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International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 536
International Journal of Otorhinolaryngology and Head and Neck Surgery
Singh G et al. Int J Otorhinolaryngol Head Neck Surg. 2023 Jul;9(7):536-542
http://www.ijorl.com
pISSN 2454-5929 | eISSN 2454-5937
Original Research Article
Clinico-pathological study of sinonasal masses at a tertiary care hospital
of southern Bihar
Garima Singh1*, Ankita Sinha1, Ranbir K. Pandey1, Deepak K. Gupta1,
Shashank Saurabh2, Kumar Sanu3
INTRODUCTION
As easy as the nasal masses may appear, diagnosing them
is a daunting task, the reason being the similarity in their
appearance and clinical presentations for a diversity of
pathology.
A sino-nasal mass (SNM) is an abnormal growth found in
the sinonasal tract radiology (SNT), which can present at
any age of life as a unilateral or bilateral lesion.
Anatomically, SNT is in close proximity to vital structures
such as the orbit, base of skull and oropharynx which
makes it a complex lesion and therefore necessitates the
need for accurate diagnosis and prompt management.
SNM poses substantial diagnostic dilemma for the
pathologists as the anatomy is complex and difficulty in
processing specimens. A great deal of effort ensures
preservation of relationship between the structures.
Secondly the tumors arising in this location demonstrates
an overlapping histologic feature despite a divergent
ABSTRACT
Background: This study focuses on sino-nasal masses (SNMs) and their presentation with their radiological findings
and corroboration with initial diagnosis and histopathological examination (HPE).
Methods: A prospective study conducted in total 62 patients with SNMs presenting between the period (September
2020 to October 2022) in medical college, southern Bihar. Patients were subjected to detailed history and battery of
tests with all necessary investigations. Final diagnosis was concluded after HPE.
Results: Age distribution ranged from 10 to 64 years with mean age of 34.2 and M: F ratio of 1.14:1. Demography
suggested predisposition in low socioeconomic strata (N=36; 58.06%). Majority fell in category of farmers (N=16;
25.8%) followed by housewives, laborers. Majority presented within a time frame of 1-2 years of onset of
symptoms/appearance of the lesion (N=25;40.3%) followed by 6 months to 1-year. Most common presenting symptom
was nasal obstruction (N=59;95.16%), followed by nasal discharge (n= 49, 79.03%). HPE concluded 45 samples
(72.58%) as non-neoplastic, 15 samples (24.19%) as benign neoplastic (96.7%) and 2 as malignant neoplastic lesions
(3.22%). In 58 out of 62 patients (93.54%) the clinical diagnosis was corroborated with HPE diagnosis.
Conclusions: Nasal polyps, the most common benign lesions and SCCs, the most common malignant lesion of SNT.
Malignant lesions common in elderlies should be differentiated from non-malignant lesions. Due to similar presentation
of diversified aetiology, a clinical and radiological evaluation is of prime for initial management. HPE remains the gold
standard for final diagnosis and definitive management.
Keywords: Sinonasal masses, Sinonasal tract radiology, Histopathological examination
1Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
2Department of Otorhinolaryngology, Lal Hospital and Research Centre, Ranchi, Jharkhand, India
3Department of Otorhinolaryngology, Madhubani Medical College and Hospital, Bihar, India
Received: 12 June 2023
Revised: 15 June 2023
Accepted: 19 June 2023
*Correspondence:
Dr. Garima Singh,
E-mail: garima.astor@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20231809
Singh G et al. Int J Otorhinolaryngol Head Neck Surg. 2023 Jul;9(7):536-542
International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 537
pathogenesis and/or tissues of origin. The pathologist
should equate the differential diagnosis as the treatment
protocol vary depending on the characteristic of the lesion.
The prevalence of SNM is 1-4% in general population.1
SNM’s can be broadly categorized as Non-neoplastic and
Neoplastic. They are further categorized as congenital,
inflammatory, granulomatous, traumatic or Neoplastic
(benign or malignant).
Amongst all the SNM’s nasal polyps are frequently
encountered with an incidence of 2-3% in general
population.2 The polypoidal SNM’s reports various nasal
symptoms like obstruction, epistaxis, blood-stained nasal
discharge, rhinorrhoea, sneezing, and smell disorders,
orbital symptoms like epiphora, proptosis, swelling,
diminution of vision and aural symptoms like earache,
discharge, hearing loss along with snoring, apnoeic spells,
cranial neuropathy and deformity.3
The recent advanced modalities like diagnostic nasal
endoscopy, computed tomography (CT) scan, magnetic
resonance imaging (MRI) and cytology have been helpful
in providing a detailed understanding of the nature and
course of the disease process and implementation of
correct, specific and timely intervention. This study aims
to revisit clinical profile, diagnostic modalities and the role
of clinical, radiological, and histopathological modalities
in diagnosis and management of sino-nasal masses.
METHODS
Ours’ is a single centred observational prospective study
that was conducted in ENT department of Narayan
Medical College and Hospital in southern region of Bihar
at a tertiary care centre over a period of 2 years (September
2020 to October 2022). The sample size was concluded in
all patients with sinonasal masses fulfilling the
inclusion/exclusion criteria coming to ENT OPD in the
given time frame of (September 2020 to October 2022).
Frequency and percentage were calculated and tabulated,
data analysis was done using statistical package for the
social sciences (SPSS) software (16.0). Patients above the
age of 5 years presenting with sinonasal tract masses
undergoing surgical excision, and willing to participate in
the study were included. Patients with age less than 5
years, those presenting with masses encroaching SNT
from adjoining area, with unclear history and those having
history of chemotherapy and/or radiotherapy, and not
willing to participate in the study were excluded. A
detailed history was taken and after the thorough clinical
examination (examination of nasal cavity, oral cavity,
throat, and neck), all the patients were subjected to
rhinoscopy, diagnostic nasal endoscopy (DNE) and
radiological evaluation (X-ray PNS, CT PNS, MRI PNS)
to aid the clinical diagnosis. The radiological evaluation
confirmed the site of origin and extent of the lesions along
with an assessment of the mass, the lining mucosa, the
paranasal cavity, soft tissue involvement and any bony
involvement. Ethical approval was obtained from
Institutional Ethical Committee IEC No: IEC/2021/59.
RESULTS
This study was conducted for the period of 23 months, in
which a total number of 62 patients presenting with
sinonasal masses were observed.
The age distribution of the patients ranged from 10 to 64
years with a mean age of 34.2 years. The highest incidence
of occurrence (N=24; 38.7%) was found in the age group
of 30 to 40 years.
The overall sex distribution showed a male preponderance
over the female (M: F ratio 1.14:1).
Figure 1: Distribution of the patients according to age
and sex.
Figure 2: Gender wise distribution.
The demography of the cohort suggested a predisposition
in low socioeconomic strata (N=36; 58.06%). By
occupation, most of the patients fell in the category of
farmers (N=16; 25.8%) followed by housewives (N=13;
20.9%), laborers (N=12; 19.3%) and students (N=10;
16.1%).
Majority of patients presented to the outpatient department
within a time frame of 1-2 years of onset of symptoms or
appearance of the lesion (N=25; 40.3%) followed by 6
months to 1-year (N=21;33.8%).
Singh G et al. Int J Otorhinolaryngol Head Neck Surg. 2023 Jul;9(7):536-542
International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 538
Figure 3: Occupational distribution.
Figure 4: Duration of illness.
Figure 5: Common presenting symptoms.
In this study group, 17 patients had a history of bidi
smoking (27.4%) with an average of 20 pack years. The
most common presenting symptom in the study population
was nasal obstruction observed in a total number of 59
patients (95.16%), followed by nasal discharge (n=49,
79.03%), anosmia (n= 32, 51.6%), epistaxis (n=29,
46.7%), postnasal drip (n=29, 46.7%), sneezing (n=19,
30.6%). Nasal discharge was mostly mucoid or
mucopurulent in nature with few patients having watery
discharge. A string test was performed in all the patients
with watery discharge to rule out the cerebrospinal fluid.
Most patients with epistaxis had history of trauma caused
by nose-picking. Patients with nasopharyngeal
angiofibroma (N=5) and capillary hemangioma (N=3) had
spontaneous epistaxis. Two patients with suspected
malignancy had intermittent epistaxis. Postnasal drip,
sneezing and anosmia were commonly associated with
sinusitis and polypoidal growth. Anterior rhinoscopy was
able to locate the mass in 49 patients (79.03%) whereas in
58 (93.54%) patients the mass was visible in DNE. In the
rest of the 4 patients, mass was confined to paranasal
sinuses and hence could only be located with CT-PNS.
Morphologically polypoidal mass was seen in 46 patients
(74.19%) whereas fleshy mass was seen in 12 patients
(19.3%). Oropharyngeal mass appearing as a polypoidal
growth was present in 2 patients (3.22%) and a fleshy
globular was seen in 1 patient (1.61%). A visible mass in
posterior rhinoscopy was seen in 4 patients (6.4%).
Figure 6: Final diagnosis of SNMs.
Figure 7: Accuracy of diagnosis with radiology and
HPE.
All patients underwent diagnostic nasal endoscopy (DNE)
and 93.54% were found to have visible masses during the
examination which helped in determining the site of
origin. The most common site of origin of polypoidal mass
was the middle meatus (N=30; 48.38%), followed by the
Singh G et al. Int J Otorhinolaryngol Head Neck Surg. 2023 Jul;9(7):536-542
International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 539
lateral wall of the nasal cavity (N=16; 25.8%) and superior
meatus (N=4;6.45%) whereas fleshy masses were mostly
originating from the nasal septum (N=12; 19.35%).
Mucoid discharge was found to be common in non-
neoplastic nasal polypoid masses. All the patients with
malignant neoplastic polypoid masses presented with
blood-stained discharge or recurrent epistaxis. Ocular
involvement was seen in 3 patients (4.8%) and a palatal
bulge was seen in 3 patients as well (4.8%) mostly with
neoplastic masses and inverted papilloma. Radiological
investigations were done on a total number of 52 patients
(83.87%) as few of them could not afford the cost of
imaging and a few didn’t require the imaging. Out of 47
patients who underwent CT-PNS, CECT was done in 21
patients (33.8%) and NCCT in 26 patients (41.9%) and
MRI in 5 patients (8.06%). All the patients underwent
surgical excision of mass under general anesthesia through
various approaches (endoscopic, lateral rhinotomy, medial
maxillectomy, transeptal excision, trans-nasal and
Caldwell-Luc). Histopathological examination was carried
out in all 62 excised specimens. Out of which 45 samples
(72.58%) were non-neoplastic, 15 samples (24.19%) were
neoplastic but benign (96.7%) and 2 were found to be
malignant neoplastic lesions (3.22%). In 58 out of 62
patients (93.54%) the clinical diagnosis was corroborated
with the HP diagnosis. However, the final diagnosis was
changed in 4 patients (6.46%) based on HP examination.
The accuracy of diagnosis with clinical and radiological
method was 94% (N=58).
Table 1: Distribution of SNM according to HPE
Type of disease on
histopathology
Freque-
ncy (n)
Percent-
age (n)
Non-neoplastic (N=45; 72.58%)
Inflammatory (N=38; 61.29%)
Antrochoanal polyp
27
43.54
Ethmoidal polyp
11
17.74
Granulomatous (N=7; 11.29%)
Rhinosporidiosis
7
11.29
Neoplastic (N=17; 27.41%)
Benign (N=15; 24.19%)
Inverted papilloma
3
4.83
Capillary haemangiomas
5
8.06
Nasopharyngeal
angiofibroma
3
4.83
Frontoethmoidal Mucocele
4
6.45
Malignant (N=2; 3.22%)
Squamous cell carcinoma
2
3.22
Total
62
100
Table 2: Co-relation of radiological finding, radiology, HPE.
Clinical diagnosis
N
Radiological diagnosis
N
Histopathological diagnosis
N
Antrochoanal polyp
27
Antrochoanal polyp
27
Antrochoanal Polyp
27
Nasal polyp
1
Antrochoanal polyp
1
Inverted Papilloma
1
Ethmoidal polyp
10
Ethmoidal polyp
10
Ethmoidal Polyp
10
Sinonasal polyposis/ allergic
fungal sinusitis
1
Ethmoidal cystic lesion
1
Mucocele
1
Rhinosporidiosis
7
Rhinosporidiosis
7
Rhinosporidiosis
7
Rhinosporidiosis
1
Nasal polyp
1
Lobar capillary hemangioma
1
Inverted papilloma
1
Inverted papilloma
1
Inverted papilloma
1
Malignant lesion
1
Inverted papilloma
1
Inverted papilloma
1
Hemangioma
4
Lobulated hemangioma
4
Lobular capillary hemangioma
4
Nasopharyngeal angiofibroma
2
Nasopharyngeal
Angiofibroma
2
Nasopharyngeal angiofibroma
2
Sini nasal mass
1
Angiomatous polyp
1
Nasopharyngeal angiofibroma
1
Frontal mucocele
3
Frontoethmoidal cystic
lesion
3
Frontoethmoidal mucocele
3
Malignant mass
2
Malignant mass
2
Squamous cell carcinoma
2
Total
62
Total
62
Total
62
DISCUSSION
Sinonasal mass is a common presentation in the outpatient
department. They have similar presenting symptoms but
with a diverse list of differential diagnoses. Therefore, it
demands a thorough clinical evaluation aided by imaging
and tissue diagnosis for accurate management. Our study
was conducted in a tertiary centre in southern Bihar, India.
A total of 62 patients with sinonasal mass were included.
Out of which majority were non-neoplastic which was in
concordance with a study conducted by Prakash et al.4
However, in another study conducted by Dasgupta et al
reported an equal prevalence of non-neoplastic and
neoplastic lesions.5 The mean age of presentation in our
study was 34.2 years which goes in the line with earlier
studies conducted by Bist et al the mean age of
presentation was 39.4 years.6 Bakari et al reported a peak
incidence of 33 years, while for Zafar et al the mean age
of presentation was 22.5 years.7,8 The 2nd to 4th decades
of life is the most vulnerable period for the development
of sinonasal masses. Malignancies have been reported
Singh G et al. Int J Otorhinolaryngol Head Neck Surg. 2023 Jul;9(7):536-542
International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 540
generally after the fourth decade of life. In our analysis 3rd
decade was the most commonly affected age group
(38.7%). Lathi et al reported a similar incidence of
prevalence in 3rd decade of life.9 In contrast, studies
conducted by Agarwal et al and Deosthale et al showed the
highest incidence of sinonasal masses in the age group of
41-50 years.10,11 In the present study, the demographic
trend showed male preponderance over female (1.14: 1)
which is in concordance with a study conducted by
Deosthale et al which showed a slight preponderance of
males to females (1.08:1) and Rokade et al with males:
female ratio of 1.6:1.11,12 The ratio was higher (M:F ratio
of 1.7:1) in the study by Zafar et al from India, while a
study from Nigeria revealed an opposite ratio showing
female preponderance (M:F ratio of 1:1.2).7,8 A British
review of nasal polyposis reported a ratio of 2:1 (M: F). A
study conducted by Hasan et al suggested that the
predilection for males over females was because of
predisposing factors such as smoking habits, dust
exposure, more infection and outdoor work prevalent in
males in comparison to females.13 We studied different
occupational exposures among the study population and
we surprisingly found that agricultural workers were the
most vulnerable group amongst all (25.8%) followed by
housewives (20.96%) and manual labour (19.35%). 1
female patient with squamous cell carcinoma had a 30
years history of firewood cooking and 1 male patient with
SCC was a chronic smoker for 45 years. Alabi et al
conducted research on sinonasal malignancy in a Nigerian
tertiary hospital over 6 years where they similarly found a
largest group (29%) was exposed to indoor cooking and
wood dust most likely in the form of firewood for
cooking.14 In addition, cigarette smoking (18%) was found
to be an important risk factor in their study which is similar
to our results. The overall pathological distribution of
sinonasal masses in our study group was non-neoplastic
i.e., 45 patients (72.58%) and neoplastic i.e., 17 patients
(27.41%). Out of the neoplastic population 15 (24.19%)
had benign lesions and 2 (3.22%) had a malignant lesion.
Diamantopoulos et al in their study on 2021 patients
revealed that 1830 (90.5%) patients were non-neoplastic
and the remaining 181 (8.9%) were of neoplastic origin.15
In the non-neoplastic cases, 1570 polyps (77.6% of the
total) were of allergic, inflammatory or infective origin. Of
the 181 neoplastic cases, 98 (4.8% of the total) were
benign while 83 (4.1% of the total) were with malignant
pathology. According to the literature, nasal polyps are the
most common tumours of the sino-nasal tract and they
result from chronic inflammation of the mucous
membrane of the nasal cavity and paranasal sinuses. The
exact pathogenesis is unknown however, a strong
association of allergy, infection, asthma and aspirin
sensitivity has been implicated and probably this is the
reason why in our study most of the cases of polyps were
seen in farmers (25.8%).9,12 The polypoidal lesion was the
most commonly diagnosed non-neoplastic lesion in our
study population and it was similarly documented by other
studies too. True nasal polyps were mostly allergic and
inflammatory polyps. Allergic polyps showed abundant
eosinophils in the stroma in addition to inflammatory cells.
Ethmoidal polyps and antrochoanal polyps are generally
allergic and inflammatory in nature respectively.9 This
trend was also seen considering the two forms of polyps in
the present study. We found 96.77% of the sinonasal
masses to be non-malignant. A such high percentage of
non-neoplastic sino nasal masses have been reported by
many studies like Gupta et al and Thakur et al.16,17 In our
study, most of the cases were unilateral lesions (N=46;
74.19%). The bilateral nasal polyp were mostly ethmoidal
polyps. Most of the neoplastic polyps were unilateral in
our study population. According to Maheshwari et al
study, the majority of the Sino-nasal masses were
unilateral (56.25%).18 Similar was the finding observed by
Bakri et al (55.3%) and Bist et al (74.55%).6,7 In contrast,
Lathi et al reported a high incidence of bilateral sino-nasal
mass (51.8%) as also by Zafar et al (60%).8,9 This
difference might be due to the geographical variation of
the disease. Rhinosporidiosis is a chronic granulomatous
disease caused by Rhinosporidium seeberi. Although a
variety of sites may be affected, the principal site is nasal
mucosa; the disease is endemic to India and Sri Lanka. In
our study, we found 7 cases of rhinosporidiosis (11.29%)
out of which 6 were male (85.7%) and 1 female (14.2%)
which is similar to the study reported by Bhattacharya et
al.19 A higher incidence of rhinosporidiosis in the present
study can be attributed to poor hygiene and the practice of
pond bathing in this topographical region of southern
Bihar. Nasopharyngeal angiofibroma is restricted to the
young aged male population. In our study, we found 3
cases of nasopharyngeal angiofibroma and all of them
were males. This was consistent with the findings of
Bhattacharya et al.19 Juvenile angiofibroma forms 0.5% of
all head and neck tumours in Europe.21 In our study benign
neoplastic lesions were seen in 15 patients (24.19%) out of
which capillary haemangioma (8.06%) was most common
followed by mucocele (6.45), inverted papilloma and
nasopharyngeal angiofibroma 4.83% each. The main
presenting complaint of majority of the study population
was a nasal obstruction in 59 patients (95.16%) which was
followed by nasal discharge in 49 patients (79.03%).
Similar presenting features were also found in study
reported by Deosthale et al.11 Intermittent epistaxis and
facial deformity were a feature of malignant masses.20
Inverted papilloma is comparatively rare, but this
morphological variant is the most commonly encountered
lesion of all sinonasal papillomas.22 The other two
morphological forms are exophytic (everted) squamous
cell papilloma and cylindrical cell papilloma. In this study,
we found 3 cases of inverted papilloma (4.83%). 2 patients
who were clinically diagnosed as a nasal polyp and
malignant polyp respectively were histologically proven to
be inverted papilloma. Inverted papilloma was associated
with squamous cell carcinoma of the sinonasal cavity in 6
(21.4%) of the 28 cases studied by Califano et al in the
USA.23 According to the literature, malignancy of the sino
nasal tract is rare.24 The incidence of sinonasal malignancy
is approximately 3.5 per 100000 populations/year. The
maxillary sinus is the most common site for the origin of a
malignant lesion.25 Squamous cell carcinoma is the most
common histological type of neoplasm and is rarely
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International Journal of Otorhinolaryngology and Head and Neck Surgery | July 2023 | Vol 9 | Issue 7 Page 541
encountered before 4th decade of life. In our study 2
patients (3.22%) had neoplastic lesions histologically
diagnosed as squamous cell carcinoma of the maxillary
sinus. Both the patients were in the elderly age group
between 61-70 years. Pradhananga et al reported 6.3% of
their sinonasal masses to be malignant, while for Fasunla
et al malignant sinonasal tumours constituted 59.4% of the
138 sinonasal neoplasms seen.25,26 Svane-Knudsen et al
have similarly reported squamous cell carcinoma to be the
most commonly encountered malignancy of the sinonasal
tract in Denmark.27 A Polish study by Zyłka et al reported
71-80 years to be the most commonly affected age group
for malignancies of the sinonasal tract. Male: female ratio
of malignancy in our study was 1:1. This was probably due
to the small cohort. More duration and sample size are
needed to establish it. Malignant tumours were treated
with wide excision followed by chemo-radiotherapy. Both
of our patients had maxillary SCC which was treated with
lateral rhinotomy and total maxillectomy followed by
chemo-radiotherapy. In our study, 5 patients out of 47 who
underwent CT imaging had a difference in clinical and
radiological diagnosis. Several studies have provided
evidence that CT and symptoms do not necessarily
correlate. In a study by Bolger et al, 42% of asymptomatic
patients had mucosal changes on CT scan.28 In a study,
Stankiewicz examined 78 patients meeting chronic
rhinosinusitis symptom criteria of which only 47% had
evidence of chronic rhinosinusitis on CT.29 In the current
study of 62 patients, 58 patients (93.54%) had a clinical
and radiological diagnosis correlating with histopathology
whereas in 4 patients (6.45%) the final diagnosis was
modified after obtaining the tissue diagnosis. In a study
conducted by Lathi et al surgery was the major modality
of treatment in all sinonasal masses.9 Sutar et al stated that
most non-neoplastic and benign neoplastic nasal masses
require surgical excision, while malignant neoplastic
lesions require wide surgical excision, followed by
radiotherapy, or chemotherapy either alone or in
combination.3 Our modality of management is at par with
their findings.
Our study had the following limitations, it was a small
sample size confined to a limited geographical location,
therefore the data cannot be extrapolated on a larger
demography. Most of the patients with malignant masses
were either lost to management or follow-up.
CONCLUSION
The study concluded that the sinonasal masses can result
from a wide variety of pathological entities ranging from
inflammatory, granulomatous and neoplastic origin. Nasal
polyps are the most common benign lesions and squamous
cell carcinoma is the most common malignant lesion of
SNT. Malignant lesions are generally observed in the
elderly and should be differentiated from non-malignant
lesions. Due to a similar presentation of a diversified
aetiology, a clinical and radiological evaluation is of prime
importance for initial management but histopathology
remains the gold standard for final diagnosis and definitive
management.
Recommendations
This clinicopathological study of Sino nasal mass helps to
diagnose the diseases of SNT at the early stage of their
presentation hence, delivering an effective management to
restore the maximum possible function.
As easy as the nasal masses appear, diagnosing them is a
challenging task, the reason being the similarity in their
appearance and clinical presentations for a diversity of
pathologies. It can also present as a considerable
diagnostic dilemma for the pathologist due to overlapping
histologic feature.
The study recommends a combination of clinical,
radiological and histopathological modalities for diagnosis
of each and every mass of SNT irrespective of age, gender
or time of presentation.
ACKNOWLEDGEMENTS
Authors would like to acknowledge the faculty members,
staffs from the department and medical record department
of NMCH Jamuhar, juniors and patients.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Singh G, Sinha A, Pandey RK,
Gupta DK, Saurabh S, Sanu K. Clinico-pathological
study of sinonasal masses at a tertiary care hospital of
southern Bihar. Int J Otorhinolaryngol Head Neck
Surg 2023;9:536-42.
