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BackgroundThe thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years.MethodsIn this double-blind placebo-controlled clinical trial, 48 cases were divided into two groups randomly. Oral isotretinoin (0.5-mg/kg) was started on the 31st day after surgery and given every other day for 1 month and after that daily for two additional months in the first group. The second group received a placebo in the same form, sequence and interval as the first group. The cosmetic results based on patient satisfaction and ranking by an expert surgeon were compared between the two groups at 3 months, 6 months and 1 year after surgery.ResultsPatient satisfaction and ranking by an expert surgeon in the isotretinoin group at 3 months and 6 months after surgery were significantly better than in the placebo group (p value < 0.05); however, at 12 months after surgery there was no statistically significant difference between the two groups (p value > 0.05).ConclusionThough postoperative use of oral isotretinoin in patients with thick nasal skin accelerates improvement in cosmetic results during the early months after surgery, it does not significantly affect the final cosmetic result 1 year after surgery.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BackgroundContinuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea can produce troublesome nasal symptoms, especially congestion, which may affect the continuity of using CPAP. Intranasal steroids are often prescribed to reduce these side effects, although few recent studies exist supporting the benefits of this treatment for CPAP-induced nasal side effects.MethodsEighty-three patients with OSA were enrolled in a prospective, randomized controlled study. All patients received CPAP treatment and were divided in two groups. The study group was prescribed fluticasone furoate nasal spray 55 μg, and the compliance to CPAP for patients in both groups was recorded by device memory card. Total nasal symptom score was assessed using a questionnaire by direct interview, with follow-up performed at 30 and 90 days after treatment.ResultCompliance to CPAP increased in both groups with significantly greater compliance in the intranasal steroid group compared to the control group without intranasal steroid (P value = 0.002, 0.001, and 0.020, respectively) after 90 days of treatment. No difference in nasal symptoms was found between the groups after 30 days of treatment. However, adding an intranasal steroid resulted in decreased rhinorrhea and congestion symptoms (P value < 0.001 and < 0.001) after 90 days of treatment.ConclusionThe addition of an intranasal steroid decreased the frequency of nasal symptoms, especially rhinorrhea and congestion, among patients with OSA initiating CPAP therapy and increased compliance to CPAP after 90 days of treatment.Trial registrationIRB approval ID: R179hClinical trial ID: TCTR20200715001

Objective and design This double-blind cross-over study compared the potential of bilastine, cetirizine, and fexofenadine to relieve the symptoms of allergic rhinitis. Subjects and methods Seventy-five allergic volunteers were challenged with grass pollen in the Vienna Challenge Chamber (VCC) on two consecutive days of allergen provocation; 6 h on day 1 and 4 h day 2. Bilastine 20 mg, cetirizine 10 mg, fexofenadine 120 mg, or placebo were taken orally 2 h after the start of provocation on day 1 only. Total nasal symptom scores, the global symptom scores, nasal secretions, and eye symptoms were assessed on both day 1 and day 2. Results and conclusions Bilastine had a rapid onset of action, within 1 h, and a long duration of action, greater than 26 h. Cetirizine was similar. Fexofenadine was similar on day 1 but less effective on day 2, indicating a shorter duration of action. Bilastine, like cetirizine and fexofenadine, was safe and well tolerated in this study.

ObjectivesAs a rose geranium in sesame oil spray product has been anecdotally noted to improve nasal vestibulitis symptoms, this study was designed to assess whether patients with nasal vestibulitis associated with cancer-directed therapy experienced symptomatic improvements from it.MethodsPatients with breast cancer, prescribed rose geranium nasal spray, were identified by looking at pharmacy records and patient diagnosis at Mayo Clinic Rochester. Patient medical information, as well as documentation of symptoms, were gleaned from medical charts. Questionnaires were sent to patients regarding their experiences.ResultsOf the 40 patients with breast cancer who were prescribed rose geranium nasal spray, 100% were receiving cancer-directed therapy: 58 % were receiving taxane chemotherapy; others received a variety of cytotoxic and targeted therapy treatments. Twenty patients who had used the spray product returned surveys. Patient-reported nasal symptoms included bleeding (90%), dryness (86%), pain (81%), scabbing (67%) and sores (52%); patients consistently reported symptoms at a higher proportion than did healthcare providers. All patients who used the rose geranium nasal spray reported symptomatic benefit; one reported a little benefit, 11 (55%) reported moderate benefit and eight (40%) reported dramatic or complete resolution of symptoms. The therapy was well tolerated in most patients.ConclusionsRose geranium in sesame oil nasal spray appears to improve patient-reported nasal symptoms associated with cancer-directed therapy.

Topical nasal sprays are commonly prescribed for sinonasal disease. Nasal drops applied in a head-down position are described alternatively to sprays. Multiple research methods have investigated the deposition pattern of intranasal medications, each with limitations. This pilot study analyzed the use of a conebeam computed tomography (CBCT) scanner to study deposition patterns of intranasal sprays and drops using radiopaque contrast solution. Nine volunteers participated in this two-trial study. In trial 1, participants instilled 3 sprays of contrast into each nostril. After 3 minutes a CBCT scan was performed. In trial 2, 3 drops of contrast were instilled into the participants' nostrils in the \"vertex-to-floor\" position. Again, after 3 minutes a CBCT scan was performed. Two otolaryngologists and a neuroradiologist reviewed the images and scored 21 sites within the sinonasal cavity for the presence of contrast. Contrast was detected in the nasal vestibule and inferior nasal vault in nearly every trial with the spray and drops. Nasal spray was more diffusely distributed within the nasal cavity and was detected at a greater proportion on the floor of the nose, inferior meatus, anterior inferior nasal cavity, and nasopharynx. Neither spray nor drops were consistently detected in spaces superior to the middle turbinate. Radiopaque contrast delivered by nasal spray and drops were detected by the CBCT scanner, with a significant difference at one subsite. Neither spray nor drops were detected in superior nasal spaces. The CBCT scan provides an alternative to conventional CT scans in future studies using this technique.

An 82-year-old man with type 2 diabetes and recent glucocorticoid use presented with a 2-week history of headache and spontaneous bruising around his eye. Black eschars were observed in the nasal cavity (shown in a video).

BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19-associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. \"R-metafor package\" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041-0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212-4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205-0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.

Background: Sino‐nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. Objectives: To assess a minimally‐invasive topical treatment protocol for sino‐nasal aspergillosis in dogs. Animals: Twelve client‐owned dogs diagnosed with sino‐nasal aspergillosis that completed recommended treatment. Methods: Medical records were retrospectively reviewed to identify dogs with sino‐nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. Results: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. Conclusions and Clinical Importance: This protocol appears to be an effective and well‐tolerated minimally invasive treatment for sino‐nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.

Background Nasal myiasis is a rare parasitic infestation caused by fly larvae, which can lead to serious complications, such as orbital cellulitis, if not treated promptly. Early recognition and intervention are essential to prevent further complications. Case presentation We present a case of a 55-year-old Thai female with advanced-stage malignant melanoma of the right nasal cavity, treated with endoscopic tumor removal and 3 months of concurrent chemoradiation. The patient developed nasal myiasis and orbital cellulitis secondary to maggot infestation. A multidisciplinary approach, including adjunctive therapy with ivermectin, resulted in the successful resolution of both the infestation and its complications. Conclusion This case highlights the effectiveness of ivermectin in treating nasal myiasis and emphasizes the importance of a collaborative medical approach in managing complex cases. It also provides insights into the mechanism and clinical application of ivermectin for similar parasitic infestations.

Nasal cutaneous tuberculosis (TB) is a rare manifestation of extrapulmonary tuberculosis and presents a diagnostic challenge, particularly in its paucibacillary form. As demonstrated in this case, achieving laboratory-confirmed diagnosis in paucibacillary TB remains a significant challenge, often resulting in missed or delayed diagnoses and increased severity of disease on presentation. We report an atypical case involving a 19-year-old male with extensive nasal destruction progressing for fourteen years. In this case, lupus vulgaris was ultimately diagnosed after extending the tissue culture duration beyond 35 days, despite prior exclusion of TB as the cause. The patient completed antituberculosis therapy with resolution of the active disease, and he was referred for further management of his facial deformity. The delayed diagnosis led to significant tissue destruction, which could have been prevented with earlier confirmation and treatment of the infection. We propose that, in diagnostically difficult cases, the investigating team consider extending the specimen culture time to the maximum before definitively excluding tuberculous disease.