This study aimed to discuss the role of large cavity functional endoscopic sinus surgery in the management of chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

This was a retrospective review of patients undergoing large cavity functional endoscopic sinus surgery for non-steroidal anti-inflammatory drug exacerbated respiratory disease from January 2016 to March 2022. Population characteristics, pre- and post-operative number of functional endoscopic sinus surgical procedures, endoscopic polyp grade, Lund–Mackay score and nasal symptoms were recorded.

Thirteen consecutive patients with a median age of 47 years were included. They all failed maximal medical treatment and/or conservative functional endoscopic sinus surgery and underwent large cavity sinus surgery followed by post-operative maximal medical therapy. All patients showed an improvement in nasal symptoms with improved Lund–Mackay scores post-operatively. The median length of follow up was 1.5 years.

Large cavity functional endoscopic sinus surgery seems to halt the progression of chronic rhinosinusitis with nasal polyps in non-steroidal anti-inflammatory drug exacerbated respiratory disease. In this case series, large cavity functional endoscopic sinus surgery combined with optimal post-operative medical treatment appeared to switch off chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

To determine the association between frontal sinus pneumatisation and concomitant anatomical variations in paranasal sinuses as seen on computed tomography.

A total of 403 patients who underwent paranasal sinus computed tomography were allocated to three groups according to the degree of frontal sinus pneumatisation (type 1 – hypoplasia; type 2 – medium size; and type 3 – hyperplasia). In this unique model, the prevalence of ipsilateral variations on paranasal sinuses on each side of the head were analysed separately within each pneumatisation group.

The type 3 frontal sinus pneumatisation group showed a greater association with ipsilateral variations of the sphenoid bone. Variations included pneumatisation of the anterior clinoid process, lateral sphenoid recess, pterygoid process and greater wing, and exposure of Vidian canal. This group also showed significant associations with male gender, and the presence of frontal and Onodi cells.

Interpretation of the paranasal sinus variations is imperative for pre-operative evaluation in functional endoscopic sinus surgery, particularly in patients with frontal sinus hyperplasia. Attention to variation on the ipsilateral side is informative.

This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate.

This technique aims to prevent unwanted damage to surrounding nasal mucosa.

Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa.

To review the origins of epistaxis in patients with unknown bleeding sites.

This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes.

The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients.

Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.

To determine the frequency distribution of bleeding sites in idiopathic hidden arterial epistaxis.

In this retrospective cohort study, 107 patients with hidden arterial epistaxis were endoscopically examined for sites of bleeding.

All sites of hidden arterial epistaxis were identified by endoscopic examination. Bleeding sites were identified at initial surgery in 103 patients and during the second surgery in 4. The bleeding sites included: the olfactory cleft region in 47 patients, the inferior meatus region in 29, the middle meatus region in 11, multiple bleeding sites (olfactory cleft and anterior septum) in 3, the anterior roof of the nasal cavity in 4, the nasal floor in 11 and the nasopharynx in 2. The bleeding points showed a white or red volcano-like bump in 75 patients, isolated prominent telangiectasia in 21 and mucosal ulceration in 11.

Common sites of hidden arterial epistaxis include the olfactory cleft, inferior meatus and middle meatus. However, there should be awareness of some uncommon bleeding sites (including the anterior roof of the nasal cavity, the nasal floor and the nasopharynx) and of multiple bleeding sites.

Sinonasal malignant melanoma is a relatively rare malignancy with poor prognosis, and effective treatments remain elusive. This analysis aimed to explore whether post-operative radiotherapy conferred any survival advantages in patients with this disease when compared with surgery alone.

Published studies were identified by searching four electronic databases. The endpoints evaluated were: rates of overall survival, disease-free survival and local control.

Twenty-eight studies including 1392 patients were identified. The results indicated that post-operative radiotherapy led to a significantly better three-year overall survival rate (p = 0.02), and suggested a borderline significant benefit for five-year overall survival (p = 0.05), when compared with surgery alone. However, no statistical advantage was found for disease-free survival, local control or one-year overall survival.

This meta-analysis indicated that adjuvant radiotherapy prolonged survival, but showed no benefit for disease-free survival or local control.

Studies on the nasal cycle can be limited by time-consuming rhinomanometric measurements. However, quantifiable subjective assessment of nasal airflow has been limited by poor correlation with rhinomanometric data, even when investigating patients with a deviated nasal septum.

Thirty healthy participants attended two study days for rhinomanometric and subjective assessment of nasal airflow (using the subjective ordinal scale). A nasal partitioning ratio was calculated for both measures.

Objective and subjective nasal partitioning ratios were compared; strong correlations were seen, with a correlation coefficient of 0.64 (p < 0.00001) on day 1 and 0.68 (p < 0.00001) on day 2.

The use of the subjective ordinal scale and nasal partitioning ratio provides a sensitive tool for assessing relative nasal airflow, with results that correlate strongly with rhinomanometric data. This finding strongly suggests that this combination could be used for future subjective assessment of the nasal cycle.

Nasal obstruction is a common ENT complaint; however, decisions on its management are challenging, with high rates of dissatisfaction following surgery. This study investigated the practice of UK clinicians in the evaluation of nasal patency.

Seventy-eight UK-based rhinologists were surveyed at the 2015 British Academic Conference in Otolaryngology.

Clinical history and examination are almost universally used to evaluate nasal blockage. The most commonly used test was the nasal misting pattern (73 per cent), followed by peak nasal inspiratory flow (19 per cent). The Sino-Nasal Outcome Test 22 or 23 was utilised by 29 per cent of respondents. Sixty-three per cent of respondents reported that a lack of equipment was the principle reason for not using objective measures, followed by time constraints and a lack of correlation with symptom scores.

British clinicians rely on clinical skills to evaluate nasal blockage. There is a desire for a simple, non-invasive device that objectively measures airflow for nasal breathing during physiological resting and correlates with subjective symptom scores.

To investigate the effects of different suture materials in the nasal cavity on encrustation and micro-organism colonisation.

Four different suture materials were used to suture the nasal septum. The effects of suture materials on intranasal encrustation were evaluated with anterior rhinoscopy. The sutures were removed and evaluated in terms of micro-organism colonisation on the 7th and 21st post-operative days.

Monofilament sutures were found to cause less encrustation and micro-organism colonisation. There was increased late-stage encrustation if an absorbable monofilament suture remained in place for a long time. The removal of a non-absorbable monofilament suture in the early or late post-operative period made no difference in terms of micro-organism growth on the suture.

The material and physical characteristics of sutures placed inside the nose may indirectly affect the healing process. It may be more appropriate to use different materials depending on the length of time the suture is to remain in place.

This paper presents an efficient and ergonomic system for performing rigid endoscopic examination in the out-patient clinic setting. The set-up encourages user comfort, and facilitates clear images of the nasal mucosa, nasal cavity and paranasal sinuses.

This consisted of anti-fog solution, a 5 ml syringe, a cardboard receiver and gauze.

By using disposable equipment we encourage good infection control practices. We recommend that users of rigid endoscopes in the out-patient setting consider setting up for each patient in this manner.

The purpose of this study was to evaluate the effectiveness of the combination of inferior and middle meatal antrostomies for treatment of a maxillary sinus fungus ball by functional endoscopic sinus surgery.

A retrospective analysis including 28 patients with non-invasive fungal maxillary sinusitis was performed. Fourteen patients underwent FESS with both middle and inferior meatal antrostomies (combined group). The remaining 14 patients were treated with FESS through only the middle meatal antrostomy (control group).

Post-operative computed tomography showed normal maxillary sinuses in all patients in the combined group. In contrast, in the control group, five patients (36 per cent) exhibited a normal maxillary sinus, seven (50 per cent) showed maxillary mucosal thickening and two (14 per cent) had persistent fungus balls in the maxillary sinus.

FESS with a combination of middle and inferior meatal antrostomies proved more effective for treating fungal maxillary sinusitis.

This study compared the results of nasal Staphylococcus aureus carriage and nasal cytology in men with and without a moustache.

The study group comprised 118 adult men with a moustache, and the control group consisted of 123 adult men without a moustache. Samples were taken from the participants' right nasal cavity for cytology and from the left nasal cavity for microbiology.

The results for S aureus were positive in 19.5 per cent (n = 23) of participants with a moustache and in 20.3 per cent (n = 25) of men without a moustache. This difference was not significant (p > 0.05). However, nasal cytology revealed rich eosinophil clusters in participants with a moustache.

The presence or absence of a moustache had no effect on nasal S aureus colonisation. However, further research is needed to understand whether the presence of a moustache increases the risk of allergic or non-allergic rhinitis.

Nasal dilator strips are thought to widen and stiffen the anterior nasal cavity, and thus improve symptoms of nasal obstruction. It is postulated that anthropomorphic differences in external nasal proportions between races may influence the effectiveness of such dilator strips.

Caucasian and Asian subjects were compared. Nasal peak inspiratory flow, nasal airway resistance, minimum cross-sectional area and visual analogue scale measurements of nasal obstruction were recorded at baseline and following the application of two different dilator strips.

Nine Caucasian and six Asian subjects were recruited (n = 15). There was a significant difference between races in terms of nasal peak inspiratory flow improvements following nasal strip application (mean of 29.4 litres per minute in Caucasians vs 14.6 litres per minute in Asians; p = 0.04). Only Caucasians experienced a significant decrease in nasal airway resistance (median of 0.12 Pa/cm3/s; p < 0.01).

Nasal peak inspiratory flow, minimum cross-sectional area and visual analogue scale values improved from baseline with strip application in both populations. Only Caucasians experienced significant nasal airway resistance improvement with strip application. Both cohorts experienced nasal peak inspiratory flow improvement, with Caucasians experiencing a significantly larger improvement.

Immunoglobulin G4 related disease is a rare condition. Cases involving the sinonasal region are exceptionally uncommon. This paper describes a case of immunoglobulin G4 related disease isolated solely to the nasal cavity.

Case report and literature review.

A 34-year-old man presented with painless, progressive bilateral nasal obstruction. Clinical examination and imaging findings demonstrated bilateral submucosal swelling of the anterior septum and right external nasal wall. Biopsy revealed immunoglobulin G4 related disease. The patient responded to oral corticosteroids initially, followed by long-term methotrexate.

To the best of our knowledge, this case represents the first report in the literature of immunoglobulin G4 related disease isolated solely to the nasal cavity.

To assess subjective preference using three nasal hygiene systems: Stérimar Original®, Emcur® and Sinus Rinse™.

We used a prospective, single-blind, randomised, crossover study to compare three nasal hygiene systems: Stérimar Original, Emcur and Sinus Rinse.

Eighteen adult volunteers were recruited and were asked to rate their experience over three days using three well-established nasal hygiene systems. A standard visual analogue scale was used to assess five criteria: (1) simplicity of instructions; (2) ease of use; (3) comfort; (4) perceived nasal clearance (effectiveness) and (5) single best overall system.

Stérimar Original was found to have the easiest instructions to understand compared to the other two systems. There was no significant difference between Stérimar Original and Sinus Rinse with regards to ease of use but they were both significantly easier to use than Emcur (p < 0.05). There was no statistically significant difference between the three systems when comparing the last three criteria. There was no alteration in preference when the cost of each treatment was disclosed to the subjects, and no significant side effects were reported.

The instructions accompanying Stérimar Original appeared to be the easiest to understand, while Stérimar Original and Sinus Rinse were easier to use than Emcur.

To report a unique case of unilateral blindness secondary to transnasal endoscopic surgery and stenting for right choanal atresia.

A 24-year-old man was referred with right eye blindness and acute headache, occurring immediately after transnasal endoscopic surgical repair of unilateral right choanal atresia with placement of an endonasal stent. Maxillo-facial computed tomography with three-dimensional reconstruction showed the endonasal stent entering the right nostril, passing through the lamina papyracea into the orbit and running anterior to the optic foramen towards the superior orbital fissure. Despite stent removal and medical treatment (ceftriaxone and dexamethasone), permanent right eye blindness secondary to an irreversible lesion of the optic nerve was diagnosed. At three-month follow up, an uncommon, complete fibrous obliteration of the right nasal fossa was noticed.

To the best of our knowledge, this is the only published report of unilateral blindness following transnasal endoscopic stenting for right choanal atresia. Causes of this complication, and ways of avoiding it, are discussed.

To highlight the important clinical and histological features of sinonasal blue naevi.

A case of blue naevus of the nasal cavity is described (including endoscopic and histological pictures) and the existing literature is reviewed.

There have been five reported cases (including the presented case). Clinically, sinonasal blue naevi are heavily pigmented lesions that are small and asymptomatic. Histopathologically, blue naevi exhibit heavily pigmented dendritic melanocytes that are never abnormal in form.

Blue naevus should be a differential diagnosis for pigmented lesions within the sinonasal cavity, despite its rarity. It may be initially suspected by its small size and asymptomatic nature. However, histological examination is required for definitive diagnosis, looking for the key microscopic features described above.

To present and evaluate the use of nasal dermoplasty for control of recurrent nasal polyps.

Prospective case series.

The mucosa of the fovea ethmoidalis and the lamina papyracea was replaced by a split-thickness skin graft. The follow-up period ranged from 2 to 12 months.

Five patients underwent nasal dermoplasty for recurrent nasal polyposis. In three cases, the graft uptake was successful. Post-operatively, four patients reported they were in better condition than at the same interval after their previous operation. Recurrence of polyps was noted in all patients but not in the grafted areas.

In this study, there was a high prevalence of successful graft uptake following nasal dermoplasty. This technique may have potential for the control of recurrent nasal polyps. Although it is demanding and time-consuming, it may reduce the need for multiple operations. Further research is justified to establish its efficacy.

To study the outcome of endonasal endoscopic surgery for adenoid cystic carcinoma of the sinonasal tract over a five-year follow-up period.

Retrospective analysis.

Four consecutive patients with adenoid cystic carcinoma of the sinonasal tract, who had undergone endonasal endoscopic surgery, were reviewed regarding age at diagnosis, sex, primary site, tumour-node-metastasis staging, treatment modalities, histopathological findings, duration of follow up, distant metastases and treatment outcome.

All patients were diagnosed at an advanced stage and had post-operative adjuvant radiotherapy. Three patients underwent endoscopic endonasal resection and one endoscopic assisted craniofacial resection. The most common primary site was the ethmoid sinus (three patients). Three patients had no evidence of recurrence. One patient who had undergone partial clearance via endoscopic endonasal resection developed cervical node metastases a year after treatment; this patient also developed distant metastases.

Adenoid cystic carcinoma is difficult to treat. Sinonasal tract tumours can be resected via endoscopic endonasal resection or endoscopic assisted craniofacial resection, but prolonged follow up is advisable. Radiotherapy is an important adjuvant treatment.

This study reports a case of a sinonasal inverted papilloma with spread to the temporal bone via the eustachian tube and subsequent transformation to squamous cell carcinoma.

An 81-year-old woman presented with sinonasal inverted papilloma which subsequently spread to the ear. A literature review of inverted papilloma was carried out based on a Pubmed search of studies published between 1987 and 2011, using the key words ‘sinonasal inverted papilloma’, ‘temporal bone inverted papilloma’ and ‘squamous cell carcinoma’.

Sinonasal and temporal bone inverted papillomas may sometimes be linked through direct spread via the eustachian tube. Inverted papillomas have the potential for malignant transformation; careful monitoring of both the nose and ear is therefore required for inverted papillomas found in the nasopharynx.