Online ISSN: 2515-8260

Keywords : Diagnostic nasal endoscopy


A Clinical Study on Etiology and Management of Sinusitis

Sanjay Pathlavath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 879-891

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.

CLINICAL PARADIGMS IN DIAGNOSIS OF MUCORMYCOSIS USING NASAL ENDOSCOPY IN COVID AND POST COVID PATIENTS

Poonam Khairnar, Mahesh Thikekar, Rajesh Kar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 12153-12163

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