Friday, April 9, 2021

Lupine Publishers | The Novel Tympanostomy U-Tube (TUT) Insertions: Preliminary Clinical Results of 132 insertions

 Lupine Publishers | Journal of Otolaryngology


Abstract

Sixty-five subjects between 0.9 and 84 years old underwent 132 tympanostomy tube (TT) insertions using the novel Tympanostomy U-Tube (TUT). The follow-up of these cases concentrated on the performance and side effects of these tubes, including insertion time, crusting around the tubes, clogging, granulation formation, and residual perforation following removal/ extrusion. Residual perforation occurred in 4 ears (3%). Two of these patients were noncompliant with suggested follow up and returned to clinic at 18 months post insertion. Preliminary results are compared to what is known from the literature about other TTs. Conclusions: preliminary results of the TUTs suggest an improved, long-term TT that has the qualities of easy insertion, stability, and painless removal. Painless removal via a novel deployment mechanism makes it ideal for short-term use especially in children, due to the qualities of stability, drainage patency, and decrease in lumen clogging.

Introduction

Current TTs in clinical practice have been used internationally since the 1950’s. They were continuously improved but still have several persistent disadvantages. They differ from each other in expected insertion time, ability to drain middle ear secretions, ease of insertion, ease of removal, tendency to clog, granulation formation, and permanent perforation after removal or extrusion. In general, it was found that in 30% of patients treated by TTs a secondary intervention was needed due to early extrusion or persistence of otitis media longer than the mean insertion period of the common TTs [1]. The popular short or medium term TTs often fail to remain in situ until the otitis media resolves [2]. Isaacson summarizes the overview of the long-term course of OME: ‘Only 30-40% of children initially treated with short-term tubes require additional tubes for otitis media [2].’ Long-term TTs have higher tendency to clog, to form granulations, and to result in permanent perforation after removal/extrusion.2 Due to these failures they sometimes need to be removed or replaced earlier than planned, necessitating repeat interventions. Four percent of patients treated with the short-term TTs have premature extrusion [1], whereas 6.8% (5-10%) of them need removal under general anesthesia for failure extrusion.2 According to the National Survey of Ambulatory Surgery, in 2006, 21,446 children underwent TT removal in the ambulatory service alone (32,214 underwent surgical removal in conjunction with other procedure) [3]. About 16.6% of the longterm treated ears end with permanent perforation [4-6] and 7% have clogging [1,4]. Drainage of pus is sometimes difficult through narrow lumen of some types of these tubes. An innovative U-shape TT (Tympanostomy U-Tube or TUT, Figure 1) has been developed to address these well-documented shortcomings. The TUT combines the advantages of previous designs with a new patented shape based on finite element analysis of pressure distribution on the tympanic membrane. Asymmetric U–shaped arms (phalanges) have been designed to displace pressure away from perforation edges to maintain vascular supply to myringotomy margins. A collapse mechanism has been developed to facilitate painless removal, and a wide conically shaped lumen allows direct visualization and micro debridement. The unique collapse mechanism contains an extraction handle and a flexible arm that allows easy painless removal. These properties enable the TUT to be inserted for the treatment of OME (otitis media with effusion) or AOM (acute otitis media). The preliminary results of these TUTs are presented hereby.

Figure 1: The Tympanostomy U-Tube (TUT) (above) and in the ear (below).

Lupinepublishers-openaccess-otolaryngology-journal

The novel tympanostomy U-Tube

A new U-shaped TT (TUT) was used in this survey. This tube combines many good qualities found separately in other TTs together with new advantages:

a) Medical grade silicone (flexible)

b) Transparent light blue color enables detection of clogging inside the shaft

c) Conical shape lumen eases cleaning of clog

d) Wide internal diameter of 1.35mm in its narrower part

e) Anterior bold arm resists extrusion forces of the tympanic membrane

f) Springy arms reposition the TUT automatically

g) U-shaped arms (phalanges) designed according to finite element analysis of pressure distribution along the myringotomized tympanic membrane, displace contact with the medial aspect of the tympanic membrane away from the rim and maintain undisturbed vascular blood supply

h) Easy insertion

i) Novel patented collapse mechanism for painless removal by pulling the extraction handle.

j) FDA cleared, patented.

Subjects and Methods

This is a retrospective study in a tertiary medical center. The study was approved by the medical ethics committee. A detailed follow-up on patients who underwent TUTs insertions has been carried on with accurate follow-up, stressing the aspects of clogging, granulations, efficiency of purulent drainage, widening or creation of tympanic membrane perforation, time length of insertion and crusts around the tube. A report on patients who have long enough follow-up is presented. In this group 65 patient (132 ears) who underwent TUT insertion are included. TUTs were removed and reinserted in 5 ears of patients with Samter’s disease who had extremely thick mucus. We began inserting the ‘Small’ size of this tube and continued with both the ‘Small’ and the ‘Regular’ size which is 15% larger and stronger than the Small size. The Small size provides a short to mid-term insertion time whereas the Regular is suitable for all indications. The Small TUT was inserted in 18 ears and the Regular in 114 ones. The patients treated suffered from otitis media with effusion (OME - 109 ears), OME with retractions (7 ears), recurrent acute otitis media (RAOM - 14 ears), and a subject who suffered from flight barotrauma (2 ears). The Regular size was used in the latter part of the study. The TUT was successfully used also for intratympanic steroids treatment in few cases, but these ears are not included in this report since they were inserted for short period. For intratympanic treatment a spinal needle could be inserted through the TUT’s opening to deliver the solution. Trimming the shaft of the TUT was another way of intratympanic medication, used to instill steroid ear drops into the middle ear cavity by the patient. All the subjects underwent microscopic otoscopy in every examination, before and after surgery. Many of them were photographed in the F-U visits by an endoscopic camera. The results of these visits were statistically analyzed for multiple aspects including, in addition to the abovementioned aspects also ease of insertion, location in the tympanic membrane, spontaneous extrusion or intended removal at the end of treatment, ease of cleaning, and painless removal. The main results are hereby presented.

Results

Number of subjects: 65. Number of ears: 132. Small TUTs: 18. Regular TUTs: 114. Evaluation of ease of insertion: insertion was easy in both sizes. In all adults the TUT was inserted in the office without any anesthesia and it was almost painless. Follow-up: maximum 3.5 years. Average: 17 months.

Insertion period

Half of the 132 TUTs (21 extruded and 43 removed) are out of the ears at the end of treatment period. The other 68 TUTs are still in the ears. The mean insertion period of the spontaneously extruded TUTs was 15 months and of the removed TUTs was 17 months. Easy removal: 43 TUTs were removed at the end of treatment (including 33 children’s ears). Removal was painless in all cases, all in the office.

Complications

a) Perforation after removal/extrusion: In 4 ears the tubes caused widening of the perforation (3%) and were removed. Two of these patients failed to appear to the follow-up and came only after repeated reminders after 1.5 years. A permanent perforation occurred in their ears. Prior to the TUT insertion one ear had thin, retracted tympanic membrane. The patients are still under follow-up, less than 6 months after removal. b) Granulation: were found in 10%, all responded to topical treatment within 1-3 weeks.

c) Purulent discharge: 32% of ears had one or more episodes of purulent discharge, mainly in young children, probably due to AOM condition on insertion or exposure to water months after the insertion. All the ears had no difficulty in draining pus and responded nicely to topical treatment which stopped the discharge.

d) Clogging: clogging occurred in 7 Small and 10 Regular TUTs (13%), mainly in patients with Samter’s syndrome. Excluding these extraordinary cases (6 ears) the clogging rate was 10%, half of them in the Regular size. All cloggings were cleaned in the office or by various otic solutions at home. The three patients (6 ears) with Samter’s syndrome, having the typical extremely thick mucus, tended to clog repeatedly. In them removal and reinsertion of TUTs after cleaning was sometimes necessary.

e) Crusts around the TUT: In 55% of the TUTs small or big crusts accumulated around the tube, especially after long term period. They could be cleaned in the office using sterile normal saline and suction/micro debridement, but in non-cooperative children normal saline drops at home helped dissolving the crusts and cleaning spontaneously or by micro debridement when necessary.

Discussion

Based on early stage results of the Small TUT we developed and preferred the Regular TUT. Although preliminary, these results show that the TUT has similar side effects to other TTs (Tables 1&2). Low tendency for perforation has been noticed (1.5% in compliant patients, 3% overall), compared to 16% of the long-term TTs.2 David: it is unclear whether the 16% rate is comparable to these tut patients at 18 mo (is 18 mo in the “long term tt” criteria? In one case a retracted, thin tympanic membrane and in two other children it was after previous TTs insertions. Failure of the children to come for follow-up visits for 1-1.5 years interval increased the probability for perforation occurrence. Thin tympanic membrane and failure of follow-up appearance are considered as risk factors for permanent perforation. It has been mentioned2 that 4-6 months intervals between follow-up visits is recommended in all TTs to minimize complications such as imminent perforations or clogging. Despite the perforations the TUT provides other qualities. Permanent perforations are considered a result of long-term implantation in the tympanic membrane and it occurs mainly in the T-tubes types.

Table 1: Comparison between TUT and average TTs data

lupinepublishers-openaccess-otolaryngology-journal

*: see Samter’s syndrome remarks in discussion

Table 2: Comparison between TUT and long-term TTs performances.

lupinepublishers-openaccess-otolaryngology-journal

*: see Samter’s syndrome remarks in discussion.

The TUT provides good drainage, easy insertion, painless removal, and easy micro debridement. The painless easy removal, when relating to the 21,446 children in the U.S. per year who needed surgical removal of TTs3 and the greater number of children (30- 40%)2 who need second insertions or other modalities for the treatment of prolonged OME cases – emphasizes the importance of stability of the TUT in the ear. The excellent control on insertion time length gives the clinician complete control on the case management. According to its qualities the TUT appears to be an improved long-term as well as short-term TT, suitable for insertion in every type of middle ear ventilation/ drainage problem. It can therefore exempt the surgeon from making compromises when choosing the optimal TT. Since in many cases it is difficult to predict the time length of otitis condition, this TUT, having wide-span arms provides long insertion time and the surgeon can decide when to terminate the insertion period. Due to its collapse mechanism, it allows for a painless removal also in children (in the office), after a short (for example – after flight or intratympanic treatment) or long period. Due to the wide internal diameter (1.35mm), it can easily drain pus. The wide lumen also eases cleaning clogs and enables intratympanic administration of solutions. Regular followup and debridement when necessary can minimize side-effects and extend the duration of insertion as clinically indicated. The 4-6 months intervals between follow-up visits, as recommended (Isaacson2) is suitable for the TUT as well as for any other kind of TT and is highly recommended to detect and treat undesired course. According to the literature the longer the TT remains in the ear the higher the incidence of complications. Crusts accumulation, granulations, clogging and widening of perforations occurred in the poor compliance patients. Combination of well-designed and tolerated TT with short intervals follow-up can minimize these complications.

As to the patients with Samter’s syndrome, they are an exception since their problem is not the typical OME that we usually see. In them, the TUTs did better than various other TTs types used before in their ears. In these cases, removal and reinsertion of the TT is sometimes essential for keeping the middle ear cavity clean for the long term. For this purpose, the TUT is the ideal tube. Excluding these cases, the clogging rate in the ‘Regular’ TUT was 7 of 115 TUTs – 6%. In the following tables a comparison between the TUT and the literature data on other TTs are presented.

Summary

The advantages of the TUT based on our findings can be summarized as:

a) Clinician control of duration of insertion

b) Good drainage due to wide lumen

c) Decreased clogging because of a wide lumen and conical shape

d) Easy cleaning due to the conical shape

e) Stable tube that diminishes the need for a second intervention

f) Easy, painless removal upon the surgeon’s decision (due to the unique collapse mechanism)

g) Low rate of perforations in our study (no final results), probably due to the novel design of the patented arched arms

h) The TUT is suitable for repeated intratympanic administration of medication

i) These qualities make the TUT a good choice TT for every indication.

Read More Lupine Publishers Otolaryngology Journal Articles:

https://lupine-publishers-otolaryngology.blogspot.com/

 

 

Friday, March 26, 2021

Lupine Publishers | Sinonasal Surgeries in a Tertiary Health Care Institution in a Developing Country, Nigeria

 Lupine Publishers | Journal of Otolaryngology


Abstract

Background: Sinonasal diseases usually required surgical management. There is increasing cases of poorly treatment by nonspecialist. This study aimed at determining sociodemographic features, indications, complication and outcome of sinonasal surgeries

Materials and methods: This was a retrospective study of patients that had sinonasal procedures in our tertiary health care facility. The data collected were collated and analyzed using Statistical Package for Social Sciences (SPSS) version 18.0.

Results: The proportion of sinonasal procedures among the patients was 31.6%. There were 58.8% males with male to female ratio of 1.5:1 Major presenting complaints was 57.3% nasal blockage and 52.8% catarrh/epistaxis. Common clinical findings were rhinorrhea and reduced nasal patency in 69.4% and 48.8% respectively. Sinonasal procedures in unilateral nasal cavity was 52.2% while right nasal cavity occurred in 29.6%. Outpatient clinic procedures was 66.7%, elective procedures accounted for 60.5% and major procedures accounted for 29.3%. masses is the commonest CT Scan findings in 20.3% followed by sinuses in 15.6%. Main diagnosis was 39.9% rhinosinusitis, 38.3% foreign body impaction and 10.8% nasal polyps. Common sinonasal procedures were 38.3% nasal foreign body removal, 10.8% polypectomy, 9.8% antral washout and 9.3% nasal packing. Main complication of sinonasal procedures were wound infection in 2.9% and recurrence in 2.6%. There was 76.2% patient’s satisfaction with the sinonasal surgeries.

Conclusion:Sinonasal surgery is common in all age group. Presentation were most late, complicated and advanced. It mostly presented as clinic and elective procedures in this study.

Keywords:Rhinologist; sinonasal surgeries; nasal diseases; sino nasal diseases

Introduction

Sino nasal surgery is an art of surgical treatment of the nose and para-nasal sinuses pathology by either otorhinolaryngologic or Rhinologist [1,2]. Sino nasal diseases are on the increase due increase in industrialisation and technology [3-5]. There is also increase in sociomedical interaction and cosmetic consciousness about nose worldwide [5]. All these has led to growing rhinology subspecialty demands. Nose occupied the strategic position in the middle third of the face [6-8]. It is the outermost and uppermost conduit of the respiratory tract and prone to all forms of environmental hazard. This ranges from congenital to acquired diseases [3,4]. Various types of acquired nasal diseases includes traumatic, inflammatory, neoplastic, metabolic and systemic diseases with nasal manifestation [3,4]. Sinonasal diseases may also be primary or secondary to diseases from other head and neck organs which includes eye/orbit, dental apparatus, brain, cranial nerves and other intracranial structures [9-11]. These are managed by different forms of surgical approach and adjunct medical treatment. Clinical presentation of sinonasal disorders and other related diseases such as rhinosinusitis, sin nasal tumour, nasal polyps, dental diseases, lacrimal disorders, pituitary tumours, sin nasal cerebrospinal fluid rhinorrhea, and anterior skull base tumours presented to family physician, casualty officers, neurosurgeons, and ophthalmologists and subsequently referred to otorhinolaryngologic [12-14]. Pattern of clinical features of sinonasal diseases are nasal discharge, nasal blockage, nasal mass, bout of sneezing, headache, fever and facial asymmetry [13,14]. Other related symptoms depends on the primary source of sinonasal diseases which includes ocular symptoms, orodental symptoms and central nervous system symptoms. Radiological imaging inform of computerised tomography scan is required to rule out the extent of the tumour and bony destruction. Sinonasal endoscopy for diagnosis and determined to tumour origin with its extent is also an important investigation.

Majority of sinonasal surgery may be done in by otorhinolaryngologist or rhinologist alone or in team in collaboration with ophthalmologist, neurosurgeon, plastic and oral and maxillofacial surgeon. The approaches may either intranasal and extra nasal depending on the site and extent of the pathology [15-16]. Non-invasive procedures such as functional endoscopic sinus surgery is a newer surgical technique [2,9]. It is not a common surgical intervention in low income country like other surgical procedures but a commonplace in the developed countries. Sinonasal surgery in most developing countries has been hampered by the dearth of otorhinolaryngologic and rhinologist. There is also inadequacy of proper diagnostic tools and therapeutic facilities in developing countries compare to developed world. There is a paucity of publication documents on the pattern of sinonasal surgeries in developing countries. The knowledge from the documentation of sinonasal surgeries in our environment will help draw attention of the appropriate authorities to the challenges in the surgical practice. This will serve as bases to develop and form policy on sinonasal surgery improvement. This study aimed determining sociodemographic features, types, indications, limitation, complication and outcome of sinonasal surgeries in a tertiary health care institution of a developing country.

Materials and Methods

This was a retrospective study of all patients that had sinonasal surgeries done in Ear, Nose and Throat department of Ekiti state university teaching hospital Ado Ekiti, Nigeria. The study was carried out over a period five years (between October 2014 to September 2019). Data for this study was obtained from the hospital medical record department, ENT clinic operation booking register for both minor and major surgery and theatre operation register. The case notes of all the eligible patients were retrieved from the medical record department. Detailed data on sociodemographic features were obtained from the patient’s case note. Data of patient on clinical features, diagnosis, and indication for procedures, and type of procedures, complications, and patient’s satisfaction with the outcome of the procedures were obtained and documented. Inclusion criteria were all the patients that had sinonasal procedures in the department during the study period. Exclusion criteria were those patients who were not operated. Also, patients with incomplete clinical data on this study or those with missing case notes. All the obtained data were collated, documented and statistically analysed using SPSS version 18.0. The data were then expressed by descriptive statistics in frequency tables, percentage, bar chart and pie chart.

Results

The total number of patients seen during the period of study was 7,916 out of which a total of 1965 (24.8%) had sinonasal diseases and 621 had sinonasal procedures done given prevalence of 31.6%. In this study, the peak age groups were at the extreme ages of (1-10) years with highest number of procedures in 218 (35.1%). This is illustrated in Table 1. Gender distribution were 365 (58.8%) males and 256 (41.2%) females with male to female ratio of 1.5:1. Urban dwellers 341 (54.9%) were commoner than rural dwellers 280 (45.1%). Christians faith occurred in 547 (88.1%) while Muslims faith occurred in 74 (11.9%). Main patient/parent education level were 182 (29.3%) primary and 173 (27.9%) secondary. Parent/ patient occupation distribution were mainly student/apprentice, civil servants and business in 277 (44.6%), 138 (22.2%) and 89 (14.3%) respectively. This is showed in Table 2. Major presenting complaints was nasal blockage in 356 (57.3%) followed by catarrh/ epistaxis, objects in the nose and bout of sneezing in 328 (52.8%), 246 (39.6%) and 228 (36.7%). Common clinical findings were rhinorrhea, reduced nasal patency, foreign body impaction and sinonasal masses in 431 (69.4%), 303 (48.8%), 238 (38.3%) and 100 (16.1%) respectively. As demonstrated in Table 3.

Table 1: Age group distribution of the patients.

lupinepublishers-openaccess-otolaryngology-journal

Table 2: Sociodemographic features of the patients.

lupinepublishers-openaccess-otolaryngology-journal

Table 3: Main clinical features among patients

lupinepublishers-openaccess-otolaryngology-journal

Sinonasal procedures was commoner in unilateral nasal cavity in 324 (52.2%) than bilateral nasal cavity in 297 (47.8%). Right nasal cavity and left nasal cavity procedures occurred in 184 (29.6%) and 140 (22.5%) respectively. As illustrated in Figure 1. Majority of the procedures in 414 (66.7%) were performed in the outpatient clinic and minority in 207 (33.3%) were performed in the theatre. Theatre procedures were classified into minor, intermediate and major procedures which accounted for 8 (1.3%), 17 (2.7%) and 182 (29.3%) respectively. All sinonasal procedures were divided into elective and emergency procedures which accounted for 376 (60.5%) and 245 (39.5%) respectively. This is demonstrated in Table 4. Intranasal masses is the commonest CT Scan findings in 126 (20.3%). CT Scan findings in the sinuses accounted for 97 (15.6%) with maxillary and ethmoid sinuses accounted for 52 (8.4%) and 39 (6.3%) respectively. Common extension of the sinonasal pathology in this study were orbital extension and intracranial extension in 59 (9.5%) and 21 (3.4%) respectively. This is illustrated in (Figure 2). Main diagnosis and indication for sinonasal procedures in this study were rhinosinusitis in 248 (39.9%), nasal polyps in 67 (10.8%), sinonasal injuries in 29 (4.7%) and foreign body impaction in 238 (38.3%). Less common diagnosis and indications were nasolabial cyst, frontoethmoidal mucocele, and fungal mass in 2 (0.3%), 3 (0.5%) and 4 (0.6%) respectively. This is showed in (Table 5). Commonest sinonasal interventional procedures in patients with sinonasal diseases in this study was 238 (38.3%) foreign body removal from the nose. Removal without anaesthesia and under general anaesthesia were 226 (36.4%) and 12 (1.9%) respectively. Other main sinonasal surgeries were polypectomy, antral washout (lavage), nasal packing, partial turbinectomy, nasal toileting/clearance and intranasal antrostomy in 67 (10.8%), 61 (9.8%), 58 (9.3%), 51 (8.2%), 46 (7.4%) and 44 (7.1%) respectively. Intranasal polypectomy occurred in 59 (9.5%) while extranasal polypectomy (Caldwell Luc procedures) occurred in 8 (1.3%). Less common sinonasal procedures were 3 (0.5%) rhinoplasty, 3 (0.5%) nasal cautherization, 3 (0.5%) reduction of nasal bone fracture and 4 (0.5%) suturing of lacerations. This is revealed in Table 6. Complications occurred in sinonasal surgeries in 64 (10.3%). Main complication of sinonasal procedures in this study was wound infection in 18 (2.9%). Other documented complication were recurrence in 16 (2.6%) and epistaxis in 14 (2.3%). Uncommon complication sin this study included septal perforation and adhesion in 1 (0.2%) and 2 (0.3%) respectively. This is shown in Figure 3. In this study, 65 (10.5%) of the patients were referred to other center for further investigation and treatment. Main limitation and indication for referral were surgical facilities, chemoradiotherapy and diagnostic equipment in 5 (0.8%), 6 (1.0%) and 41 (6.6%) respectively. Endoscopic sinus surgery was responsible for 4 (0.6%) referral. Patient financial constraints in 28 (4.5%) leads to delayed surgery. This is illustrated in Figure 4. In this study, 473 (76.2%) of the patients and their parents were satisfied with the sinonasal surgeries. Revision sinonasal surgeries were offered in 4 (0.6%). We recorded 14 (2.3%) patients’ loss to follow up. Surgical failure was noted in 12 (1.9%) patients. Patient in 6 (0.6%) was referral for sinonasal surgery in other center. Referral in 3 (0.5%) was for family support in other center. This is illustrated in Table 6.

Figure 1: Coronal CT imaging. In hypotympanun the foreign body is visualized (A).

Lupinepublishers-openaccess-otolaryngology-journal

Figure 2: CT Scan findings among patients.

Lupinepublishers-openaccess-otolaryngology-journal

Figure 3: Complications among the patients.

Lupinepublishers-openaccess-otolaryngology-journal

Figure 4: Limitation and indication for referral among the patients.

Lupinepublishers-openaccess-otolaryngology-journal

Table 4: Main clinical features among patients.

lupinepublishers-openaccess-otolaryngology-journal

Table 5: Diagnosis and indications for surgeries among patients.

lupinepublishers-openaccess-otolaryngology-journal

Table 6: Procedures/Surgeries among patients.

lupinepublishers-openaccess-otolaryngology-journal

Discussion

Sinonasal diseases is very common among otorhinolaryngology, head and neck diseases that visited our department. Most of these diseases presented late, untreated, poorly treated and usually complicated at presentation. There was high prevalence of surgical interventions due to the disease’s stages at presentation. In this study, sociodemographic features affected the pattern of sinonasal surgeries. The procedures were commonest in children and this is associated with high rate of infection, immunity, injuries and insertion of infected objects into head and neck orifices. Sinonasal surgeries are commoner in male than female (Figure 5). This may be due to high rate of infection and outdoor activities such as trauma and hazard in offices in male. Also, high rate of smoking and snuff in male. Due to availability, accessibility, affordability and better informed, urban dwellers had more sinonasal procedures than rural dwellers in this study [17].

Figure 5: Outcome of the surgeries/procedures among patients.

Lupinepublishers-openaccess-otolaryngology-journal

Sinonasal diseases in this study presented mainly with nasal blockage, objects in the nose, catarrh/epistaxis and bout of sneezing.18 Most of the patients presented late or with complicated cases. All sinonasal symptoms were assumed to be flu which is selftreated. Most patients or parents wrongly believe it is a household disease, self-limiting, treated at home and does not worth hospital consultation. Common clinical findings in our study were anterior rhinorrhea, reduced nasal patency, nasal foreign body impaction and sinonasal masses [19,20]. Unilateral sinonasal disorder were commoner than bilateral this may be because of the aetiology origins of the pathology. Likewise, right sinonasal conditions were commoner than left. Most patients are right handedness with easy picking of right nose. Most patients sleep on the right side with poor venous drainage and accumulation and gravitation of infectious mucous on right nose. Main sinonasal diseases in this study were rhinosinusitis, foreign body impaction and nasal polyps. In this study, sinonasal diseases are not limited to the nose and sinuses alone irrespective of the aetiopathogenesis. Radiologic imaging is essential to rule out extent of the pathology and adequate preparation for the surgery. Commonest extension was orbit followed by intracranial and palatal extension [21]. Sinonasal Surgeries usually required teamwork with ophthalmologist, neurosurgeon and oral and maxillofacial surgeon depending on the extent of the pathology. Chronic rhinosinusitis with major nasal obstructions in adult is usually secondary to enlarge and obstructive inferior turbinate. In this study, clinic procedures were commoner than theatre surgeries this may be due to inclusion of all cases. There was preponderance of emergency surgery over elective procedures because of self-medications, untrained hand interventions and presentation of complicated cases to our department. Among the theatre cases, commonest surgery was major surgery followed by intermediate and minor surgeries. This is because most of the cases were advanced and extranasal extensions. Commonest procedures were nasal foreign body removal of which majority were performed in outpatient clinic and minority in theatre under general anaesthesia. Polypectomy were performed under general anaesthesia because they are advanced with Intranasal approach commoner than extranasal approach such as Caldwell Luc procedures [22].

Antral washout mainly bilateral was carried out on patients with mucopurulent collection in the maxillary sinuses. Nasal packing was carried out among patients seen with epistaxis mainly secondary to inflammation and trauma. Anterior nasal packing was commoner than posterior packing where chemical cautherization was performed where bleeding point was visualized. Cases of rhinosinusitis were further treated with partial turbinectomy in obstructive turbinate and Intranasal antrostomy to aid antral drainage and ventilation. Nasal toileting/clearance were performed in outpatient clinic among patients mucopurulent and clotted blood in the nasal cavity. Other approach to sinonasal masses in our study was external frontoethmoidectomy or excisional biopsy for histological diagnosis. Depending on the type and form sinonasal injuries surgical interventions in this study were suturing, wound dressing, reduction of nasal bone fracture and rhinoplasty. Nasal septal abscess was drained. No functional endoscopic sinus surgery was performed in our center because endoscope, forceps and other accessories are yet to be procured by hospital management [23]. Associated complications of our sinonasal surgeries were surgical site infection which were treated by antibiotics institutions [24,25]. Recurrent tumour in malignancy were referred for chemoradiation therapy. Immediate reactionary haemorrhage which was treated with nasal packing. Temporary loss of olfactory from clotted blood and oedema. Adhesion was released and nasal patency was restored. The septal perforation was asymptomatic, not noticed by patient and being followed up in our out patients clinic. Patients that required are CT Scan referred. Patients with financial constraints were assisted in sourcing for funds and surgery was eventually performed [26]. Patients that required further surgery and chemoradiotherapy were referred to centers where they were available. Majority of the patients were satisfied with the offered procedures. However few cases of revision surgery, referral, loss to followed up and Surgical failure were recorded in this study. This may be due to lower number of major sinonasal surgeries in this study.

Conclusion

Sinonasal surgeries are still not fully practice despite all the cases and Practicing rhinologist/ otorhinolaryngologist. This is due to limited equipment and adequate funding by policy makers. Provision of adequate surgical facilities will tremendously reduce referral cases and encourage surgical tourism in our center and other developing country.

Funding

There was no financial support. It is a self sponsored research study.

Competing interests

All the authors declare that there were no competing interests.

Acknowledgement

The authors are most grateful to Ekiti state university teaching hospital, the staff and all the patients who participated in this study.

Read More Lupine Publishers Otolaryngology Journal Articles:
https://lupine-publishers-otolaryngology.blogspot.com/

 

 

Lupine Publishers | The Novel Tympanostomy U-Tube (TUT) Insertions: Preliminary Clinical Results of 132 insertions

 Lupine Publishers | Journal of Otolaryngology Abstract Sixty-five subjects between 0.9 and 84 years old underwent 132 tympanos...