic images (of the inferior turbinate) were compared using the hue, saturation, and luminance (HSL) color system of Matrox Design Assistant, version 5.0. The multiple allergen simultaneous test was used to distinguish normal subjects from patients with AR. HSL patterns were compared among images. We enrolled 14 normal subjects and patients with AR and 1 patient with confirmed SARS-CoV-2 infection. The inferior turbinates of normal subjects and patients with AR were smooth and uniform, while those of the patient with SARS-CoV-2 were scratched and stretched. Although additional data are needed, optical analysis of nasal endoscopy images may be useful to screen for SARS-CoV-2 infection. This imaging method is rapid, non-invasive, and inexpensive.

Introduction: To evaluate the effect of submucosal platelet-rich plasma (PRP) therapy on intraoperative bleeding and early postoperative pain and crusting in patients undergoing inferior turbinate radiofrequency. Methods: A total of 70 adult patients with isolated inferior turbinate hypertrophy were included in this prospective study and randomized to the PRP or control groups. PRP was prepared for all patients. After applying submucosal radiofrequency to the inferior turbinates under local anesthesia, submucosal PRP was injected into the study group, and submucosal saline was injected into the control group. Patient controls were performed by another specialist. The patients and the specialist who performed the controls were blinded to which group they were in. All patients were evaluated endoscopically 1, 7, and 21 days after the operation. Results: The mean age of the patients was 33.37±11.92 years (range: 18 to 54). The two groups had no significant differences in intraoperative bleeding and mucociliary clearance values (p>0.05). The amount of crusting and the visual analog scale pain values were significantly lower in the submucosal PRP-injected group (p<0.05). Conclusion: Submucosal injection of PRP after radiofrequency of the inferior turbinate reduces nasal obstruction and pain due to crusting. With these features, it can be concluded that this procedure accelerates recovery and increases patient comfort in the early postoperative period. [ABSTRACT FROM AUTHOR]

Introduction  Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL). Objectives  The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors. Methods  The method of the study involves contemporary literature review and summary of implications for clinical practice. Results  Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results. Conclusion  This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation. [ABSTRACT FROM AUTHOR]

Objectives Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy. Methods First, computed tomography images of patients with no evidence of sinonasal disease were evaluated to measure and compare the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on the above human anatomical studies. The experimental study was performed in five pigs; the nasal volume and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and a control group. Results The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial space was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm, respectively. HIFU showed no postoperative complications, including bleeding or scar formation. After HIFU treatment, the nasal volume increased by 196.62 mm3 (7.8%) and 193.74 mm3 (8.3%) at 1 week and 4 weeks, compared with the increase of 87.20 mm3 (3.1%) and 213.81 mm3 (9.0%), respectively,after radiofrequency therapy. A qualitative histological analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis, along with decreased glandular structure, at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis and decreased glandular structure. Conclusion The efficacy and safety of HIFU turbinoplasty were demonstrated in an animal study. Our results warrant further human clinical trials.

This study investigated the influence of hypoxic culture conditions on human nasal inferior turbinate-derived stem cells (hNTSCs), a subtype of mesenchymal stem cells (MSCs). It aimed to discern how hypoxia affected hNTSC characteristics, proliferation, and differentiation potential compared to hNTSCs cultured under normal oxygen levels. After obtaining hNTSCs from five patients, the samples were divided into hypoxic and normoxic groups. The investigation utilized fluorescence-activated cell sorting (FACS) for surface marker analysis, cell counting kit-8 assays for proliferation assessment, and multiplex immunoassays for cytokine secretion study. Differentiation potential—osteogenic, chondrogenic, and adipogenic—was evaluated via histological examination and gene expression analysis. Results indicated that hNTSCs under hypoxic conditions preserved their characteristic MSC phenotype, as confirmed by FACS analysis demonstrating the absence of hematopoietic markers and presence of MSC markers. Proliferation of hNTSCs remained unaffected by hypoxia. Cytokine expression showed similarity between hypoxic and normoxic groups throughout cultivation. Nevertheless, hypoxic conditions reduced the osteogenic and promoted adipogenic differentiation potential, while chondrogenic differentiation was relatively unchanged. These insights contribute to understanding hNTSC behavior in hypoxic environments, advancing the development of protocols for stem cell therapies and tissue engineering.

Silent sinus syndrome (SSS) is a rare disease characterized by spontaneous enophthalmos and hypoglobus secondary to collapse of the orbital floor in patients with asymptomatic maxillary sinusitis. Radiographic findings include ipsilateral maxillary sinus opacification, lateralization of the uncinate and middle turbinate, and infundibular occlusion. We present a case series of three patients with clinical and radiographic evidence of SSS but without maxillary sinus opacification. Although uncommon, an aerated maxillary sinus in patients with unexplained enophthalmos, hypoglobus, and maxillary atelectasis should not exclude the diagnosis of SSS. Laryngoscope, 128:2004-2007, 2018.

This study focused on outcomes of endoscopic posterior nasal neurectomy and turbinate reduction with regard to the common symptoms of allergic and vasomotor rhinitis. This randomized experimental study conducted between December 2018 to November 2020 included 60 patients, aged 18–50 years with allergic or vasomotor rhinitis with/ without deviated nasal septum of grade 3 and 4, not responding to conservative management. Patients were divided into two groups. 30 patients were operated for Posterior nasal nerve resection and 30 patients underwent turbinate reduction. SNOT 22 (Sino-nasal outcome test) questionnaire was given to every patient and they were asked four major symptoms of nasal obstruction, rhinorrhoea, sneezing and post nasal discharge and were told to rate their symptom in 1 to 5 severity scale before surgery and in postoperative follow up. Mean ± SD(standard deviation) of percentage change in SNOT 22 score in Posterior Nasal Nerve resection was 88.09 ± 4.38 which was significantly higher than turbinate reduction (82.95 ± 5.33) (p value = 0.0001). Distribution of post-operative complications was comparable in turbinate reduction and Posterior Nasal Nerve resection (Both synechia and crusting:10 versus 6.67% respectively) (p value = 1). No patient had bleeding in both groups. Though skill demand is high, posterior nasal neurectomy is highly safe and effective, as there was no bleeding post-operatively in spite of handling the sphenopalatine artery. Symptom relief with this surgery was 88.09% which was significantly higher as compared to submucosal resection of inferior turbinate with microdebrider (82.95%) [ABSTRACT FROM AUTHOR]

Background: The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods: A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results: The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate. [ABSTRACT FROM AUTHOR]

Secondary atrophic rhinitis (AR), a consequence of mucosal damage during nasal surgeries, significantly impairs patient quality of life. The lack of effective, lasting treatments underscores the need for alternative therapeutic strategies. A major impediment in advancing research is the scarcity of studies focused on secondary AR. Our study addresses this gap by developing an animal model that closely mirrors the histopathological changes observed in patients with secondary AR. These changes include squamous metaplasia, goblet cell hyperplasia, submucosal fibrosis, and glandular atrophy. Upon administering human nasal turbinate stem cells embedded in collagen type I hydrogel in these models, we observed ciliary regeneration. This finding suggests the potential therapeutic benefit of this approach. Our animal models not only emulate the clinical manifestations of secondary AR but also serve as valuable tools for evaluating the efficacy of cell-based biotechnological interventions., (© 2024 The Authors. Cell Proliferation published by Beijing Institute for Stem Cell and Regenerative Medicine and John Wiley & Sons Ltd.)

Background: The vertebrate olfactory system entails a complex set of neural/support structures that bridge morphogenetic regions. The developmental mechanisms coordinating this bridge remain unclear, even for model organisms such as chick, Gallus gallus. Here, we combine previous growth data on the chick olfactory apparatus with new samples targeting its early embryogenesis. The purpose is to illuminate how early developmental dynamics integrate with scaling relationships to produce adult form and, potentially, evolutionary patterns. Olfactory structures, including epithelium, turbinate, nerve, and olfactory bulb, are considered in the context of neighboring nasal and brain structures., Results: Axonal outgrowth from the olfactory epithelium, which eventually connects receptor neurons with the brain, begins earlier than previously established. This dynamic marks the beginning of a complex pattern of early differential growth wherein the olfactory bulbs scale with positive allometry relative to both brain volume and turbinate area, which in turn scale isometrically with one another., Conclusions: The mechanisms driving observed patterns of organogenesis and growth remain unclear awaiting experimental evidence. We discuss competing hypotheses, including the possibility that broad-based isometry of olfactory components reflects constraints imposed by high levels of functional/structural integration. Such integration would include the frontonasal prominence having a strong influence on telencephalic patterning., (© 2024 American Association for Anatomy.)

Abstract Background The Nasal Obstruction Symptom Evaluation (NOSE) scale has been developed and validated in English to overcome the controversies concerning other methods of evaluation of nasal obstruction. The scale is currently used worldwide and has been translated into several languages. The purpose of the present work was to translate the English (NOSE) scale into Arabic (A-NOSE) and to assess its validity and reliability in Arabic-speaking patients. Results The internal consistency and test-to-test reliability of the Arabic scale were statistically good. The differences between the scores of the patients and control subjects were statistically significant. Postoperative scores of the patients were significantly higher than preoperative scores. All participants completed the Arabic questionnaire easily and few of them required slight assistance. Conclusions The translated NOSE scale is easy to administer and can be a robust and usable outcome measure for patients with nasal obstruction. The translated scale is sensitive to changes in nasal airway patency and can be used in clinical practice and outcome research.

Background The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate.

Background: Congenital midnasal stenosis has previously been described as a cause of nasal obstruction in infants, and conservative and interventional treatments have been suggested. However, midnasal stenosis in adults has not been reported and related normative measurements have not been studied. Methods: Three adult patients presented with nasal obstruction and, based on examination and radiological findings, were diagnosed with midnasal stenosis. Anatomical measurements were studied in axial and coronal computed tomography scans, and compared with findings for 161 healthy individuals. Results: Anatomical measurements showed that the endonasal cavity was larger in males than females. The midnasal region was found to be constricted in patients compared to healthy controls. Conclusion: This is the first study to report on midnasal stenosis in adults and to define normative anatomical measurements in adults. In patients presenting with nasal obstruction, midnasal stenosis should be suspected during endoscopic visualisation of medially located middle turbinates and uncinate processes in nasal cavities. A definitive diagnosis of midnasal stenosis can be made by examining paranasal sinus computed tomography scans. Endoscopic middle turbinectomy, complete uncinectomy, mega maxillary antrostomy and partial anterior ethmoidectomy have been suggested to relieve midnasal stenosis. [ABSTRACT FROM AUTHOR]

Objective: Nasal obstruction and congestion can occur because of turbinate and septal variations with or without rhinitis. A combined treatment for nasal obstruction and congestion was examined retrospectively in cases where the nasal swell body was addressed with inferior turbinectomy, with or without posterior nasal nerve ablation. Methods: A 940 nm laser was utilised for contact (nasal swell body, septum and inferior turbinate) and non-contact (posterior nasal nerve) ablation. Total Nasal Symptoms Score, visual analogue scale pain score, complications and procedure location (office vs operating theatre) were recorded. Results: All 242 patients underwent nasal swell body reduction with inferior turbinate reduction, and 150 had posterior nasal nerve ablation also. No laser complications were observed. An 80 per cent reduction in medication usage was noted. Total Nasal Symptoms Score decreased by 73 per cent; rhinorrhoea and congestion scores decreased by 54 per cent and 81 per cent respectively. Crusting, epistaxis and infections were minimal, and resolved within two weeks. Conclusion: Nasal swell body with inferior turbinate reduction, with or without posterior nasal nerve ablation, is a new method of treating nasal obstruction and congestion. Laser posterior nasal nerve ablation can be utilised as a complementary tool to deliver anatomical obstruction relief. [ABSTRACT FROM AUTHOR]

Background: The immunomodulatory and pharmacokinetic effects of cyclosporine A are used to treat diverse disease entities in different medical fields, including organ transplantation and/or autoimmune diseases. It is also applied in patients with nephrotic range proteinuria as an adjunct to steroids and supportive antihypertensive/anti- proteinuric medications. Cyclosporine has a small therapeutic window and is dosed with respect to the under- lying disease entity and severity via trough level adaptations. Among its most frequent adverse effects are hypertension, nephrotoxicity, neurotoxicity, and electrolyte disturbances. Hypertrichosis and gingival hyperplasia are obvious and widely recognized adverse effects. Case Report: We report on a 66-year-old woman who was treated with cyclosporine A for primary membranous nephropa- thy. During treatment with cyclosporine, she developed hirsutism and gingival hyperplasia. Later, she reported having impaired nasal breathing and dyspnea on mild physical exercise. Clinical, rhinoscopic, and radiological evaluations showed marked conchal hyperplasia as a potential cause of her symptoms. An extensive medical work-up did not show evidence of allergic, immunologic, or other drug adverse effects, suggesting cyclosporine-induced hyperplasia of the turbinates as a hypothetical causative factor. Dose reductions did not lead to resolution of symptoms but resulted in increasing proteinuria. Therefore, cyclosporine was stopped, and the patient was treated with rituximab. Thereafter, hirsutism and gingival and conchal hyperplasia gradually regressed over 2-4 months, showing complete resolution of conchal hyperplasia on computed-tomography fol- low-up after 6 months. Conclusions: Cyclosporine can not only result in gingival hyperplasia but also in hyperplasia of the turbinates leading to impaired nasal breathing and shortness of breath on exertion. An extensive search for many other known causes of conchal swelling is warranted to finally suggest an adverse effect of cyclosporine. Discontinuation of cyclosporine resulted in complete remission of conchal hyperplasia as well as other adverse effects. [ABSTRACT FROM AUTHOR]

Objective: Resection of middle turbinate in the setting of endoscopic sinus surgery is a controversial procedure. Our aim is to assess the impact of the anterior part middle turbinoplasty on the outcome of endoscopic sinus surgery, incidence of synechia between the middle turbinate and the lateral nasal wall, intra- and post-operative accessibility to the paranasal sinuses. Methods: Single blinded randomized controlled study of 120 patients with chronic rhinosinusitis without polyps, they were allocated into two groups, we performed anterior part middle turbinoplasty in the group one "60 patients", and we preserved the middle turbinate in the group two "60 patients". We assessed the patients pre-operatively by Sino-nasal outcome Test (SNOT-22), intra-operatively by Likert scale score for the sinuses accessibility. At least 6 months post-operatively, we assessed the patients by SNOT-22, and Likert scale score for sinus accessibility. Results: During and after surgery, the Likert scale score in the group one showed statistically significant better sinuses accessibility than in the group two. We noticed synechia between the MT and the lateral nasal wall in 9.2% and 18.2% of the operated sides in group one and group two, respectively. SNOT-22 and its smell item improved significantly in both groups with no statistically significant differences between them. No major complications were reported. Conclusion: Anterior part middle turbinoplasty is a safe and effective technique during endoscopic sinus surgery to improve the intra- and post-operative sinus accessibility, and decrease the incidence of post-operative synechia, with no adverse effect on olfaction or bleeding. [ABSTRACT FROM AUTHOR]

Objective: Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty. Methods: Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up. Results: Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43). Conclusion: Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention. [ABSTRACT FROM AUTHOR]

Objectives: The volume of the inferior turbinates (IT) and the lining of the maxillary sinuses are important parameters when assessing sino-nasal diseases. However, no radiographic studies have investigated the correlation between these parameters. The present study was conducted to analyze the association between IT volumes and thickness of maxillary sinus mucosal lining. Materials and methods: A retrospective evaluation of the cone-beam computed tomography (CBCT) scans of 100 adult subjects was carried out by two radiologists. The scans were assigned to two groups (Group 1 & 2) based on the radiographic evidence of maxillary sinus lining in the CBCT scans. Group 1 consisted of 50 CBCT scans of subjects with no evidence of maxillary sinus mucosal lining, whereas Group 2 consisted of 50 subjects with evidence of maxillary sinus mucosal lining. The scans in the Group 2 were further sub-classified into five categories, based on the thickness of the maxillary sinus mucosal lining. Vesalius 3D software was used to evaluate the total volume of inferior nasal turbinates by the two radiologists and a mean volume was obtained for each study subject. Results: The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologist was 0.87. Analysis of the results revealed that there was no significant gender-based difference (Group 1, P = 0.67 and Group 2, P = 0.95) in the total turbinate volume in either of the study groups. The total turbinate volume did not show any significant correlation (Group 1, r = 0.24 and Group 2, r = 0.12) with the age. There was a significant increase (P = 0.001) in the total turbinate volume of the subjects in Group 2 compared to Group 1. Regression analysis revealed that the thickness of sinus lining correlated significantly (P = 0.001) with the total turbinate volume. Conclusion: An increase in the total turbinate volume has been associated with an increase in the thickness of the maxillary sinus mucosal lining. The data from this study will be useful for post-operative follow-up of inferior turbinates and maxillary sinus lining after the turbinate volume reduction procedures.

Aim of this manuscript is to propose a clear and easily applicable classification for turbinate surgery, based on the use of a numerical model, which could be introduced in the practice of Otolaryngologists and Maxillo-Facial surgeons.Applying this classification, it will be possible to offer an easy format when describing which turbinates are involved in a procedure, and to offer a quick method to record and analyse clinical data, also for scientific purpose. [ABSTRACT FROM AUTHOR]

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergicmedication in patientswith allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged > 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p<0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days (p=0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days (p<0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. [ABSTRACT FROM AUTHOR]

Objective: This study investigated whether inferior turbinate reduction combined with septoplasty improves patients' outcomes, as assessed by objective and subjective methods. Methods: A single-centre, parallel-group, randomised, open-label trial was conducted at a tertiary hospital ENT clinic. Patients who underwent septoplasty were divided into two groups: group A underwent septoplasty with radiofrequency ablation; group B underwent only septoplasty. All patients were assessed before and three months after surgery using acoustic rhinometry and peak nasal inspiratory flow measurements, as well as Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores. Results: Seventy-four patients completed the study (36 in group A and 38 in group B). The patients in both groups showed significant improvements in acoustic rhinometry and peak nasal inspiratory flow measurements and in Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores after the surgery (p < 0.05). However, the differences between the groups were not significant (p > 0.05). Conclusion: Inferior turbinate ablation combined with septoplasty does not provide any more benefit to the objective and subjective outcomes of patients than septoplasty alone. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis. Materials and Methods This study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4. Results Intersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201). Conclusion Although nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.

Abstract Background Septoplasty (surgery to straighten a deviation in the nasal septum) is a frequently performed operation worldwide, with approximately 250,000 performed annually in the US and 22,000 in the UK. Most septoplasties aim to improve diurnal and nocturnal nasal obstruction. The evidence base for septoplasty clinical effectiveness is hitherto very limited. Aims To establish, and inform guidance for, the best management strategy for individuals with nasal obstruction associated with a deviated septum. Methods/design A multicentre, mixed-methods, open label, randomised controlled trial of septoplasty versus medical management for adults with a deviated septum and a reduced nasal airway. Eligible patients will have septal deflection visible at nasendoscopy and a nasal symptom score ≥ 30 on the NOSE questionnaire. Surgical treatment comprises septoplasty with or without reduction of the inferior nasal turbinate on the anatomically wider side of the nose. Medical management comprises a nasal saline spray followed by a fluorinated steroid spray daily for six months. The recruitment target is 378 patients, recruited from up to 17 sites across Scotland, England and Wales. Randomisation will be on a 1:1 basis, stratified by gender and severity (NOSE score). Participants will be followed up for 12 months post randomisation. The primary outcome measure is the total SNOT-22 score at 6 months. Clinical and economic outcomes will be modelled against baseline severity (NOSE scale) to inform clinical decision-making. The study includes a recruitment enhancement process, and an economic evaluation. Discussion The NAIROS trial will evaluate the clinical effectiveness and cost-effectiveness of septoplasty versus medical management for adults with a deviated septum and symptoms of nasal blockage. Identifying those individuals most likely to benefit from surgery should enable more efficient and effective clinical decision-making, and avoid unnecessary operations where there is low likelihood of patient benefit. Trial registration EudraCT: 2017–000893-12, ISRCTN: 16168569. Registered on 24 March 2017.

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p

Superior repositioning of the maxilla during Le Fort I osteotomy (LFI) may narrow the inferior nasal passage. This retrospective study was performed to investigate morphological changes in the inferior nasal passage following LFI with/without additional procedures performed for nasal ventilation (horseshoe osteotomy or inferior turbinate partial resection). Three groups of patients were compared: those undergoing conventional LFI (Conv, 63 patients), LFI with horseshoe osteotomy (Hs, eight patients), and LFI with inferior turbinate partial resection (Turb, 21 patients). Coronal computed tomography images were used to evaluate the degree of stenosis of the inferior nasal passage. The soft tissue and bony tissue volumes in the inferior turbinate were also calculated three-dimensionally. The rate of obstruction of the inferior nasal passage postoperative was 65.9%, 50%, and 11.9% in the Conv, Hs, and Turb groups, respectively (Fisher's exact test, P < 0.001). Patients in the Turb group had significantly less nasal obstruction regardless of the pitch direction of the maxillary movement or volume of the bone in the inferior turbinate (all P < 0.001). In conclusion, for patients with high superior repositioning and well-developed bony tissue in the inferior turbinate, additional procedures are recommended to maintain the ventilation of the nasal passage postoperatively., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to investigate the presence and severity of inferior turbinate hypertrophy (ITH) in patients with hypertrophic scars (HTS)., Methods: This case-control study was conducted with patients diagnosed with HTS during dermatologic examination and a control group without HTS. An otolaryngologist evaluated the presence and severity of inferior turbinate hypertrophy by anterior rhinoscopy., Results: ITH was more common in patients with HTS compared to the control group (64%, and 34%, respectively) (p=0.014). In the HTS group, 48% of patients had grade 2, and 16% had grade 3 ITH; in the control group, 24% had grade 2, and 10% had grade 3 ITH (p=0.046). Also, ITH was higher in patients who complained of pruritus or pain (83%, and 80%, respectively) in the HTS than in asymptomatic HTS patients (p=0.020)., Conclusion: A higher number of patients with HTS had ITH compared to the control group, especially those who reported pruritus or pain associated with scar. Given the limited understanding of the full pathogenesis and treatment of HTS and ITH, their association potentially provides new insights into these related conditions., Competing Interests: The authors declare no conflicts of interest., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty., Competing Interests: Disclosures E.M. Kirkham, is an author for UpToDate and is supported by the National Heart Lung and Blood Institute of the National Institutes of Health (K23HL153897). C.M. Baldassari reports involvement in the Inspire Registry. No other financial disclosures or conflicts of interest exist., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. Methods: Children between 4 and 15 years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. Results: Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden's index was the 38.88% improvement in nasal resistance with nasal decongestant. Conclusions: In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the autonomic reflexes caused by inferior turbinate outfracture or bipolar cauterization for inferior turbinate reduction surgery. Methods: The investigators designed and implemented a prospective study composed of 80 patients who underwent a septoplasty with inferior turbinate reduction. The predictor variable was the type of bilateral reduction operation and included inferior turbinate outfracture with a freer elevator and 20 watts bipolar cauterization for 15 s per side after septoplasty. The primary outcome variable was the intraoperative changes of the heart rate monitored preoperatively and 20 s, 1 min, and 4 min after the turbinate reduction procedure. Other variables were systolic and diastolic blood pressure alterations after the inferior turbinate outfracture or bipolar cauterization procedure. Descriptive and bivariate statistics were computed and the P-value was set at.05. Results: The sample was composed of 160 procedures in 80 patients grouped as follows: Outfracture (n = 100) and Cauterization (n = 60). There were no significant differences between the ages; grades of the turbinate hypertrophy; preoperative heart rates; and intraoperative 4th-minute heart rates, systolic and diastolic blood pressures. However, baseline systolic (p < 0.001) and diastolic (p < 0.001) blood pressures of the bipolar cauterization group were higher than outfracture group. Bipolar cauterization did not cause any significant changes in the heart rate, systolic and diastolic blood pressures. Inferior turbinate outfracture procedure caused a significant increase in heart rate (65.4 ± 9.82, p < 0.001), systolic (103 ± 8.62, p < 0.001) and diastolic (63.5 ± 7.37, p < 0.001) blood pressures. Conclusion: The results of this study suggest that during the inferior turbinate outfracture procedure, it is important to closely monitor sympathetic and parasympathetic reflexes. The surgeon, and anesthesiologist, must be aware of the early stages of the autonomic reflexes during turbinate reduction. [ABSTRACT FROM AUTHOR]

Introduction: The role of the anatomical variations and severity of acute rhinosinusitis (ARS) in the development of ARS complications is still an unknown issue. Regarding this, the present study evaluated the relationship between the severity of ARS and anatomical nasal variations in pediatric patients with ARS-related orbital complications. Materials and Methods: This study was conducted on 134 pediatric patients with orbital complications related to ARS. The data related to patients’ demographics, complication types, and involved side were collected. Nasal sides were also compared in terms of the Lund-Mackay score (LMS), osteomeatal complex (OMC) obstruction, Keros classification, presence of agger nasi cells (AGC), concha bullosa, Haller cells, Onodi cells, septal deviation, and lower turbinate hypertrophy. Results: The comparison of LMSs indicated a significant difference between the complicated and contralateral sides (8.37±2.44 vs. 5.62±2.71; P