European Journal of Molecular & Clinical Medicine

Background: Symptomatic deviated nasal septum is one of the most common diagnosis in otolaryngology. Nasal obstruction is most common presentation of the symptomatic DNS. Diagnosis can be made reliably through patient symptoms and examination. The diagnostic accuracy can be increased greatly by anterior rhinoscopy and diagnostic nasal endoscopy (DNE) Aim: To evaluate Anterior Rhinoscopy and Diagnostic Nasal Endoscopy findings in patients with symptomatic Deviated Nasal Septum (DNS). Methods: A profile of 120 Patients with chief complaints of nasal obstruction and findings of deviated nasal septum with or without inferior turbinate hypertrophy on anterior rhinoscopy  attending the department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College Srinagar, over a period of 18 months were included after fulfilling the inclusion criteria in this study. Results: In this study,120 patients were enrolled, majority of the patients (~80%) were young <30 years old. Most common presentation was nasal obstruction in 120(100%) patients. On examination C shaped DNS was seen in 93 (77.5%) patients followed by S shaped DNS in 17 (14.2%) patients and C/S shaped DNS with spur was noted in 10 (8.3%) patients, among 120 patients, 22 (18.3%) had hypertrophied inferior turbinate on anterior rhinoscopy. On DNE Most common type of DNS (Mladina classification) was type 2 in 52 (43.3%) patients, followed by type 3 in 35 (29.2%) patients, type 4 in 18 (15.0%) patients, type 5 in 6 (5.0%) patients, type 1 in 5 (4.2%) patients and type 6 in 4 (3.3%) patients. 10 (8.3%) had bullous middle turbinate. Middle meatus discharge was seen in 10 (8.3%) patients. Sphenoethmoidal recess secretions were seen in 1(0.8%) patient.  Paradoxical middle turbinate and accessory ostia were seen in 12 (10%) patients and 2 (1.7%) patients respectively. Conclusion: Preoperative evaluation with anterior rhinoscopy and diagnostic nasal endoscopy is adequate in most of the cases of symptomatic DNS. It is particularly important in developing countries were CT scans are not readily available and that x ray exposure can be avoided by a thorough clinical examination.

Background: Sinusitis, defined as inflammation of one or more of the paranasal sinuses,
is characterized as acute when lasting less than 4 weeks, subacute when lasting 4 to 8
weeks, and chronic when lasting longer than 8 weeks. Recurrent sinusitis consists of 3
or more episodes of acute sinusitis per year. A noninfectious form of chronic sinusitis is
termed chronic hyperplastic eosinophilic sinusitis. Viral upper respiratory tract
infections frequently precede subsequent bacterial invasion of the sinuses by
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These
organisms can also be found in chronic sinusitis, as well as Staphylococcus aureus,
Pseudomonas aeruginosa, and certain anaerobes. Fungi are being recognized
increasingly as a factor in chronic sinusitis, particularly in the southeast and southwest
parts of the countryDespite the prevalence of the disease there has been relatively few
studies on the etiological factors and various management options in sinusitis suggesting
the need to take up this study. Objectives: To study the etiological factors involved in
acute and chronic sinusitis. To study the effectiveness of conservative management in
sinusitis. To study the effectiveness of surgical procedures performed in the
management of chronic sinusitis.

Background: Nasal endoscopy is a procedure to examine the nasal and paranasal sinus passages with 0 degree nasal endoscopes. Mucormycosis is an aggressive, life-threatening invasive fungal infection affecting paranasal sinuses, orbits and brain. Early diagnosis of mucormycosis  is possible with   diagnostic nasal endoscopy (DNE) in  covid and post covid  high risk patients.
Objective: To substantiate the need of nasal endoscopy in high risk covid and post covid patients.
Materials and Methods: Covid (48) and Post covid (64) patients (both male and female) underwent diagnostic nasal endoscopy at tertiary care hospital during period of Jan 2021 to Dec 2021. All study subjects were screened with nasal endoscopy in ENT OPD. On nasal endoscopy the target area showed eschar or blackish discolouration of turbinates and septal perforation. MRI (PNS+ORBITS+BRAIN) with contrast was carried out in suspected patients to know the extent of invasive fungal infection. All symptomatic patients were screened by opthalmologists to see extent of invasion.
Results-Out of 112 patients, 70 patients were asymptomatic while only 42 patients were symptomatic for fungal invasion.  Out of 70 asymptomatic patients, 52 patients   were positive for fungal infection. Chronic diabetes mellitus and newly diagnosed diabetes mellitus (95 patients) was common co-morbidity associated with fungal positive HPR sampling.(71 patients).
Conclusion -Follow up of the high risk post covid patients, for sequeale with diagnostic nasal endoscopy should be mandatory as majority of our patients are asymptomatic.  Patient may present with atypical symptoms like earache, nasal polyposis so high degree of suspicion is essential.    Besides mucormycosis, coinfection with aspergillus also observed in our study. So reporting of such cases is also important. A coordinated effort from a multidisciplinary team including otorhinolaryngology, ophthalmology, neurosurgery, critical care, microbiology, and pathology department is also important. A delay of initiating treatment of mucormycosis may lead to  gross rise in morbidity and mortality rate