Israel Medical Association Journal

Background: Nasal obstruction is one of the most common symptoms encountered in the otorhinolaryngology clinic, with diverse etiology including deviated nasal septum (DNS) and sinusitis. When surgical intervention is considered, the referring surgeon must decide whether preoperative imaging is indicated.

Objective: To identify clinical and physical examination predictors associated with significant sinus findings on computed tomography (CT) imaging in patients with nasal obstruction. To define specific factors in the medical history and physical examination of patients with nasal obstruction, which are associated with positive CT findings.

Methods: We conducted a retrospective review of patients presenting with nasal obstruction. We collected demographic data, clinical and physical examination findings, CT imaging results, and surgical outcomes.

Results: A total of 242 patients were included (mean age 38.5 ± 16.8 years, 65.7% male), all of whom underwent CT imaging prior to surgery. On univariate analysis, nasal edema, ostiomeatal complex (OMC) blockage, or edema, were all associated with positive findings from the CT (defined as Lund–Mackay > 3). On multivariate analysis, OMC obstruction or edema were associated with positive CT findings.

Conclusion: A thorough patient history and detailed physical examination are essential for evaluating nasal obstruction and identifying patients who may benefit from preoperative CT imaging. Specific clinical symptoms can indicate chronic sinusitis, thus guiding surgeons to perform preoperative imaging for accurate diagnosis and targeted treatment beyond deviated nasal septum management.

Background: Hypofractionation regimens shorten the overall duration of treatment, thereby reducing the risk of accelerated tumor cell repopulation following the initiation of radiotherapy. These regimens have been shown to improve overall survival and locoregional control in patients with laryngeal cancer. The toxic effects from radiotherapy for laryngeal squamous cell carcinoma (SCC) include dysphagia, mucositis, laryngeal edema, weight loss, and pain.

Objectives: To evaluate early toxicity and opioid usage associated with hypofractionation treatment of the larynx compared to standard fractionated radiotherapy.

Methods: We retrospectively analyzed 127 laryngeal SCC patients who underwent radiotherapy. Among these, 50% with early glottic cancer received hypofractionation (2.25 Gy per fraction, totaling 63 Gy) directed at the larynx, while 50% with advanced-stage disease underwent standard fractionation (2 Gy per fraction, totaling 70 Gy) targeting both the larynx and bilateral neck, with or without concurrent chemotherapy.

Results: Patients in the hypofractionation group required significantly higher dosages of opioids due to increased pain and swallowing discomfort (P < 0.05). Those in the hypofractionation group who received dexamethasone boluses experienced significantly less weight loss compared to hypofractionation patients who did not receive steroids, with some even experiencing weight gain (P < 0.005). Patients with advanced-stage cancer treated with chemoradiotherapy exhibited greater toxicity than those receiving radiotherapy alone.

Conclusions: Patients undergoing hypofractionation treatment generally require significantly higher doses of opioids than those treated with standard fractionation. Treatment protocols for patients receiving hypofractionation should include effective pain management strategies and, where feasible, the use of corticosteroids.