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Key Points Nasal valve treatment with TCRF results in NAO symptom improvement in the presence of septal deviation. Severe septal deviation does not impact the beneficial effect of TCRF nasal valve treatment. Symptoms improve with TCRF nasal valve treatment even if septal deviations involve the nasal valve. [ABSTRACT FROM AUTHOR]

Introduction: Nasal airway obstruction (NAO) could be a common symptom that influences a person's quality of life. It can be assessed by patient perception or by physical measurements. Computational fluid dynamics (CFD) can be used to analyze nasal function. There is a need of comparative studies for assessment of airflow regimes using CFD. Assessment of the different CFD utilities as an objective method for evaluation of nasal airflow characteristics was our main goal. Studied were collected from MEDLINE (Ovid), Google Scholar, Cochrane Library and EMBASE using a combination of the MeSH terms "septal deviation", "nasal obstruction", "Computational fluid dynamics (CFD)". Methods: We investigated all the results obtained by the authors with respect to the CFD parameters and the evaluation of nasal obstruction (clinical or physical). Results: To compare nasal obstruction with CFD parameters, most studied used heat flow, Wall Shear Stress (WSS), pressure drop, velocity and streamlines. We found that heat flux appeared to be the CFD parameter which most strongly correlated with patient perception. Pressure drop, wall shear stress and velocity were moreover valuable and appeared a great relationship. Conclusion: More and more research on CFD on the nasal cavity has caused a better understanding of nasal obstruction. Further studies need to be done, including temperature and humidity exchange. [ABSTRACT FROM AUTHOR]

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations. [ABSTRACT FROM AUTHOR]

Objectives: Prior studies evaluating the role of sinonasal anatomic variants with recurrent acute rhinosinusitis (RARS) are limited by inconsistent results. The goal of this study is to evaluate the association between sinonasal anatomic variants and RARS. Methods: A 1:2 retrospective case–control study was conducted using patients presenting to the rhinology clinic from August 2020 to January 2023. A total of 60 patients with RARS were compared to 120 control patients. RARS was diagnosed based on the International Consensus Statement on Allergy and Rhinology criteria of four or more independent episodes of acute rhinosinusitis per year with at least one episode documented by objective findings, with complete resolution of the infection in‐between episodes. Sinonasal anatomic variants included nasal septal deviation (NSD), concha bullosa (CB), infraorbital (Haller) cells, nasal septal spur in the middle meatus, and frontal sinus cells (supra‐agger, supra‐agger frontal, and suprabullar frontal cells). Results: Age was similar in RARS and control patients (47.4 ± 16.5 vs. 49.3 ± 14.5, p = 0.432). Both the RARS group and control group were more likely to be female (78.3% vs. 77.5%, p = 0.899). There was no significant association between NSD and RARS compared to the control group (OR = 0.97, p = 0.916), and no significant association between any of the anatomic variants and RARS [infraorbital cells (OR = 0.64, p = 0.167), CB (OR = 0.84, p = 0.596), spur in the middle meatus (OR = 1.28, p = 0.514), supra‐agger (OR = 0.88, p = 0.708), supra‐agger frontal cells (OR = 0.97, p = 0.939), or suprabullar frontal cells (OR = 1.13, p = 0.766)]. Conclusion: Our findings suggest no association between nasal septal deviation or any of the anatomic variants studied and RARS. Level of Evidence: 3 Laryngoscope, 134:3489–3492, 2024 [ABSTRACT FROM AUTHOR]

OBJECTIVE: The maxillary accessory ostium (AMO) has been associated with chronic rhinosinusitis and nasal septal deviation (NSD), but AMO may also be present in healthy individuals. AMO's purpose, origin, and effects are uncertain. This study aimed to investigate the types and frequency of AMO and NSD, as well as their relationship. METHODS: In our retrospective, single-center study, paranasal sinus tomographs performed in our clinic between 2022 and 2023 were scanned, and 200 patients who met the inclusion criteria were evaluated in terms of AMO direction (right/left), accessory ostium location (superior/middle/inferior 1/3), presence of NSD, and deviation type according to the Mladina index. RESULTS: 60.5% of the patients were female and 39.5% were male. AMO distribution was similar between the groups (p>0.05). There was no significant correlation between the presence and localization of AMO and the presence of NSD (p>0.05). NSD was detected in 93 patients (89.4%) with AMO and 78 patients (81.3%) without AMO (p=0.16). The distribution of NSD presence and types was similar in right or left localization, AMO (+) and AMO (-) patients (p>0.05). CONCLUSION: The evidence that AMOs cause chronic sinusitis and FESS failure is insufficient and cannot explain the presence of AMOs in healthy individuals or children. There are very few studies in the literature examining the NSD-AMO relationship. In our study, high rates of NSD and AMO were found in individuals without paranasal disease, but no statistically significant relationship was found between the presence, location, and type of NSD and AMO. Early-onset, long-term prospective studies on the relationship between NSD and AMO may help to explain the etiopathogenesis of paranasal diseases that reduce quality of life. [ABSTRACT FROM AUTHOR]

Background and Objectives Sinonasal fungal balls (FBs) most commonly occur in the maxillary sinus, followed by the sphenoid sinus (SS). Relatively little is known about the predisposing factors and pathogenesis of unilateral sphenoid sinus fungal balls (SSFBs) compared to maxillary sinus FBs. We investigated whether anatomical variations have clinical implications for the location of unilateral SSFBs. Methods This study included 33 patients who underwent endoscopic sinus surgery for unilateral SSFBs between 2010 and 2021. Preoperative computed tomography scans were used to analyze the presence of anatomical variations, including sphenoid lateral recess, complete accessory septum of the SS, types of SS pneumatization, anterior and posterior nasal septal deviation (NSD), cephalocaudal NSD, concha bullosa (CB), Haller cell (HC), paradoxical middle turbinate (MT), everted uncinated process (UP), and Onodi cell. Results The presence of HC (33.3% vs. 12.1%, p=0.04), complete accessory septum of the SS (51.6% vs. 25.8%, p=0.04), and the sellar type of the SS (90.9% vs. 50%, p=0.003) differed significantly according to the presence or absence of FBs in the SS. However, other anatomical variations, including NSD, CB, paradoxical MT, everted UP, Onodi cell, and sphenoid lateral recess, were not significantly associated with the presence of unilateral SSFBs (all p>0.05). In the multivariable analysis, only sellar-type pneumatization of the SS showed a statistically significant relationship with SSFB, not the combined conchal and presellar type (adjusted odds ratio, 8.96; 95% confidence interval, 1.27–63.19; p=0.03). Conclusion We demonstrated that unilateral SSFBs were most strongly associated with the ipsilateral type of SS pneumatization, followed by the presence of HC and a complete accessory septum of the SS. Intranasal anatomical variations may play a significant role in the location of unilateral SSFBs.

Background: Priming is a psychological phenomenon where subconscious cues in the environment impact our behavioral responses in certain situations. Well studied in the worlds of business, marketing, and even politics, it is unclear how the priming phenomenon impacts patient perception of their own disease state nor how they report that perception using tools like the Sinonasal Outcomes Test (SNOT-22), used to measure that perception in chronic rhinosinusitis. Objective: To determine the impact of positive or negative priming on self-reported patient perception of their chronic rhinosinusitis disease using the SNOT-22 disease-specific quality of life instrument. Methods: Single-blind, randomized, prospective cohort pilot study of 206 consecutive adult patients with a clinical diagnosis of chronic rhinosinusitis presenting to a university rhinology clinic. Patients were randomized to receive "positive priming" (103) or "negative priming" (103) by reading a passage about the positive or negative aspects of chronic sinusitis and its treatment respectively. Patients were then asked to fill out the SNOT-22 and results between the two groups were compared. Results: The negative priming group had a higher median SNOT-22 score of 49 [IQR = 39] compared to the positive priming groups' score of 22 [IQR = 27], p < 0.0001), a difference of nearly three times the minimal clinical impactful difference (MCID). This effect was consistent regardless of age or sex of the patient. Subgroup analysis revealed a greater impact when priming was performed by the senior male attending regardless of patient age or sex (p < 0.001), while priming performed by the younger female research fellow had greater impact on older patients (>59 years, p = 0.001) and female patients (p = 0.003). Conclusions: Priming impacts how patient's perceive their chronic rhinosinusitis as determined by the SNOT-22. It is imperative that the rhinologist understand this when using this instrument in research applications and in clinical decision-making for patients. [ABSTRACT FROM AUTHOR]

Objectives: Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation. Methods: A prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high‐arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height‐to‐width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing. Results: Ninety‐three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter‐premolar palatal height and the degree of septal deviation at the inter‐molar region. No significant correlation was observed between palatal dimensions and NOSE score. Conclusion: This study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures. Level of Evidence: 4 Laryngoscope, 134:2464–2470, 2024 [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to perform morphometric measurements of the pterygopalatine fossa (PPF), the transition zone to critical neurovascular structures. The second aim was to investigate the relationship between the volumes of the PPF and the paranasal sinuses and the effect of nasal septum deviation (NSD) types on all these measurements. Methods: We performed PPF's morphometry and all volume measurements on the CT images of 260 patients (130 male and 130 female, age range 18–79). Results: All volumetric measurements and the angle between foramen rotundum (FR) and pterygomaxillary fissure (PMF) were significantly higher in males than females. In contrast, the distance between sphenopalatine foramen (SPF) and PMF was considerably higher in females than in males. The PPF volume, the distance between the pterygoid canal (PC) and maxillary sinus, and the angle between FR and PMF were significantly higher on the right side than on the left. In contrast, the angle between PC and SPF and between greater palatine canal and PPF were considerably higher on the left side than on the right. The angle between PC and SPF decreased markedly with age. Only sphenoidal sinus volume was significantly smaller on the same side as the septal deviation. There was no correlation between PPF volume with maxillary and sphenoid sinus volumes from adjacent paranasal sinuses. Conclusions: Volumetric and morphometric data obtained from PPF and paranasal sinuses can aid clinicians in diagnosing and treating patients by guiding them in selecting the right surgical approach or tools, especially in endoscopic procedures. [ABSTRACT FROM AUTHOR]

The present study was designed to test the hypothesis that there would be a correlation between nasal septum deviation (NSD) and a decreased maxillary sinus volume (MSV) in a Colombian population, using Cone Beam Computed Tomography (CBCT); other sinusal anatomical structures found during the reading were described and analyzed. A retrospective analysis of 537 CBCT scans of adult patients taken between January 2014 and January 2017 included measuring the maxillary sinus diameter in the vertical, horizontal, and sagittal planes. NSD was quantified and related to MSV using the same field of view (FOV). The volume of the right and left maxillary sinuses showed a median and interquartile range (IQR) of 8.18 mm3 (IQR: 6.2–10.33) and 8.3 mm3 (IQR: 6.4–10.36). Statistically significant differences were observed between sex and right and left MSV (p = 0.000), with higher MSV in men. The presence of NSD was observed in 96.81% of the sample and was evaluated in degrees, observing a median of 11° (IQR: 7–16) where 40% of the sample had moderate angles (9–15°). There was no correlation between NSD and a decreased MSV in the population studied. Detailed CBCT analysis with a large FOV is crucial for the analysis of anatomical structures before performing surgical procedures that involve the MS as a preventive diagnostic and therapeutic step for appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Nasal septal deviation is a common anatomical variation that can lead to significant impairment in nasal airflow and quality of life. Septoplasty is a surgical procedure aimed at correcting septal deviation to alleviate symptoms and improve nasal function. Methods: A prospective study was conducted over a one-year period, involving 60 patients with septal deviation who underwent septoplasty. Pre- and post-operative assessments included subjective quality of life measures (Rhinoplasty Outcome Evaluation [ROE] questionnaire, 36-item Short Form Health Survey [SF-36]), objective measures of nasal function (acoustic rhinometry, peak nasal inspiratory flow [PNIF]), and nasal obstruction symptom evaluation (NOSE) scale. Results: Septoplasty resulted in significant improvements in subjective quality of life measures, as evidenced by increased ROE and SF-36 scores post-operatively. Objective measures of nasal function also showed improvement, with increased nasal volume and airflow post-septoplasty. These improvements were sustained over the one-year follow-up period. Conclusion: Septoplasty is an effective treatment option for patients with septal deviation, leading to improvements in both subjective quality of life measures and objective measures of nasal function. [ABSTRACT FROM AUTHOR]

Objectives: To investigate how eustachian tube dysfunction symptoms change following surgical treatment of nonsinusitis‐related nasal obstruction. Study Design: Retrospective chart review. Setting: Single academic center. Methods: We assessed patients who underwent septoplasty, turbinate reduction, or both for nasal obstruction. Chronic sinusitis patients were excluded. Eustachian tube dysfunction (ETD) symptoms were studied using the Eustachian Tube Dysfunction Questionnaire (ETDQ‐7), collected preoperatively and postoperatively (1 week, 1 month, 3 months, 6 months postop). Patients with preoperative ETDQ‐7 > 14.5 were considered to have clinically significant symptoms. Sinonasal outcomes test scores were also assessed. Pre‐ and postoperative ETDQ‐7 scores were compared using t test. Multivariate linear regression analysis identified factors associated with ETDQ‐7 change. Results: We analyzed 259 patients. Preoperatively, 37.5% of patients with nasal obstruction had clinically significant ETD symptoms. These patients exhibited significant improvement in ETDQ‐7 at all postoperative timepoints from 23.3 ± 7.6 at baseline to 19.1 ± 9.1 at 1 week, 16.5 ± 8.0 at 1 month, 16.2 ± 7.8 at 3 months, and 16.7 ± 10.4 at 6 months (all P <.01). In patients without baseline ETD symptoms, (baseline ETDQ‐7: 9.1 ± 2.3) ETDQ‐7 scores did not change significantly at postoperative timepoints, except for an acute worsening at 1 week postoperatively (10.7 ± 5.1, P <.001). Regression analysis showed that higher preoperative ETDQ‐7 score (β = −0.84, 95% confidence interval [CI]: −1.10 to −0.59) and postoperative antihistamine spray usage (β = −8.70, 95% CI: −14.20 to −3.20) were associated with ETDQ‐7 improvement, while comorbid GERD (β = 7.50, 95% CI: 3.42‐11.58) and asthma (β = 5.62, 95% CI: 0.80‐10.45) were negatively associated with improvement. Conclusion: Surgical correction of nasal obstruction may improve ETD symptoms. [ABSTRACT FROM AUTHOR]

Objective: Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient‐reported nasal obstructive symptoms in the post‐operative follow‐up. Methods: An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results. Results: A total of 2577 patients (males: 65.1%, 95% CI: 59.9–70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4–36.2) were included in this meta‐analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3–71.9). The pooled MD in NOSE score at 6‐months follow‐up compared to baseline was −48.8 (n = 1730, 95% CI: −54.6 to −42.9). Conclusions: Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score. Level of Evidence: NA Laryngoscope, 133:3237–3246, 2023 [ABSTRACT FROM AUTHOR]

IntroductionExtensive septal deviations requiring advanced correction beyond conventional methods. Extracorporeal rhinoplasty technique, involving complete septum removal, reshaping, and reinsertion. While this technique possesses unacceptable risks, the current study aims to introduce a new approach, the sling-bridge technique to enhance and simplify extracorporeal septorhinoplasty, with more tip control and better integrity within the keystone area.MethodsThis prospective analytical study included 50 patients with crooked nasal septum who underwent extracorporeal septorhinoplasty between 2021 and 2023 with the new technique. Patients underwent a full clinical examination, consultation and facial analysis to examine the nose shape and identify any abnormalities and asymmetries in the face.ResultsIn the study involving 50 patients, 41 (82%) were males, and with no history of prior rhinoplasty, primarily seeking aesthetic improvements in 44(88%) of participants. Facial asymmetry was observed in 35(70%) of the patients, with 42(84%) individuals exhibiting reduced nasal projection index, nasolabial angle, or nasofrontal angle. The novel technique achieved a straight nose outcome in 45(90%) of patients out of 50, while 5(10%) patients experienced mild deviation linked to extensive preoperative facial asymmetry.ConclusionThe surgery yielded highly satisfactory results in most patients, with straight nose outcomes being almost 10 times more likely than mild nose deviation outcomes, and no frank deviations. Throughout the follow-up period, none of the patients had complications, especially those that are common in other techniques attributed with extracorporeal septorhinoplasty, such as dorsal irregularities, septal perforation/deviation or abscesses.

To determine minimal clinically important differences (MCIDs) for the DyNaChron chronic rhinosinusitis quality-of-life questionnaire. MCIDs are the smallest changes in a quality-of-life score that are of clinical relevance for the patient. They allow treatment benefit to be estimated. MCIDs have not previously been determined for DyNaChron. A single-center retrospective study analyzed DyNaChron questionnaires filled out between June 2016 and December 2021 by all patients consulting for chronic nasal dysfunction. Five hundred and thirteen of the 2390 patients were operated on for nasal polyposis (NP; n = 282) or septo(rhino)plasty + inferior turbinoplasty (SPIT; n = 231). Standard error of measurement was used to determine MCIDs. MCID for DyNaChron global score was 60 in NP and 58 in SPIT. MCIDs per symptom domain in NP and SPIT respectively were: 15 and 13 for nasal obstruction, 21 and 21 for anterior rhinorrhea, 20 and 19 for posterior rhinorrhea, and 17 and 17 for olfaction. In agreement with global MCID, 257 NPs (91%) and 149 SPITs (65%) showed clinical improvement. MCID helps assess response to treatment. In the DyNaChron questionnaire, MCIDs enable global and symptom-specific assessment of chronic nasal dysfunction and its impact on quality of life in a single patient or in groups. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of Paranasal Sinus Abnormalities with Primary Acquired Nasolacrimal Duct Obstruction (PANDO). Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan, from Jul 2021 to Feb 2022. Methodology: A total of 90 patients were included in the study. 40 were part of the control Group while 50 formed the Study Group. Patients presenting with Nasolacrimal Duct Obstruction and Sinonasal Abnormalities were included in the study. All Data Analysis was performed using statistical package for social sciences (SPSS) 23.0 software (SPSS inc., Chicago, IL, USA). Results: The Mean age of control group was 50.0±8.3 years while the mean age of patients in the NLDO group was 53.8±6.5 years. 32(64%) had right sided NLDO while 18(36%) had left sided NLDO. No statistically significant association was found between PANDO and Sino-nasal abnormalities such as Concha Bullosa, Chronic Sinusitis, Turbinate Hypertrophy and Septal Deviation (p=0.05). Conclusion: No Association was found between Sino-nasal pathologies and their potential role in the development of PANDO. Further researches are needed on this topic especially ones exploring gender predilection and ethnicity to ascertain with certainty the potential relation of PANDO with paranasal pathologies. [ABSTRACT FROM AUTHOR]

The present study was designed to test the hypothesis that there would be a correlation between nasal septum deviation (NSD) and a decreased maxillary sinus volume (MSV) in a Colombian population, using Cone Beam Computed Tomography (CBCT); other sinusal anatomical structures found during the reading were described and analyzed. A retrospective analysis of 537 CBCT scans of adult patients taken between January 2014 and January 2017 included measuring the maxillary sinus diameter in the vertical, horizontal, and sagittal planes. NSD was quantified and related to MSV using the same field of view (FOV). The volume of the right and left maxillary sinuses showed a median and interquartile range (IQR) of 8.18 mm3 (IQR: 6.2–10.33) and 8.3 mm3 (IQR: 6.4–10.36). Statistically significant differences were observed between sex and right and left MSV (p = 0.000), with higher MSV in men. The presence of NSD was observed in 96.81% of the sample and was evaluated in degrees, observing a median of 11° (IQR: 7–16) where 40% of the sample had moderate angles (9–15°). There was no correlation between NSD and a decreased MSV in the population studied. Detailed CBCT analysis with a large FOV is crucial for the analysis of anatomical structures before performing surgical procedures that involve the MS as a preventive diagnostic and therapeutic step for appropriate treatment.

Introduction: Choanal atresia is a rare anomaly of the nasal cavity, which is associated with other congenital malformations in half of the cases. The diagnosis is usually made immediately after birth, but late diagnoses are not rare in otorhinolaryngology practice. Case report: We are presenting the case of an eighteen-year-old woman with a history of difficulty in breathing through her left nostril that lasted for many years, increased secretion from the nostril and frequent headaches. During preoperative preparation, computerized tomography of the paranasal sinuses revealed left-sided choanal atresia and obstruction in the region of the left osteomeatal complex, which was then successfully resolved using a modern surgical approach. She was observed postoperatively. A control examination with an endoscope was performed one month after the operation, indicating that both choanae were passable. Choanal atresia can be an isolated craniofacial malformation or associated with CHARGE, Teacher Collins, Down, Crouson and Pfeiffer syndromes. Bilateral choanal atresias are life-threatening. Unilateral choanal atresias can present with a variety of symptoms depending on the type of atresia and the age of the patient. Conclusion: The diagnosis is made with a clinical otorhinolaryngological examination, nasal endoscopy and computerized tomography of the paranasal sinuses and the skull base. The therapy is surgical.

Background and objective. In cases of rhinoplasty with septal deviation, the clinical diagnosis by the specialist is a core part of the conduct to be taken, whether clinical or surgical, because nasal obstruction, which is usually caused by this pathology, is one of the most frequent symptoms, this being the first indication of non-aesthetic nasal surgery Objective. To determine the concordance between clinical and radiographic diagnosis in patients undergoing septoplasty in a specialized clinic in Lima, Peru, during the period 2020 - 2021. Methods. Observational, quantitative, retrospective, analytical study of concordance. By non-probabilistic sampling by convenience, all patients with clinical diagnosis of septal deviation and radiographic studies who underwent septoplasty surgery in our clinic were considered. A total of 124 medical records were obtained that met the inclusion criteria. The percentage of concordance between these two metrics was calculated, and we estimated weighted and unweighted Cohen's kappa statistics across all samples and then by configuration. Results. With a mean age of 33 years, it was found that the majority were women (55.28%) without a predilection for the degree of significant deviation; the predominant clinical diagnosis was moderate degree (54.84%) and the radiological diagnosis was severe (49.19%). The main gnosology was congenital (38.8%), followed by acquired (34.7%), even so, there is no significant relationship between sex and the type of deviation found. An insignificant concordance was found between clinical and radiographic diagnosis in all its forms. Conclusions. In our study, there was no concordance between clinical and radiological diagnosis with respect to the degree or severity of septal deviation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effect of septoplasty on nasal functional outcomes, sleep quality, and anxiety scores in patients with different types of septal deviation. Methods: A total of 90 patients (27 females and 63 males) were included in the study. The patients were divided into 3 groups of 30 each as anterior (group 1), posterior (group 2), or anteroposterior (group 3) deviations according to the type of septum deviation. Beck Anxiety Inventory, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Nasal Obstruction Symptom Assessment questionnaires were administered to all groups and completed at preoperative and 6 months postoperative time points. Results: Septoplasty significantly reduced the Beck Anxiety Inventory, Hospital Anxiety Scale, and Pittsburgh Sleep Quality Index scores in all groups but did not affect the Hospital Depression Scale score. Group 2 had the highest preoperative and postoperative Beck Anxiety Inventory scores. Pittsburgh Sleep Quality Index scores of groups 1 and 2 decreased after septoplasty. Conclusion: The septoplasty procedure improved nasal functional outcomes, sleep quality, and anxiety parameters. Sleep quality and anxiety levels may be affected differently in different types of septum deviations. [ABSTRACT FROM AUTHOR]

The air conditioning capacity of the nasal cavity is influenced by nasal septal deviations. As corrective surgery for septal deviation alters the anatomical structure of the nasal cavity, modification of the airflow behavior after surgery is likely to also change the heat recovery characteristics. The present study investigated the improvement in heat recovery characteristics after septoturbinoplasty using computational fluid dynamics techniques with realistic cavity models constructed from computed tomography scans. The results indicated that the mucosal surface heat transfer rate was strongly correlated with the airflow rate in both the inspiration and expiration phases (Pearson correlation coefficient greater than 0.9). Because the increase in the airflow rate was greater during expiration, the heat recovery rate with the same breathing effort improved by more than 30 % after surgery. [ABSTRACT FROM AUTHOR]

Objectives: Nasal Septal Deviation (NSD) is one of the most common causes of nasal obstruction. This study aims to further examine the clinical utility of imaging assessment in the workup and management of symptomatic nasal septal deviation, across all levels of medical training. Study design: Cross-sectional survey. Methods: CT scans of 10 confirmed NSD patients and 36 healthy controls (HC) were mixed and emailed through anonymous REDCap surveys to otolaryngologists in the US. The HC had no reported sinonasal obstruction symptoms—NOSE (NSD: 62.2 ± 12.5; HC: 5.69 ± 5.99, p < 0.05); SNOT-22 (NSD: 31.4 ± 14.5; HC: 9.72 ± 10.76, p < 0.05). The images consisted of a coronal slice at each subject's most deviated location. Participants were instructed to choose the patients suspected to present with symptoms of sinonasal obstruction. Results: 88 otolaryngologists responded to the survey. 18 were excluded due to incomplete responses. On average, they identified 64.2 ± 29.8% of symptomatic NSD subjects correctly, but misidentified 54.6 ± 34.6% of HC as symptomatic. Their decisions were strongly correlated to degree of NSD (r = 0.69, p < 0.05). There exists a significant degree of NSD among HC (38.7 ± 17.2%), which does not significantly differ from symptomatic subjects (51.0 + 18.7%, p = 0.09). Residents and fellows performed similarly, with responses correlated between levels of training (r = 0.84–0.96, p < 0.05). Conclusions: The incorporation of a substantial number of otolaryngologists, large patient sample, and blind mixing with HC gives us greater insight to the relative contribution of the extent of septal deviation to symptoms of nasal obstruction. Although NSD is a common factor contributing to nasal obstruction, the results of this study suggest that it is difficult to reliably infer obstructive symptoms based on degree of NSD on CT. Level of evidence: Three. [ABSTRACT FROM AUTHOR]

Background: A nasal septal dislocation is a common form of septal deviation with many challenges and different surgical techniques for correction. Objective: To assess the efficacy of fashioned mucoperichondrial flap technique versus fishing line technique in the repair of septal dislocation. Methods: The study was a prospective comparative cohort study conducted on 88 patients aged above 18 years who have symptomatic mild to moderate caudal septal dislocation spanning the period from June 2021 to June 2022. Preoperatively, all patients were evaluated by the Nasal Obstruction and Septoplasty Effectiveness (NOSE) scale to assess the degree of nasal obstruction. Anterior rhinoscopy and endoscopic examination of the nose were done for every patient to assess the degree of obstruction, whether mild, moderate, or severe. Outcomes included an assessment of both techniques' efficacy in managing nasal obstruction as expressed by the NOSE scale and comparing both techniques regarding the operative and postoperative details. Results: The current study showed a highly significant improvement in the NOSE scale postoperatively in both groups (P <.00001 for both groups). The mean operative duration for group I was significantly less than that for group II (P <.00001). There was a nonsignificant difference between both groups regarding the postoperative NOSE scale, and postoperative degree of obstruction (P =.066 and.56, respectively). Regarding postoperative complications, there was a nonsignificant difference between both groups except for patient discomfort as assessed 1 week postoperatively. Group II showed significantly more patient discomfort (P =.02), which improved 4 weeks postoperatively. Conclusion: Both techniques presented in this study effectively corrected mild and moderate caudal septal dislocation with significant improvement of nasal obstruction postoperatively. Both techniques produced good esthetic outcomes and were associated with few comparable complications in both groups. [ABSTRACT FROM AUTHOR]

Given the high burden of olfactory dysfunction worldwide, recently increased due to the COVID-19 pandemic, it is mandatory to adopt a specific questionnaire to assess the impact of olfactory impairment on quality of life, to be used in clinical practice. The aim of this study is to adapt and validate the short version of the Questionnaire of Olfactory Disorders-Negative Statements (svQOD-NS) for Italian. In the pilot phase, the Italian version of the questionnaire (ITA-svQOD-NS) was produced following recommended guidelines. It was then given to 50 healthy subjects and 50 patients (affected by either nasal polyposis or septal deviation), and results were compared to those of other widely used questionnaires. Test-retest reliability was assessed on a sample of 25 patients. All 50 patients repeated the questionnaires at one and nine months after surgery. The internal consistency of ITA-svQOD-NS measured with Cronbach α was excellent (α = 0.92). The intraclass correlation coefficient for test-retest reliability was also optimal (0.93; 95%CI: 0.90–0.96). Concurrent validity tested with the Pearson coefficient was significant with all other tests administered; also, concerning responsiveness, statistically significant differences were obtained between pre- and post-operative conditions. ITA-svQOD-NS showed high internal consistency, test-retest reliability, and significant correlation with all most-used clinical questionnaires; thus, it can be efficiently applied to assess olfaction-related QoL in the Italian population. [ABSTRACT FROM AUTHOR]

Nasal packing is the classic method adopted by many otolaryngologists to stabilize the nasal septum and decrease the occurrence of postoperative bleeding and septal hematoma after septoplasty. However, because of its associated postoperative morbidity, many surgeons started to adopt alternative methods. This study aimed to assess the outcome and benefits of septal quilting sutures in comparison to nasal packing after septoplasty. A prospective non-randomized comparative interventional study was carried out at two teaching hospitals in Mosul city from January 2020 to January 2021. A total of 60 patients who were candidates for septoplasty, were included in the study. According to the surgeon's preference; 30 patients had placement of septal quilting sutures (group A), and in the other 30 patients nasal packing was performed (group B). Patients were assessed for postoperative morbidity and early outcome in the first 24 h, 1 week and 1 month postoperatively. In the first 24 h after septoplasty, patients in group B had significantly higher levels of nasal/facial pain, headache, sleep disturbance, breathing difficulties and swallowing difficulties compared to group A (p < 0.001). Over the follow up period of 1 month, no significant differences were recorded regarding postoperative bleeding, hematoma, infection, adhesions formation and septal perforation between the two groups (p > 0.05). Septal quilting sutures technique is more favorable in the early period in terms of patient discomfort after septoplasty, better nasal block and nasal/facial pain, the absence of misery on pack removal, with minimal bleeding after surgery. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis is very common disorder encountered in general population. Anatomical variations in the nasal cavity are mainly responsible for improper drainage and subsequent chronic rhinosinusitis. Present study is crosssectional and observational study undertaken at ENT department of tertiary care hospital. 200 cases of chronic rhinosinusitis fulfilling inclusion criteria were evaluated for various anatomical variations in the nasal cavity using diagnostic nasal endoscopy and computed tomography. Present study of 200 cases showed male preponderance M: F ratio 1:0.56. Most cases (79.5%) belonged to age group 11–50. Nasal obstruction was presenting complaint in 90% cases. 78% cases had septal deviation. 20% had septal spur. 32% cases had enlarged inferior turbinate, 9% had paradoxical middle turbinate, 13% had enlarged middle turbinate, 1% had bifid middle turbinate. 12% had pneumatised middle turbinate. 7% had enlarged uninate process, 1.5% cases had hypoplastic uncinate process and 7% had enlarged ethmoidal bulla. 45% cases showed oval sphenoid ostium while 31% showed circular and 8% slit like opening. Agger nasi cells were present in 82% cases. All 200 cases had anatomical variations in nasal cavity so it can be concluded that these are responsible for chronic rhinosinusitis [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of nasal surgery including endoscopic sinus surgery (ESS) and/or septoplasty on Eustachian tube dysfunction (ETD) symptoms using the Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7). Methods: Patients who underwent ESS and/or septoplasty between April 2020 and October 2021 were retrospective reviewed. The patients were divided into 3 groups according to the type of surgery: group A, septoplasty alone (76 patients); group B, ESS alone (209 patients); and group C, septoplasty + ESS (74 patients). Responses to the ETDQ-7, SNOT-22, and NOSE questionnaires were collected preoperatively and at 3 months after surgery and compared between groups. Results: A total of 359 patients were included in the study. The prevalence of ETD was 28.9% (22 patients) in group A, 27.3% (57 patients) in group B, and 31.1% (23 patients) in group C. The ETDQ-7 score decreased significantly after surgery: total patient population, 12.47 ± 7.0 to 8.2 ± 2.48 (p < 0.001); group A, 12.76 ± 6.62 to 8.47 ± 2.66 (p < 0.001); group B, 12.05 ± 6.89 to 8.35 ± 2.73 (p < 0.001); and group C, 13.24 ± 7.72 to 7.55 ± 1.25 (p < 0.001). Both SNOT-22 and NOSE scores also decreased significantly after surgery in the total patient population and in all three groups. There was a strong correlation between ETDQ-7 and SNOT-22 scores (r = 0.56, p < 0.001) and a moderate correlation between ETDQ-7 and NOSE scores (r = 0.33, p < 0.001). Conclusion: Patients with CRS and/or NSD suffered from ETD, and showed significant improvement after surgery. In addition, ETD symptoms were shown to be affected by nasal obstruction as well as CRS symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The integration of virtual visits has been met with skepticism by many surgical specialties, including otolaryngology, due to the lack of a complete physical exam. Analysis of differences in the workup between patients triaged virtually or in-person is warranted., Methods: A chart review was performed for a cohort of adults undergoing septoplasty (January 2021-May 2022). Groups (telemedicine, in-person) were compared by 2-sample t -test and chi-square test to determine the difference in the number of preoperative visits and to assess the variation in patients with preoperative laboratory testing, imaging, or referrals., Results: Of 338 patients, initial evaluation was in-person for 225 (66.5%) and via telemedicine for 113 (33.5%). The groups were similar in demographics (mean age 39.1 years for telemedicine vs 38.8 years for in-person, female 28.9% vs male 37.7%, P = 0.088). The telemedicine group had a significantly higher number of preoperative visits (3.03) compared to the in-person group (2.38, P = 0.001). There was no significant difference in patients who underwent preoperative laboratory testing, imaging, or referrals. Patients triaged via telemedicine experienced a shorter time to surgery compared to those triaged in person (434 vs 208, P = 0.003)., Discussion: In this cohort, triage by telemedicine allowed otolaryngology patients to have an expedited path to surgery despite having more visits. There is no evidence to suggest that otolaryngologists had an overreliance on diagnostic modalities when triaging by telemedicine., Conclusion: Among patients undergoing septoplasty, those initially evaluated by telemedicine were more likely to have more preoperative visits and shorter time to surgery than those evaluated in person. Telemedicine can serve as an effective method for triaging surgical patients without excess diagnostics.

Background: There is a growing body of evidence on shared decision-making (SDM) training programs worldwide. However, there is wide variation in program design, duration, effectiveness, and evaluation in both academia (ie, medical school) and the practice setting. SDM training has been slow to integrate in practice settings., Methods: A pilot study of 6 multidisciplinary clinicians was conducted using quantitative and qualitative methods to evaluate changes in participant understanding and implementation of SDM in the practice setting. A 2-rater criterion-based evaluation method was used to assess a simulation-based case study role-play program using 7 domains of SDM pre and post training. The authors assessed whether clinicians addressed each of the 7 domains or what fraction of each domain was addressed as part of their simulation case study role-play performance. Focus groups were conducted pre- and postintervention to provide feedback to participants and to understand the clinician experience in greater detail., Results: The increase in improvement in SDM ranged from 17% to 37%, and 7 of 8 domains for which participants were rated showed significant improvement. The areas of greatest improvement were seen in determining a patient's goals/preferences, including risk tolerance regarding treatments (+37%) and values and self-efficacy (+37%)., Conclusion: The results of this study reveal a significant shift in clinician awareness of a patient's goals, preferences, and values. Postintervention, clinicians began to understand the value of building a partnership with their patients whereby the patient becomes an active participant in their clinical care., Competing Interests: Conflict of Interest This work was developed using data from Projects In Knowledge Powered by Kaplan (PIK). The results and findings are entirely the authors’ own and were not influenced by thoughts or opinions from PIK.

Objective: Existing literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging., Methods: A retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19-20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate., Results: In this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB., Conclusions: The prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Cleft lip and palate, the most common congenital orofacial anomalies, result in complex nasal deformities due to deficient bony maxilla, dentoalveolar arch, teeth, and soft tissues. This article explores nasal deformities in patients with cleft lip and palate, surgical techniques and considerations in cleft rhinoplasty, particularly focusing on nasal valves in both unilateral and bilateral cases. Unilateral cleft lip deformities include asymmetry of the nasal tip, flattened nostril, and displaced caudal septum, while bilateral cleft lip deformities present a wider and flatter nose with complex nasal features., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and objective: Causes for nasal airway obstruction (NAO) are many but septum deviation is the most prevalent etiology. A deviated septum affects the airflow dynamics in the human nasal cavity, which in turn affects the physiological functions of the nasal cavity like heating, humidification, and filtration capabilities. The present study investigates and compares the airflow patterns in a healthy nasal cavity to a septal deviated nasal cavity.Methods: Two nasal airway models are considered and compared in this study. One with a septal deviation and the second with a healthy patent nasal cavity. Airflow analysis is carried out by developing the CT scans into 3D models using Materialise MIMICS (Materialise, Ann Arbor, MI), and then using the FLUENT solver of ANSYS 2020R2. The simulations are carried out for airflows ranging in laminar and turbulent flows using the SST k-ω turbulence model. Polyhedral meshes are used and the mesh check using Grid Convergence Index studies is adopted.Results: The pressure and velocity profiles are assessed for a wide range of mass flow rates. The results indicate a turbulent flow pattern for mass flow rates over 15 LPM. The velocity profiles show aberrated flow profiles in a septal deviated nasal cavity where the peak velocity is observed at the mid-nasal region rather than the nasal valve region. There was a 38% to 55% higher nasal resistance in the septal deviated nasal cavity as compared to a normal and healthy nasal cavity. The pressure drop in the septal deviated nasal cavity is higher by 60%–120% when compared to a healthy nasal cavity.Conclusion: The septal deviated nasal cavity greatly affects the nasal airflow distribution resulting in higher velocities in the mid-nasal region, increased pressure drop and higher nasal resistance. Hence the NAO with septal deviation has to be rectified with proper surgical procedures.

Objectives: The purpose of the study was to examine the various preoperative predictive factors of inferior turbinate surgery and to find possible factors that predict an optimal subjective response using 3 common surgical techniques—radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT)—in a randomized, prospective study with a 1-year follow-up. Methods: The patients filled a visual analogue scale (VAS) questionnaire regarding the severity of nasal obstruction prior to and 1 year after surgery. A VAS score improvement of 3 points or more was chosen as an optimal subjective response. Univariate and multivariate regressions were used to evaluate the effect of the predictive factors. In total, 80 patients attended a 1-year control visit. Results: In the multivariate analysis, patients without anterior septal deviation had a statistically significantly higher odds ratio of a satisfactory subjective response compared to patients with anterior septal deviation (5.6; 95% CI: 1.4-23.1; P =.02). Patients treated with RFA had a statistically significantly higher odds ratio of an optimal subjective response compared to patients treated with MAIT (9.0; 95% CI: 1.5-54.2; P =.02). Conclusions: Anterior septal deviation seems to decrease the likelihood of an optimal subjective response to inferior turbinate surgery, which supports the consideration of concomitant septoplasty at least in clear cases to optimize the subjective response. Radiofrequency ablation had a significantly higher likelihood of an optimal subjective response compared to MAIT. Further investigations regarding the findings are needed. [ABSTRACT FROM AUTHOR]

Septoplasty is one of the most common procedures performed by facial plastic surgeons. Surgical decision-making surrounding septal deviation repair centers around the location of deviation and need for dorsal and/or caudal septal correction. Endonasal approaches are often adequate and external approaches are utilized for significant L-strut involvement. For severe deformities, extracorporeal septoplasty and anterior septal reconstruction can be utilized. We present an overview of septal deviation repair with technical nuances and advanced reconstruction techniques. [ABSTRACT FROM AUTHOR]

Septal deviation causes the air entering the nose to encounter resistance and leads to turbulent flow formation by disrupting laminar air flow. In the literature, the Schirmer test has been recommended to evaluate the moistening of the nasal mucosa. The purpose of this study was to evaluate the degree of nasal humidification using the intranasal schirmer test in patients with septal deviation and to reveal changes in mucosal dryness and humidity in both nasal cavities following septoplasty surgery. Fifty-three patients with septal deviation detected at endoscopic rhinoscopic examination and scheduled for surgery were enrolled. Schirmer test was performed twice, at a one-month interval, pre- and postoperatively and test records were compared. The Schirmer test value for the deviated side of the septum was significantly lower than that for the contralateral side, for both nasal cavities. Schirmer test values increased significantly on the side of the septal deviation compared to the preoperative values. Septoplasty surgery performed for septal deviation significantly and reduces nasal mucosa dryness so increases Schirmer test results on the deviated side. We attribute this to septal deviation impairing air flow in the nasal cavity and causing nasal mucosa dryness. [ABSTRACT FROM AUTHOR]

Abstract A numerical simulation of a patient’s nasal airflow was developed via computational fluid dynamics. Accordingly, computerized tomography scans of a patient with septal deviation and allergic rhinitis were obtained. The three-dimensional (3D) nasal model was designed using InVesalius 3.0, which was then imported to (computer aided 3D interactive application) CATIA V5 for modification, and finally to analysis system (ANSYS) flow oriented logistics upgrade for enterprise networks (FLUENT) to obtain the numerical solution. The velocity contours of the cross-sectional area were analyzed on four main surfaces: the vestibule, nasal valve, middle turbinate, and nasopharynx. The pressure and velocity characteristics were assessed at both laminar and turbulent mass flow rates for both the standardized and the patient’s model nasal cavity. The developed model of the patient is approximately half the size of the standardized model; hence, its velocity was approximately two times more than that of the standardized model.

Introduction: The caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship. Objectives: In this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty. Methods: This study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months. Results: In most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery. Conclusion: With these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation. Resumo: Introdução: O enxerto de extensão caudal é geralmente um enxerto de cartilagem que se sobrepõe à margem caudal do septo nasal. Uma combinação do enxerto de extensão caudal e a técnica de tongue-in-groove é utilizada para estabilizar a base nasal, definir a projeção da ponta e refinar a relação alar-columelar. Objetivos: Neste estudo apresentamos algumas novas modificações na colocação dos enxertos de extensão caudal na rinoplastia. Método: Este estudo é uma revisão retrospectiva de um banco de dados prospectivamente coletado de 965 pacientes que se submeteram a rinosseptoplastia de junho de 2011 a julho de 2015. Destes, 457 pacientes necessitaram de enxerto de extensão caudal e foram incluídos no estudo. O seguimento mínimo foi de 13,2 meses, com tempo médio de seguimento de 17,4 meses. Resultados: Na maioria dos casos, a comparação das fotografias antes e após a cirurgia foi satisfatória e apresentou melhora do contorno. Pequenas deformidades foram detectadas em 41 pacientes e 11 pacientes necessitaram de cirurgia de revisão. Conclusão: Com essas modificações, o cirurgião pode utilizar o enxerto de extensão caudal mesmo em desvios angulares do septo caudal. Vários métodos têm sido propostos para correção do desvio septo-caudal.

Introduction: Respiratory diseases may affect the functioning of the heart, lung and heart work synchronously. Clinical assessment and work-up of patients with pulmonary problems may need an extension to cardiac disease. Thoracic Ultrasonography (TUS) is a diagnostic modality being used to assess respiratory conditions as it carries the inherent advantages of ultrasonography such as being reliable, inexpensive, safe, reproducible, and having no radiation hazard. Aim: To assess the usefulness of performing Thoracic Ultrasound (TUS) and 2D Echocardiography in the same sitting, so as to confirm the respiratory diagnosis and to early identify various cardiac dysfunctions in patients with respiratory illnesses. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department (OPD) of Respiratory Medicine at Netaji Subhash Chandra Bose Medical College (tertiary care hospital), Jabalpur, Madhya Pradesh, India, from January 2019 to March 2020. Patients hospitalised with clinico-radiological diagnosis of pleural effusion, pneumonia, pulmonary fibrosis of interstitial lung disease, pulmonary oedema and Chronic Obstructive Pulmonary Disease (COPD) were subjected to TUS and echocardiography. Sonological findings and cardiac abnormalities were recorded. Data was analysed by applying descriptive statistics, t-test, and Chi-square test. A p-value <0.05 was considered as statistically significant. Results: A total of 133 patients were enrolled with diagnosis of pleural effusion (n=46), COPD (n=33), pneumonia (n=22), pulmonary fibrosis (n=18) and pulmonary oedema (n=14). Out of total 46 patients, 36 patients with pleural effusion had cardiac findings. The presence of pleural effusion showed a significant association with cor-pulmonale (p-value=0.012), dilated Right Ventricle (RV) (p-value=0.012), septal deviation (p-value=0.012), Pulmonary Hypertension (PH) (p-value=0.0002), Left Ventricular (LV) dysfunction (p-value=0.02) and Left Ventricular Ejection Fractions (LVEF) (p-value=0.006). The focal B-lines were seen in patients with pneumonia. Patients with Pulmonary fibrosis had scattered B-Lines, and patients with pulmonary oedema had bilateral diffuse B-lines. Among patients with pulmonary fibrosis, 11 (61.1%) had cor-pulmonale and dilated RV, whereas 10 (55.5%) had septal deviation. Patients with scattered B-lines more commonly had PH. In patients with COPD, cor-pulmonale was detected in 21 (63.6%), LV dysfunction in 5 (15.1%), mild PH in 14 (42.4%), moderate PH in 7 (21.2%), and severe PH in 5 (15.1%) using echocardiography. Conclusion: This study reveals the importance of performing a combination of TUS with 2D Echocardiography and suggests its usefulness in early diagnosis of cardiac dysfunctions in patients with various respiratory illnesses. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. Study Design: Blinded cohort study. Methods: Two fellowship‐trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non‐NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT‐based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. Results: aNSD reported no nasal symptoms – Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non‐NSD: 6.66 ± 7.17, P <.05); 22‐item Sino‐Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non‐NSD: 9.08 ± 12.42, P <.001). No significant differences in measured nasal resistance, minimum cross‐sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non‐deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non‐NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). Conclusions: This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. Level of Evidence: 3 Laryngoscope, 132:509–517, 2022 [ABSTRACT FROM AUTHOR]

Introduction: Respiratory diseases may affect the functioning of the heart, lung and heart work synchronously. Clinical assessment and work-up of patients with pulmonary problems may need an extension to cardiac disease. Thoracic Ultrasonography (TUS) is a diagnostic modality being used to assess respiratory conditions as it carries the inherent advantages of ultrasonography such as being reliable, inexpensive, safe, reproducible, and having no radiation hazard. Aim: To assess the usefulness of performing Thoracic Ultrasound (TUS) and 2D Echocardiography in the same sitting, so as to confirm the respiratory diagnosis and to early identify various cardiac dysfunctions in patients with respiratory illnesses. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department (OPD) of Respiratory Medicine at Netaji Subhash Chandra Bose Medical College (tertiary care hospital), Jabalpur, Madhya Pradesh, India, from January 2019 to March 2020. Patients hospitalised with clinico-radiological diagnosis of pleural effusion, pneumonia, pulmonary fibrosis of interstitial lung disease, pulmonary oedema and Chronic Obstructive Pulmonary Disease (COPD) were subjected to TUS and echocardiography. Sonological findings and cardiac abnormalities were recorded. Data was analysed by applying descriptive statistics, t-test, and Chi-square test. A p-value

Genetic, developmental, traumatic factors can produce a wide variety of nasal septal deformities in caudal–cephalic/dorsal–maxillary planes alone or in combination. These can be corrected by an endonasal approach through a transfixion incision by resecting, transposing, or utilizing principles of cartilage biomechanics. The authors are proposing a "Rosetta Stone" based on a trizonal analysis of the deviated nose that considers the contribution of each region to the deformity. Clinical assessment of the deviated nose should be segmental as well as global. Surgical correlation of the nasal bones, perpendicular, and quadrilateral plates, lateral cartilages, and turbinates may be necessary to achieve a satisfactory cosmetic and functional results. [ABSTRACT FROM AUTHOR]

Purpose: This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty. Methods: This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days. Results: One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37 years (range: 18–57 years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p < 0.05). The transseptal suture group had significantly lower EAT-10 and VAS scores on the second postoperative day than the Merocel packing and silicone packing groups (p < 0.05). Both EAT-10 and VAS scores on the postop 7th day significantly decreased in all groups compared to the postop second day (p < 0.05). Conclusions: Septoplasty affects swallowing, regardless of whether a tampon is applied. Transeptal suturing has a lesser effect on swallowing than other techniques. Although silicone packing is a less invasive method, it negatively affects swallowing, similar to Merocel packing. The transseptal suture technique is more comfortable than the other techniques in terms of swallowing function in the postoperative period. [ABSTRACT FROM AUTHOR]

Nasal septoplasty is often required to correct a cosmetic deformity, which is a common reason for patients to present to a plastic surgeon. If nasal septoplasty is insufficient, a residual deformity or nasal obstruction may remain after surgery. Even if the nasal septum is corrected to an appropriate position, nasal congestion could be exacerbated if the turbinate on the other side is not also corrected. Therefore, appropriate treatment is required based on the condition of the turbinates. Herein, we survey recent trends in treatment and review previous research papers on turbinoplasty procedures that can be performed alongside nasal septoplasty.

INTRODUCTION[|]The aim of this prospective clinical study was to compare the incidence of difficult airway in patients undergoing septal deviation with the incidence of difficult airway in patients undergoing tympanoplasty and to determine the factors associated with the incidence of the difficult airway. Investigation of predisposing factors for difficult airway in patients undergoing septal deviation surgery was evaluated as a secondary outcome. [¤]METHODS[|]A total of 255 participants, 130 patients undergoing septoplasty (study group-Group S) and 125 patients undergoing tympanoplasty (control group-Group T) were included in this study. Preoperative airway evaluation was performed using the LEMON protocol. For all patients, the STOP-BANG questionnaire was performed to identify the risk of Obstructive Sleep Apnea Syndrome (OSAS). Cormack-Lehane laryngeal view grades were noted during laryngoscopy. The definition of difficult intubation was identified according to the Cormack-Lehane scale (I–II=easy, III–IV=difficult). Additionally, the intubation method used, number of intubation attempts, use of stylet, cricoid pressure, and usage of airway were recorded.[¤]RESULTS[|]There were no unintubated patients in this study population. Cormack-Lehane score and incidence of difficult airway were significantly higher in the Group S than the Group T (p

Objectives: The aim of this manuscript is to analyse a diagnostic protocol to select correctly patients with Rhinogenic Headache Contact Point (RH) and to investigate the effect of surgical treatment and medical therapy in pain relief., Methods: A prospective no-randomized study selected adult patients with headache and nasal alteration at CT exam or endoscopic vision with positive response to test with nasal spray with corticosteroids and antihistamine or/and local anesthesia test to the contact points. MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month were collected in patients who performed surgery and in patients who performed medical therapy., Results: Following the inclusion, 415 patients were selected for this study. 302 patients performed nasal surgery (septoplasty, turbinoplasty and/or endoscopic surgery with centripetal technique), 113 performed medical therapy. There was a statistically significant improvement in MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month in patients who performed surgery and in patients who performed medical therapy. Regarding the comparison between patients who performed surgery (Group A) and patients who performed only medical therapy for RH (Group B), better outcomes were obtained by Group A. Considering the daily life handicap index, the lowest handicap was obtained in Group A., Conclusion: This study demonstrates that surgery, using in some cases centripetal technique, gives an improvement statistically significant than medical therapy in RH. The use of nasal spray with corticosteroids and with anti-histamine is a good method in the diagnosis of RH, especially in patients with anatomical variants such as concha bullosa, agger nasi cells and Haller cells., Competing Interests: Declaration of competing interest There is no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Granulomatous lesions in the nasal sinuses are associated with a variety of diseases, including immune disorders such as sarcoidosis, vasculitis, immunoglobulin G4 (IgG4)-related diseases, malignant lymphomas, and microbial infections. Here, we report a rare case of fungal granuloma that occurred exclusively within the nasal septum. The patient presented to the Department of Surgery with the chief complaint of nasal obstruction associated with nasal septal deviation. A bulge was found below the right nasal septum. Initially, it was diagnosed as mucosal swelling associated with rhinitis, and surgery was performed. A granulomatous lesion with bone destruction was found under the mucosa of the nasal septum, which led to the diagnosis of fungal granulation based on postoperative pathology. Though bacterial and fungal infections of the nasal septum are occasionally observed, this is the first reported instance of a fungal granuloma confined to the nasal septum. Infection within the nasal septum, although rare, should also be considered as a differential diagnosis for morphological abnormalities of the nasal septum., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of Osaka University issued approval 16329. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tamura et al.)

Deviated nasal septum is one of the most commonly encountered nasal anatomical abnormalities. Various studies showed that deviated nasal septum results in the osteo-meatal complex disease and compensatory turbinate hypertrophy. But only a few studies described the association between type and degree of angle of deviated nasal septum and measured the angle of septal deviation and explore its effect in causation of nasal symptomatology. Hence, this study was undertaken with the aim to study the relation between type and degree of septal deviation with nasal symptomatology and to measure the degree of septal deviation. This was an observational study and data collection was done from August 2017 to August 2019. A total 52 patients with symptomatic deviated nasal septum were studied. Higher septal deviation caused symptoms in 73% of cases and severe degree of angle of septal deviation caused symptoms in 63% of cases. High and severe deviated nasal are more associated with nasal symptoms. Therefore, we could derive a correlation between the cases with higher septal deviation and incidence of nasal symptoms. [ABSTRACT FROM AUTHOR]

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two‐block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross‐sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re‐establish a good function of the nasomaxillary complex. [ABSTRACT FROM AUTHOR]