Chronic rhinosinusitis (CRS) is defined as the inflammation of nose and paranasal sinuses, affecting the patients' quality of life and productivity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a principal clinical entity confirmed by the existence of chronic sinonasal inflammation and is characterized by anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or facial pain. Several epidemiologic studies have revealed wide variations in the incidence of CRS among regions globally ranging from 4.6% to 12%. The Gulf countries are also witnessing an unprecedented burden of CRSwNP. According to the current clinical guidelines, glucocorticosteroids and antibiotics are the principal pharmacotherapeutic approaches. Endoscopic sinus surgery is recommended for those who have failed maximal pharmacotherapy. Recently, biologics are considered as an alternative best approach due to the complications associated with medical therapy and surgery. However, precise data on the clinical position of biologic agents in the management of CRSwNP in the Gulf region is not available. The present review article addresses the current diagnostic and management approaches for CRSwNP and also emphasizes the role of emerging biologics in the current treatment strategies for CRSwNP in the Gulf region. Further, a consensus protocol was convened to rationalize the guideline recommendations, strategize the best practices with biologics, and develop clinical practice guidelines for all primary-care specialists in the Gulf region. The consensus-based report will be a useful reference tool for primary-care physicians in primary-healthcare settings, regarding the appropriate time for the initiation of biological treatment in the Gulf region.
<div class="WordSection1"><p><strong>Background:</strong> Several studies have been conducted to forecast the top emergencies that are frequently seen among patients in an ENT clinic. In the past four years, there has been only one study that calculates the prevalence of a specific rhinology disease (allergic rhinitis) in five Middle Eastern countries. The results of the study have demonstrated that 1808 of 33,486 subjects enrolled in the study have fulfilled the case definition of allergic rhinitis. The mentioned study has only reviewed active cases of allergic rhinitis, disinclining other rhinology conditions that patients frequently complain of. The following paper will calculate the prevalence of common rhinology conditions generally in a specialized ENT clinic in the Kingdom of Bahrain over a period of 1 year.</p><p><strong>Methods:</strong> Patients’ information was collected prospectively on monthly basis starting from June 2021 until June 2022. The patients were registered under a senior ENT consultant at a semi-governmental hospital in The Kingdom of Bahrain.</p><p><strong>Results:</strong> Out of 2711 subjects enrolled in the study, 1424 patients have been registered with rhinology related complaints, exhibiting approximately (52.4%) of the total sample size. Allergic rhinitis was the most prevalent clinically diagnosed rhinology disease and Rhinoplasty surgery was the most frequently operated surgery. The socio-demographics of the study measured (52.0%) Higher females ration between Rhinology patients. In contrast, A higher percentage of males attended the clinic for otology/ear consultations (57.2%).</p><p><strong>Conclusions:</strong> Rhinology related consultations is concluded to be more prevalent compared to otology and laryngology.</p></div>
A 39-year-old male patient was presented with foreign body sensation eight months post unilateral dacryocystorhinostomy (DCR) tube procedure in his right lower Punctum. On examination, the (silicon-based stent) was patent on the right orbital Punctum. However, the nasal element of the DCR tube was undetected during examination using the nasal speculum. endoscopic examination of the nasal cavity failed to reveal the nasal portion of the tube. None of the approaches performed were successful to detect the exact site of the stent. Therefore, the patient was transferred to the theatre to remove the tube surgically under general anaesthesia. In the operating table, endoscopic examination of the right nasal cavity revealed a granuloma over the nasal portion of the tube, embedded in the lateral nasal wall. Accordingly, the granuloma was then suctioned, which led to the appearance of the DCR tube. The tube was then removed, and the patient established a patent nasal airway. The patient was discharged on the same day, with no postoperative complication. As per the presented case, the following case report will be discussing the potential causes that might have led to the granuloma formation. We aim in the analysis of this case to scale down post DCR procedure complications by comparing the efficacy of silicon-based stents to other type of stents, as to guide surgeons into a safer and lesser invasive approach. In the majority of complicated DCR procedures with granuloma formation, the granulomas are suctioned in a clinical setting. However, the patient needed a more invasive approach, by removing the granuloma surgically to establish a patent nasal airway.
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