Autoimmune-related nasal septum perforation: A case report and systematic review

Granulomatosis With Polyangiitis (GPA): Isolated Nasal Bridge Involvement

Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis primarily affecting small blood vessels and presenting with systemic manifestations, including those in the kidneys and respiratory tracts. Diagnosis involves clinical assessment and specific serological tests. This paper presents the case of a 68-year-old morbidly obese woman with chronic sinusitis, hypertension, and hyperlipidemia who developed a saddle nose deformity. Despite the absence of typical respiratory and renal symptoms, her laboratory results showed positive antineutrophil cytoplasmic antibodies (ANCA) and antinuclear antibodies (ANA), with a nasal septal biopsy confirming GPA. She was treated with methotrexate and folic acid. This case underscores the variability of GPA presentations and the critical importance of early diagnosis and treatment to prevent irreversible damage.

ENT Manifestations of Celiac Disease: A Scholarly Review

OBJECTIVES

Celiac disease is a common multisystemic autoimmune disorder. It is now increasingly recognized that it may present with extraintestinal manifestations which contribute to the difficulty in its diagnosis. The objective of this scholarly review was to examine the extraintestinal ENT manifestations of celiac disease and its pathophysiology and management, in order to highlight that some patients with celiac disease may present initially to the otolaryngologist. Improving awareness of celiac disease among otolaryngologists may aid in the correct diagnosis and correct management plan.

METHODS

A literature review was conducted using the PubMed database to identify original articles related to celiac disease and ENT manifestations between the years 2000 and 2020. The search was performed using the search string: ("coeliac disease" OR "celiac disease") AND ("ENT manifestations" OR "hearing loss" OR "epistaxis" OR "nasal septal perforation" OR "obstructive sleep apnoea" OR "vertigo" OR "tonsillitis" OR "sinusitis"). Only articles written in English were reviewed.

RESULTS

A total of 17 papers met the inclusion criteria. Extraintestinal ENT manifestations of celiac disease include sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, epistaxis, and vertigo with nystagmus. Sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, vertigo, and nystagmus are thought to result from immunologically mediated mechanisms, with intestinal malabsorption resulting in epistaxis.

CONCLUSIONS

Celiac disease can cause extraintestinal ENT manifestations and requires a high index of suspicion from the otolaryngologist to diagnose and suitably manage. A gluten-free diet may result in sufficient symptom resolution for most manifestations. Sensorineural hearing loss due to celiac disease appears to be progressive and permanent and may require frequent audiological monitoring.

Custom Nasal Septum Prosthesis Fabricated from a 3D-Printed Working Model: A Clinical Report

This clinical report describes the treatment of a 47-year-old female patient with a nasal septum perforation. The treatment used a 2-piece magnetic custom prosthesis fabricated from a 3D-printed model. By using an existing medical CT scan to generate the printed working model, the number of clinical appointments was reduced. The workflow expanded the purpose of the radiologic images from simply diagnostic to include the prosthetic aspect of treatment.

[Vasculitis mimics]

Vasculitis mimics need to be differentiated from primary and secondary vasculitides as described in the Chapel Hill nomenclature. The clinical symptomatology resembles that of vasculitis of small and medium, rarely also large vessels and hence imitates the classical vasculitic disorders. Pathogenetically, the causes are partly genetic mutations, embolization syndromes, infections and substance abuse. Also, B‑cell lymphomas can mimic vasculitis. The present manuscript summarizes the vasculitis mimics.

Nasoseptal Perforation: from Etiology to Treatment

PURPOSE OF REVIEW

Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment.

RECENT FINDINGS

NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.