Proptosis in Otorhinolaryngology: An Overview

Nazeer, Novshaba; Ivaturi, Phani Bhushan

doi:10.1055/s-0040-1709986

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International Archives of Otorhinolaryngology

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Original Research • iao 25 (2) • Apr-Jun 2021 • https://doi.org/10.1055/s-0040-1709986 copy

Proptosis in Otorhinolaryngology: An Overview

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Ear, nose and throat (ENT)pathologies can present with proptosis as the early manifestation. The majority of ENT pathologies present with ocular manifestations, due to close anatomical relationship.

Objective

To study proptosis in ENT disorders in terms of etiology, pathogenesis, and management.

Methods

The present article is a prospective study conducted at a tertiary care center, in Telangana, India. Patients presenting with proptosis secondary to ENT disorders were thoroughly evaluated and subjected to surgical exploration after providing a signed informed consent.

Results

Sixty cases of proptosis secondary to ENT disorders have been reported. The most common cause was sinonasal squamous cell carcinoma followed by juvenile nasopharyngeal angiofibroma and allergic fungal rhinosinusitis.

Conclusion

Many ENT disorders can present with proptosis. Proptosis needs to be evaluated completely for proper management and to limit the morbidity associated with it.

Keywords
proptosis; orbit; Graves'disease; ethmoid

Etiology	N; %
Nose and sinuses
Nasal vestibulitis	1; 2%
Acute bacterial rhinosinusitis	3; 5%
Allergic fungal rhinosinusitis	6; 10%
Acute invasive fungal sinusitis	1; 2%
Fungal granuloma	3; 5%
Wegener granulomatosis	1; 2%
Ethmoid mucocele	2; 3%
Sinonasalschwannoma	2; 3%
Inverted papilloma	1; 2%
Frontal sinus osteoma	1; 2%
Fibrous dysplasia of maxilla	3; 5%
Fibrous dysplasia of ethmoid	1; 2%
Sinonasalsquamous cell carcinoma	12; 20%
Sinonasaladenocarcinoma	2; 3%
Sinonasaladenoid cystic carcinoma	2; 3%
Sinonasalembryonal rhabdomyosarcoma	1; 2%
Olfactory neuroblastoma	1; 2%
Nasopharynx
Juvenile nasopharyngeal angiofibroma	7; 11%
Nasopharyngeal carcinoma	4; 6%
Thyroid
Graves' disease	6; 10%

Etiology	Pathogenesis
Nose and sinuses
Nasal vestibulitis	Vascular (1; 2%)
Acute bacterial rhinosinusitis	Vascular (2; 3%) Compression (1; 2%)
Allergic fungal rhinosinusitis	Compression (6; 10%)
Acute invasive fungal sinusitis	Erosion (1; 2%)
Fungal granuloma	Compression (1; 2%) Erosion (2; 3%)
Wegener granulomatosis	Erosion (1; 2%)
Ethmoid mucocele	Compression (1; 2%) Erosion (1; 2%)
Sinonasalschwannoma	Compression (1; 2%) Erosion (1; 2%)
Inverted papilloma	Erosion (1; 2%)
Frontal sinus osteoma	Compression (1; 2%)
Fibrous dysplasia of maxilla	Compression (3; 5%)
Fibrous dysplasia of ethmoid	Compression (1; 2%)
Sinonasalsquamous cell carcinoma	Erosion (12; 20%)
Sinonasaladenocarcinoma	Erosion (2; 3%)
Sinonasaladenoid cystic carcinoma	Erosion (2; 3%)
Sinonasalembryonal rhabdomyosarcoma	Erosion (1; 2%)
Olfactory neuroblastoma	Erosion (1; 2%)
Nasopharynx
Juvenile nasopharyngeal angiofibroma	Erosion (1; 2%) Compression (3; 5%) Spread via fissures (3; 5%)
Nasopharyngeal carcinoma	Erosion (2; 3%) Spread via fissures (2; 3%)
Thyroid
Graves' disease	Increased intraconal fat (6; 10%)
TOTAL: Erosion: 28; 47% Compression: 18; 30% Vascular causing cavernous sinus involvement: 3; 5% Spread via fissures: 5; 8% Increased intraconal Fat: 6; 10%

Etiology	Non-surgical management
Nose & sinuses
Nasal vestibulitis	IV antibiotics (1; 2%) IV steroids (1; 2%)
Acute bacterial rhinosinusitis	IV antibiotics (3; 5%) IV steroids (2; 3%)
Allergic fungal rhinosinusitis	Intranasal steroids (6, 10%)
Acute invasive fungal sinusitis	IV amphotericin B (1; 2%) Oral itraconazole (1, 2%)
Fungal granuloma	IV amphotericin B (3; 5%) Oral itraconazole (3; 5%)
Wegener granulomatosis	Oral steroids (1, 2%) Oral cyclosporin (1; 2%)
Ethmoid mucocele	-
Sinonasal schwannoma	-
Inverted papilloma	-
Frontal sinus osteoma	-
Fibrous dysplasia of maxilla	-
Fibrous dysplasia of ethmoid	-
Sinonasal squamous cell carcinoma	Radiotherapy (10; 17%) Postoperative radiotherapy (2; 3%)
Sinonasal adenocarcinoma	-
Sinonasal adenoid cystic carcinoma	Postoperative radiotherapy (2; 3%)
Sinonasal embryonal rhabdomyosarcoma	Chemotherapy (1; 2%)
Olfactory neuroblastoma	Postoperative radiotherapy (1; 2%)
NASOPHARYNX
Juvenile nasopharyngeal angiofibroma	-
Nasopharyngeal carcinoma	Radiotherapy (4; 6%)
Thyroid
Graves' disease	Antithyroid drugs (6; 10%)
TOTAL: Antibiotics: IV (4; 6%) Steroids: Oral (1; 2%), IV (3; 5%), intranasal (6; 10%) = 10, 17% Immunosuppressive: Oral cyclosporin (1; 2%) Antifungals: IV amphotericin B (4; 6%), Oral itraconazole (4; 6%) Antithyroid drugs: 6; 10% Radiotherapy: 19; 32% of which 5; 8% were postoperative radiotherapy Chemotherapy: 1; 2%

Etiology	Surgery
Nose & sinuses
Nasal vestibulitis	Incision &drainage (1; 2%)
Acute bacterial rhinosinusitis	Functional endoscopic sinus surgery (3; 5%)
Allergic fungal rhinosinusitis	Functional endoscopic sinus surgery (6; 10%)
Acute invasive fungal sinusitis	Endoscopic sinus surgery and debridement (1; 2%)
Fungal granuloma	Endoscopic sinus surgery (3; 5%)
Wegener granulomatosis	Endoscopic sinus surgery (1; 2%)
Ethmoid mucocele	Functional endoscopic sinus surgery (2; 3%)
Sinonasalschwannoma	Endoscopic resection (2;3%)
Inverted papilloma	Endoscopic resection (1; 2%)
Frontal sinus osteoma	Bicoronalincision and excision (1; 2%)
Fibrous dysplasia of maxilla	Lateral rhinotomy &paring (3; 5%)
Fibrous dysplasia of ethmoid	Lynch-Howarth external approach and removal (1,; 2%)
Sinonasalsquamous cell carcinoma	Total maxillectomy (2; 3%)
Sinonasaladenocarcinoma	Total maxillectomy (2; 3%)
Sinonasaladenoid cystic carcinoma	Total maxillectomy (2; 3%)
Sinonasalembryonal rhabdomyosarcoma	-
Olfactory neuroblastoma	Endoscopic resection (1; 2%)
Nasopharynx
Juvenile nasopharyngeal angiofibroma	Endoscopic surgery with coblation (2; 3%) Lateral rhinotomy (5, 8%)
Nasopharyngeal carcinoma	-
Thyroid
Graves' disease	Orbital decompression (2; 3%) Subtotal thyroidectomy (6; 10%)
TOTAL: Incision and drainage: 1; 2% Functional endoscopic sinus surgery: 11; 18% Endoscopic sinus surgery: 5; 8% Endoscopic resection: 4; 6% Bicoronal incision & excision: 1; 2% Lynch-Howarth external approach & removal: 1; 2% Lateral rhinotomy: 8; 13% Total maxillectomy: 6; 10% Endoscopic coblation surgery: 2; 3% Orbital decompression: 2; 3% Subtotal thyroidectomy: 6; 10%

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[1] Address for correspondence Phani Bhushan Ivaturi,MS ENT, Assistant Professor, Department of ENT, Government Medical College, Nalgonda, India (e-mail: novshani@gmail.com).