Structural Variations of Nose and Paranasal Sinuses in Various Sinonasal Pathologies: Tomographic Study of 50 Cases in Bangladeshi People

The aim of this study was to determine the frequency of structural variations in nose & paranasal sinuses in computed tomography in Bangladeshi people. This retrospective study was done at the Sir Salimullah Medical College Mitford Hospital and Apollo Hospitals, Dhaka, Bangladesh. Fifty (50) CT scan of Nose and Para nasal sinuses were collected from the patients presented with different sinonasal pathologies in OPD, IPD of both hospitals from July 2013 to June 2014. The scans were reviewed for the presence of different structural variations of nose and paranasal sinuses. The age range of the patients was 25 to 65 years. The most common anatomical variation in this study was hypertrophied inferior turbinate (82%) followed by ethmoidal bulla (70%), deviated nasal septum (64%), agar nasi cell (40%), concha bullosa (38%). In most of the patients we found more than one variation. There is wide range of anatomical variations in nose and paranasal sinuses which might be regarded as the aetiological factors of different sinonasal pathologies. To maximize patients' benefit and to avoid unexpected situations during surgeries as well as dreadful complications, individualized pre-planning through tomographic study should be considered.

Laryngeal histoplasmosis

Histoplasma capsulatum is an endemic granulomatous fungus disease. Involving the larynx of an immunocompetent patient with this is a rare manifestation. A sixty years old farmer who was previously diagnosed and treated as pulmonary tuberculosis was presented as a progressive change of voice and intermittent attack of unproductive cough with no history of stridor and fever for last 7 months. Clinical and imaging investigations were suggestive of laryngeal tuberculosis or laryngeal neoplasm. Laryngoscopy revealed edema, erythema and leukoplakia of the right vocal cord. Histopathological report showed intracellular hyphae of Histoplasma capsulatum, features were consistent with histoplasmosis. Patient were treated accordingly and improved. Laryngeal histoplasmosis present as a mimicker of squamous cell carcinoma or tuberculosis, may lead to the misdiagnosis and mistreatment of tuberculosis or laryngeal cancer. A high index of suspicion and a thorough histologic workup is needed to establish the diagnosis correctly.