Introduction Headache is a common complaint that brings patients to multidisciplinary clinics. It is utmost important to have meticulous clinical diagnosis of patients with rhinogenic and non sinusogenic headaches. The diagnosis has become easier with the advent of modern endoscopy and endoscopic sinus surgical techniques. This study aims to investigate the role of some anatomical nasal abnormalities in rhinogenic contact headache and to evaluate response to endoscopic surgery. Materials and Method A prospective study was conducted at a secondary level regional referral Hospital in the Sultanate of Oman. Patients with long-lasting, frequent, severe headaches not amenable to medical treatment, above 20 years of age were taken into consideration. Routine nasal endoscopy, Computerized tomography scan of the paranasal sinuses, Nasal decongestion and various surgical techniques to correct the anatomical abnormalities were included in our study and results were correlated statistically. Result There was a male predominance in our study with duration of headache ranging from 2 weeks to 5 years. There was a preponderance of headache in frontal region in our study group. Diagnostic nasal endoscopy and CT scan of PNS revealed Deviated nasal septum / septal spur, concha bullosa, Haller cell, pneumatised uncinate process and agar nasi cells. The overall success rate of the surgery in relieving headaches, measured by the MIDAS- VAS score, was approximately 75 %. The non-parametric Wilcoxon signed rank test, Chi square and paired T tests shows that the following study has rejected the null hypothesis as statistically significant where the P value <0.05. Discussion Researchers have examined the contact points as a source of rhinogenic / contact headache. Intranasal mucosal contact released substance P, causing pain and headache, Substance P has a potent vasodilator effect. Vasodilatation and perivascular inflammation are the final common pathways in pain. Surgical treatment for contact point-induced headaches has had good success. Conclusion The etiology of rhinogenic headache is multifactorial. Complete history taking, scrupulous preoperative evaluations, multidisciplinary consultations, Initial medical controls, long observation, and diligent postoperative follow-ups are mandatory for not only accurate diagnosis but also for promising surgical outcomes of non-sinusitis related rhinogenic headache. Our experience reveals that patients with rhinogenic contact headaches can benefit significantly from meticulous endoscopic decompression
Introduction Vitamin D deficiency has multitude of causes and can present with varying clinical manifestations. Studies show that it can lead on to recurrent respiratory infections, ear infections and deafness. Vitamin D also has immunomodulant action. Here we discuss the varying features concerning an Otolaryngologist in general as far as Vitamin D metabolism is concerned. Materials and Methods This retrospective study was performed on 800 patients 152 males and 648 females of different socioeconomic background at secondary level regional referral hospital under Ministry of Health in Sultanate of Oman. The patients attending the outpatient clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH) D] level in blood. The patients were evaluated with general history, blood samples of serum calcium, phosphate, alkaline phosphatase and serum vitamin D level were measured by the most standardized laboratory of the country. Results Out of 800 patients, 275 cases had Vitamin D levels below 20 ng/ml and 167 patients had values greater than 30 ng/ml in serum.81% patients with vitamin D deficiency were females.56.25% patients were between third and sixth decade. Otolaryngologic manifestations were acute and recurrent URTI (n=352) 44%. 7% of the patients presented with recurrent ear infection (otitis externa). The rest of them presented to a lesser extent with deafness, otosclerosis. Discussion Vitamin D deficiency has been reported worldwide as one of the commonest deficiency diseases. It can lead to autoimmune dysfunctions, Beta cell dysfunction in pancreas, Multiple sclerosis, recurrent chest infections and congestive cardiac failure. Studies have shown the involvement of cochlea with sensorineural hearing loss and otosclerosis. Conclusion Vitamin D deficiency has multi system implications as patients presenting with different signs and symptoms. Mass level screening and vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health. Adequate vitamin D supplementation and sensible sunlight exposure to reach optimal vitamin D status are among the front line factors of prophylaxis for spectrum of disorders.
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