bluuebunny/crossref_metadata_2025 huggingface dataset:
P2X4-receptor participates in EAAT3 regulation via BDNF-TrkB signaling in a model of trigeminal allodynia
Authors: Liu Chaoyang , Zhang Yixin , Liu Qing , Jiang Li , Li Maolin , Wang Sha , Long Ting , He Wei , Kong Xueying , Qin Guangcheng , Chen Lixue , Zhang Yuhong , Zhou Jiying
Published: August 2018

Objective

Previous studies of neuropathic pain have suggested that the P2X4 purinoceptor (P2X4R) in spinal microglia is essential for maintaining allodynia following nerve injury. However, little is known about its role in inflammatory soup-induced trigeminal allodynia, which closely mimics chronic migraine status. Here, we determined the contributions of P2X4R and related signaling pathways in an inflammatory soup-induced trigeminal allodynia model.

Methods

P2X4R gene and protein levels in the trigeminal nucleus caudalis were analyzed following repeated dural inflammatory soup infusions. p38, brain-derived neurotrophic factor, excitatory amino acid transporter 3, c-Fos, and calcitonin gene-related peptide protein levels in the trigeminal nucleus caudalis, as well as trigeminal sensitivity, were assessed among the different groups. Immunofluorescence staining was used to detect protein localization and expression in the trigeminal nucleus caudalis.

Results

Repeated inflammatory dural stimulation induced trigeminal hyperalgesia and the upregulation of P2X4R. Immunofluorescence revealed that P2X4R was expressed in trigeminal nucleus caudalis microglial cells. Blockage of P2X4R produced an anti-nociceptive effect, which was associated with an inhibition of inflammatory soup-induced increases in p38, brain-derived neurotrophic factor, excitatory amino acid transporter 3, c-Fos, and calcitonin gene-related peptide protein levels. The tyrosine receptor kinase B antagonist ANA-12 reversed trigeminal allodynia and the upregulation of excitatory amino acid transporter 3, c-Fos, and calcitonin gene-related peptide, whereas the agonist 7,8-dihydroxyflavone exacerbated these effects. Double immunostaining indicated that p38 and brain-derived neurotrophic factor were mainly expressed in microglial cells, whereas excitatory amino acid transporter 3 was primarily expressed in trigeminal nucleus caudalis neurons.

Conclusions

These data indicate that microglial P2X4R is involved in the regulation of excitatory amino acid transporter 3 via brain-derived neurotrophic factor-tyrosine receptor kinase B signaling following repeated inflammatory dural stimulation. Microglial P2X4R activation and microglia–neuron interactions in the trigeminal nucleus caudalis may play a role in the pathogenesis of migraine chronicity, and the modulation of P2X4R activation might be a potential therapeutic strategy.
Citizenship: A core motive for South African university student volunteers
Authors: Joseph Bianca Monique , Carolissen Ronelle
Published: August 2018

Research suggests that the desire to help others (value) and learning interpersonal skills (understanding) are core reasons for student volunteerism. Interpretations of such reports often minimise the role of contextual factors in shaping volunteer motives. This study considers the policy and institutional contexts that advocate for community engagement and social impact in South African higher education as a contributing factor in shaping student perceptions on reasons for volunteering. This article draws on student volunteers’ responses to an open-ended question exploring their volunteer motives. Active student volunteers (N = 70) were recruited from six community projects across three South African universities in the Western Cape region. The findings suggest that citizenship together with the value and understanding functions are core motives for volunteering among South African university students. These accounts of student volunteer motives posit strong links to contextual factors; a phenomenon that holds significant implications for policy makers.
Protest songs about the Iraq War: An effective trigger for critical reflection?
Authors: Esteve-Faubel José-María , Martin Tania Josephine , Esteve-Faubel Rosa-Pilar
Published: August 2018

The question of developing educational policies that involve training people to be capable of critical reflection and skilled in approaching the discussion-debate binomial, with the overall goal of achieving learning which is of a transformative kind, is currently embraced by the transdisciplinary paradigm known as Global Citizenship Education. This qualitative study investigates the impact of protest or topical songs released in response to the Iraq War on a cohort of university students and explores whether these songs could be useful in Global Citizenship Education. The results of the study emphasize the value of these types of songs as triggers for transformative learning, because, independently of respective national educational policies or the possible influence of the mass and digital media, these songs were shown to tap into an underlying set of universal values, rights and attitudes among citizens that drive the need for Global Citizenship Education design and evaluation.
Ischemia–reperfusion injury in stroke: impact of the brain barriers and brain immune privilege on neutrophil function
Authors: Enzmann Gaby , Kargaran Soghra , Engelhardt Britta
Published: August 2018

Reperfusion injury following ischemic stroke is a complex pathophysiological process involving numerous mechanisms ranging from the release of excitatory amino acids and ion disequilibrium to the induction of apoptosis and necrosis, to oxidative stress and inflammation. The migration of neutrophils into the brain parenchyma and release of their abundant proteases are generally considered the main cause of neuronal cell death and acute reperfusion injury following ischemic stroke. Recent findings in experimental and human stroke have challenged this view, as the majority of neutrophils were rather found to accumulate within the neurovascular unit (NVU) and the subarachnoid space (SAS) where they remain separated from the brain parenchyma by the glia limitans. The brain parenchyma is an immune-privileged site that is not readily accessible to immune cells and does not elicit stereotypic adaptive or innate immune responses. Understanding brain immune privilege requires intimate knowledge of its unique anatomy in which the brain barriers, that include the glia limitans, establish compartments that differ remarkably with regard to their accessibility to the immune system. We here propose that the brain immune privilege also extends to an ischemic insult, where the brain parenchyma does not evoke a rapid infiltration of neutrophils as observed in ischemic events in peripheral organs. Rather, neutrophil accumulation in the NVU and SAS could have a potential impact on cerebrospinal fluid (CSF) drainage from the central nervous system (CNS) and thus on edema formation and reperfusion injury after ischemic stroke. Integrating the anatomical and functional implications of the brain immune privilege with the unquestionable role of neutrophils in reperfusion injury is a prerequisite to exploit appropriate strategies for therapeutic interventions aiming to reduce neuronal cell death after ischemic stroke.
Analytic description of flame intrinsic instability in one-dimensional model of open–open combustors with ideal and non-ideal end boundaries
Authors: Kanta Mukherjee Nalini
Published: August 2018

This paper is concerned with the theoretical study of thermo-acoustic instabilities in combustors and focuses upon recently discovered flame intrinsic modes. Here, a complete analytical description of the salient properties of intrinsic modes is provided for a linearized one-dimensional model of open–open combustors with temperature and cross-section jump across the flame taken into account. The standard [Formula: see text] model of heat release is adopted, where n is the interaction index and τ is the time lag. We build upon the recent key finding that for a closed–lopen combustor, on the neutral curve, the intrinsic mode frequencies become completely decoupled from the combustor parameters like cross-section jump, temperature jump and flame location. Here, we show that this remarkable decoupling phenomenon holds not only for closed–open combustors but also for all combustors with the ideal boundary conditions (i.e. closed–open, open–open and closed–closed). Making use of this decoupling phenomenon for the open–open combustors, we derive explicit analytic expressions for the neutral curve of intrinsic mode instability on the [Formula: see text] plane as well as for the linear growth/decay rate near the neutral curve taking into account temperature and cross-section jumps. The instability domain on the [Formula: see text] plane is shown to be qualitatively different from that of the closed–open combustor; in open–open combustors it is not confined for large τ. To find the instability domain and growth rate characteristics for non-ideal open–open boundaries the combustor end boundaries are perturbed and explicit analytical formulae derived and verified by numerics.
Quality of Life of Patients with Refractory Chronic Rhinosinusitis: Effects of Filgrastim Treatment
Authors: van Agthoven Michel , Fokkens Wytske J. , Van de Merwe Joop P. , Van Bolhuis E. Marijke , Uyl-de Groot Carin A. , Busschbach Jan J.V.
Published: August 2018

In this double-blind placebo-controlled randomized clinical trial, we investigated the influence of filgrastim administration on the quality of life (QOL) of refractory chronic sinusitis patients who did not respond to regular treatments. QOL was considered to be an important outcome measurement because apart from classic sinusitis parameters, it measures the overall burden of the symptomatology of chronic sinusitis patients caused by general malaise, tiredness, and social impediments. The QOL of 56 patients was assessed five times during the 24-week trial with the EuroQol, the Short Form (SF)-36, and the McGill pain questionnaire (MPQ). The QOL scores were all well below population norm scores and scores in a group of patients with chronic sinusitis who had sinus surgery. QOL scores of the filgrastim group suggested a better QOL than the placebo group, although none of the differences were statistically significant. There were indications that it might be possible to determine a subpopulation in which the results are better. Although the QOL measurements were not able to show a significant treatment effect of filgrastim in this group of patients with refractory chronic sinusitis, these measurements are important in studying chronic sinusitis because they enable the comparison of the burden of illness of patients with chronic sinusitis with other patient groups.
Use of a Portable Spirometer for Studies on the Nasal Cycle
Authors: Hanif Junaid , Eccles Ron , Jawad Suhair S.M.
Published: August 2018

Studies based on the nasal cycle are difficult because multiple measurements of nasal patency need to be made over many hours. There is a great need for a simple portable instrument that can be used away from the clinical laboratory for studies on the nasal cycle. Our aim was to investigate the usefulness of a small portable spirometer in studying the nasal cycle. The Mir Spirobank spirometer was fitted with a nasal adapter to measure the volume of air expired from each nasal passage during a slow vital capacity (VC). The spirometer was used to measure the fractions of the slow VC volume of air expired through the right and left nasal passage in turn. Hourly measurements were made over a 5-hour period in six healthy volunteers. The spirometry measurements of the volume of air expired from each nasal passage were compared with nasal conductance of each nasal passage (airflow at 75 Pa) obtained by posterior rhinomanometry. The spirometer was found easy to use by both the investigator and the patients. Simple regression analysis of the spirometer and rhinomanometer measures of airflow partitioning found a correlation coefficient of r = 0.827 (p < 0.0001; n = 36). These results indicate that the partitioning of nasal expired volume measured by spirometry is directly comparable with partitioning of nasal airflow obtained with rhinomanometry. Spirometry has considerable advantages over rhinomanometry for studies on the nasal cycle because of portability and ease of use.
Treatment of Hypoxemia in Obstructive Sleep Apnea
Authors: Friedman Michael , Landsberg Roee , Ascher-Landsberg Jessica
Published: August 2018

Many patients suffering from obstructive sleep apnea (OSA) have intermittent oxygen desaturation associated with periods of apnea or hypopnea. Oxygen saturation levels below 90% are considered harmful.1 Usually, treatment is directed at correcting the apnea, which will in turn prevent hypoxemia. Unfortunately, many patients fail or are not candidates for nasal continuous positive airway pressure (CPAP) or surgical correction of their OSA. Forty-three patients with persistent OSA and nocturnal hypoxemia below 90% who were not candidates for additional surgical or CPAP therapy were treated with nocturnal oxygen supplementation. Standard symptoms associated with OSA and the Epworth Sleepiness Scale (ESS) were recorded before treatment and 30 days after the start of the treatment. In 21 patients, polysomnography studies were performed to compare the Respiratory Disturbance Index (RDI) score and minimum oxygen saturation levels when the patients were breathing room air or breathing 4 L/minute of oxygen by nasal cannula. Subjective symptoms of obstructive sleep apnea improved, and the ESS score significantly decreased after a 30-night treatment with oxygen. Split-night polysomnography showed a significant increase in minimum oxygen saturation during oxygen administration. The RDI did not significantly change with treatment. Oxygen administration for the correction of OSA-related nocturnal hypoxemia was both safe and effective in alleviation of OSA-related symptoms. It also appeared to have a beneficial effect on minimum oxygen saturation levels. Thus, oxygen therapy may be considered a treatment option in patients who fail to comply with CPAP and are not candidates for a surgical procedure.
Postoperative Antibiotic use of Septoplasty: A Survey of Practice Habits of the Membership of the American Rhinologic Society
Authors: Rechtweg Jay S. , Paolini Raymond V. , Belmont Michael J. , Wax Mark K.
Published: August 2018

Prophylactic antibiotics are used routinely in otolaryngology. Little objective data exist concerning their use in sinonasal procedures. We wished to determine the practice patterns of otolaryngologists regarding prophylactic antibiotics for septoplasty patients. A survey of 743 (60.3% responded) members of the American Rhinologic Society was used to get information about their practice habits and rationale for using antibiotics after septoplasty. Sixty-six percent of respondents routinely used antibiotics. Postoperative infection and toxic shock syndrome (TSS) were the primary indications. Forty-four percent of respondents used some form of packing and 38% used a splint. There was no relationship between the annual number of procedures and the reasons for using antibiotics. Doctors who performed more than 50 cases a year were less likely to use packing or splints (p < 0.001). Older surgeons used less packing/splints (p < 0.001). Respondents who used packing/ splints were more likely to use antibiotics (p = 0.008). Older respondents used packing whereas younger respondents used splints (p = 0.002). The rationale for antibiotics varied by age; younger surgeons are more concerned with TSS and older physicians were more concerned with infection (p = 0.005). This survey shows great variability in the usage and rationale for antibiotics after septoplasty.
Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures
Authors: Castelnuovo Paolo , Mauri Silvia , Locatelli Davide , Emanuelli Enzo , Delù Giovanni , Di Giulio Giuseppe
Published: August 2018

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.
Complications in Sinus Surgery and New Classification Proposal
Authors: Rombout Jan , De Vries Nico
Published: August 2018

Complication overviews may lead to measures directed toward quality improvement and to better information for patients. When evaluating the rhinological literature from 1979 to 1999, a detailed comparison could not be made because of differences in reporting. With the advent of electronically stored medical data, events can be registered better than before. To be able to compile very diverse data from electronic dossiers into concise overviews for feedback, a simple general scale with broad categories is needed. These feedback overviews enable insight in the complication rates of different kinds of sinus surgery and monitoring of changing trends in sinus surgery. An example of a general classification based on severity is presented for use when electronically storing medical data. This scale varies from adverse events (grade A) to death (grade D). A consensus on categorization of complications is a prerequisite for a valid comparison with other clinics. To instigate a discussion about consensus, this classification is presented as an example. Our proposal is presented together with an overview of sinus surgery complications in recent literature for reference.
Diabetes Insipidus after Pituitary Surgery: Incidence after Traditional versus Endoscopic Transsphenoidal Approaches
Authors: Shah Samir , Har-El Gady
Published: August 2018

The endoscopic transnasal approach is gaining increasing popularity as the surgical method of choice for treatment of pituitary lesions. Previous studies have shown advantages such as quicker recovery and fewer cosmetic, dental, and nasal complications. However, no study has compared the rate of diabetes insipidus (DI) between the traditional and endoscopic approaches. This study will examine the incidence of short-and long-term postoperative DI after transnasal pituitary surgery and compare it with the incidence after traditional transseptal surgery. Eighty-one patients underwent transnasal surgery for the management of pituitary lesions. Fifty-five had the traditional sublabial, transseptal, transsphenoidal surgery and 26 patients had the direct transnasal, transsphenoidal endoscopic procedure. The incidence of immediate postoperative DI was 36% in the traditional group and 15% in the endoscopic group. Short-term (>2 weeks) DI that required treatment occurred in 11 patients (20%) in the traditional group and 2 patients (7.6%) in the endoscopic group. Long-term (>6 months) incidence of DI was 7.2% in the traditional group and 3.8% in the endoscopic group. We found a decreased incidence of immediate DI after transnasal endoscopic pituitary surgery as compared with the traditional sublabial transseptal approach. However, the incidence of long-term DI was not significantly different in the two groups.
Safety of Steroid Injections in the Treatment of Nasofrontal Recess Obstruction
Authors: Dutton Jay M. , Bumsted Robert M.
Published: August 2018

A retrospective review was undertaken to determine if steroid injection is a safe and effective intervention in the management of chronic nasofrontal recess obstruction. Seventy-four patients were identified who had undergone prior endoscopic sinus surgery and subsequently developed nasofrontal recess obstruction that was treated with injection of Kenalog 20 mg/mL (Bristol-Myers Squibb Co., Princeton, NJ) directly into the polyps or fibrosis. The study included 38 men and 36 women with a mean age of 45.4 years. These patients collectively underwent 687 injections, an average of 9.3 injections per patient. The indication was polyposis in 70 patients and fibrosis in 17 patients, with 13 sharing both indications. These patients also required 112 office procedures to maintain nasofrontal recess patency, an average of 1.5 procedures per patient. Three patients eventually required frontal sinus obliteration. The mean follow-up period from the initial injection was 50.1 months, and no complications were reported. Therefore, nasofrontal steroid injection appears to be safe and effective in the treatment of nasofrontal recess obstruction.
Analysis of the Adult Chronic Rhinosinusitis Working Definition
Authors: Orlandi Richard R. , Terrell Jeffrey E.
Published: August 2018

In 1997, the Task Force on Rhinosinusitis produced a working definition for adult chronic rhinosinusitis. The diagnostic criteria grew out of expert consensus opinion and were “intended to serve as a unifying starting point for further research.” The validity of these criteria has not been tested yet. This article summarizes our experience with these diagnostic criteria. All patients presenting for evaluation of rhinosinusitis were routinely questioned as to the presence of a number of sinonasal symptoms, including those contained within the Task Force's working definition. The presence or absence of nasal purulence on anterior nasal examination was noted also. Patients who subsequently had surgery to address their chronic rhinosinusitis were felt to be the “gold standard” and comprised the study population. All patients included in the study had symptoms for .12 weeks, evidence of rhinosinusitis that was discovered by computed tomography (CT), and inflammation found on analysis of pathology specimens. These patients’ symptom questionnaires and nasal examinations were reviewed. Fifty-seven patients met the criteria for inclusion in the study. Nasal obstruction/blockage and facial congestion/fullness were the most common symptoms. The average numbers of major and minor symptoms were 3.2 and 2.8, respectively. Patients with polyps and with previous nasal or sinus surgery differed little from the overall population. Of the 57 patients in the study, 50 patients met the diagnostic criteria set forth by the Task Force for a sensitivity of 87.7%. Diagnosing chronic rhinosinusitis without radiological imaging or nasal endoscopy is difficult. The criteria set forth by the Task Force provide a relatively sensitive working definition of chronic rhinosinusitis. Further work is underway to assess the specificity and predictive value of these criteria.
Cetirizine Decreases Interleukin-4, Interleukin-5, and Interferon-γ Gene Expressions in Nasal-Associated Lymphoid Tissue of Sensitized Mice
Authors: Jin Hong-Ryul , Okamoto Yoshitaka , Matsuzaki Zensei , Endo Shuichiro , Ito Eiko
Published: August 2018

Although the action of cetirizine dihydrochloride (cetirizine), a potent histamine H1 receptor antagonist, has been well known, its effect on the cytokine profiles in the nasal immune inductive site has not been elucidated yet. We studied the effect of cetirizine on the cytokine profiles in the nasal-associated lymphoid tissue (NALT), which is a principal mucosal lymphoid tissue of the respiratory tract in rodents. Two different doses of cetirizine were given intraorally for 5 days before the nasal challenge of ovalbumin in sensitized mice. The sensitized group was given normal saline instead of cetirizine, and the nonsensitized group had no sensitization or medication. The cytokine gene expressions in the NALT taken from the mice were investigated with real-time quantitative reverse-transcription polymerase chain reaction. The effect of cetirizine on the allergic symptom score, histamine threshold, and the eosinophil count in the nasal septal mucosa were examined also. Compared with the normal mice, the sensitized mice showed significantly increased levels of interleukin (IL)-4 and IL-5 gene expression although the increase of interferon (INF)-γ gene expression was not significant. In the cetirizine groups, the levels of expression of IL-4, IL-5, and INF-γ in the NALT were significantly decreased compared with the sensitized group. The cetirizine groups also showed decreased allergic symptom score, histamine threshold, and eosinophil count in the nasal septal mucosa compared with the sensitized group. In conclusion, cetirizine reduced the levels of expression of IL-4, IL-5, and INF-γ in the NALT of ovalbumin-sensitized mice. Cetirizine also reduced the acute allergic symptom, histamine sensitivity, and eosinophil count in the nasal septal mucosa.
Acoustic Rhinometry in the Dog: A Novel Large Animal Model for Studies of Nasal Congestion
Authors: Koss Michael C. , Yu Yongxin , Hey John A. , McLeod Robbie L.
Published: August 2018

The aim of this project was to develop and pharmacologically characterize an experimental dog model of nasal congestion in which nasal patency is measured using acoustic rhinometry. Solubilized compound 48/80 (0.3–3.0%) was administered intranasally to thiopental anesthetized beagle dogs to elicit nasal congestion via localized mast cell degranulation. Compound 48/80–induced effects on parameters of nasal patency were studied in vehicle-treated animals, as well as in the same animals pretreated 2 hours earlier with oral d-pseudoephedrine or chlorpheniramine. Local mast cell degranulation caused a dose-related decrease in nasal cavity volume and minimal cross-sectional area (Am in) together with a highly variable increase in nasal secretions. Maximal responses were seen at 90–120 minutes after 48/80 administration. Oral administration of the adrenergic agonist, d-pseudoephedrine (3.0 mg/kg), significantly antagonized all of the nasal effects of compound 48/80 (3.0%). In contrast, oral administration of the histamine H1 receptor antagonist chlorpheniramine (10 mg/kg) appeared to reduce the increased nasal secretions but was without effect on the compound 48/80–induced nasal congestion (i.e., volume and Am in). These results show the effectiveness of using acoustic rhinometry in this anesthetized dog model. The observations that compound 48/80–induced nasal congestion was prevented by d-pseudoephedrine pretreatment, but not by chlorpheniramine, suggest that this noninvasive model system may provide an effective tool with which to study the actions of decongestant drugs in preclinical investigations.
Surgical, Radiologic, and Histologic Findings of the Antrochoanal Polyp
Authors: Chung Seung-Kyu , Chang Byung-Chan , Dhong Hun-Jong
Published: August 2018

Background

Of 15 patients with primary unilateral antrochoanal polyps (ACPs), we noticed that all ACPs except one extended through the accessory ostium of the maxillary sinus projected posterior along the nasal cavity. We observed no structural changes in ostiomeatal area on a coronal computed tomography scan.

Methods

We classified 15 patients with ACP into three stages according to the coronal computed tomography findings of (i) status of the accessory ostium of the maxillary sinus and (ii) level of extension to the nasopharynx. The extent of inflammation in the computed tomography and histologic aspects were also evaluated according to such stages.

Results

In three patients, ACPs did not extend to the nasopharynx (stage I). Among the other ACPs reaching the nasopharynx, complete occlusion of the opening (stage II) was noted in seven patients, and partial occlusion of the opening (stage III) was noted in five patients. The extent of ipsilateral, as well as bilateral, inflammation in the imaxillary sinus in stages I and II was greater than that in stage III. More severe inflammatory cell infiltration was observed in stage II in histologic examination.

Conclusions

We hypothesize that stage I may correspond to an early stage, stage II to full-blown disorder, and stage III to a regression stage. When the exit site of an ACP is the accessory ostium, this opening should be connected to the natural ostium of the maxillary sinus to prevent a possible recirculation phenomenon.
The Endoscopic Modified Lothrop: Long-Term Follow-Up on 44 Patients
Authors: Schlosser Rodney J. , Zachmann Gregory , Harrison Scott , Gross Charles W.
Published: August 2018

Background

The gold standard for surgical treatment of chronic frontal sinusitis has been the osteoplastic flap with obliteration. In an attempt to preserve the frontal sinus, we have been performing the endoscopic modified Lothrop or frontal drill-out.

Methods

Retrospective chart review.

Results

We performed the modified Lothrop on 54 patients between 1993 and 1998. The modified Lothrop was successful (no revision surgeries and only an occasional need for antibiotics) after one procedure in 68% (30/44) of patients followed up for ≥1 year. Six patients underwent successful revision, bringing the overall success rate to 82% (36/44). Eight patients (18%) eventually underwent osteoplastic flap with obliteration, three of those after attempted revision. Mean follow-up was 40 months with failures occurring a mean of 12 months after initial Lothrop. Overall complication rate was 11%.

Conclusions

The modified Lothrop is a technically challenging operation that provides an acceptable alternative to the osteoplastic flap with obliteration.
Endoscopic Endonasal Approach for the Treatment of Benign Schwannoma of the Sinonasal Tract and Pterygopalatine Fossa
Authors: Pasquini Ernesto , Sciarretta Vittorio , Farneti Giovanni , Ippolito Antonio , Mazzatenta Diego , Frank Giorgio
Published: August 2018

Schwannomas are tumors that rarely involve the sinonasal tract or the pterygopalatine fossa. Three cases of benign schwannomas originating in the nasal cavity, the nasal-ethmoid, and the pterygopalatine fossa are reported. Surgical treatment is considered the treatment of choice to achieve long-term success. In this study, the effectiveness of the endoscopic endonasal approach is outlined for the diagnosis and treatment of these benign tumors.
Multiplanar Reconstructed Computed Tomography Images Improves Depiction and Understanding of the Anatomy of the Frontal Sinus and Recess
Authors: Kew Jacqueline , Rees Guy L. , Close David , Sdralis Theo , Sebben Ruben A. , Wormald Peter-John
Published: August 2018

Aims

The use of multiplanar reconstructed computed tomography (CT) images of frontal recess and sinuses was assessed with regard to depiction and understanding of anatomy and effect on surgical approach.

Materials and Methods

Three otorhinolaryngologists and one radiologist read CT scans of 43 patients referred for routine paranasal sinus scans. Spiral (helical) CT scans were obtained and coronal and parasagittal reconstructions were imaged. Three hundred forty-two readings were analyzed. The scans were assessed in the coronal plane and then in the parasagittal plane. The images were assessed for (i) Bent and Kuhn classification of frontal ethmoidal sinus air cells, (ii) size of frontal sinus ostium (assessed as unsure, normal, small, or large), (iii) use of parasagittal scans regarding additional understanding of the anatomy with particular reference as to how the agger nasi cell and frontal ethmoidal cells were arranged in a three-dimensional space, and (iv) if the parasagittal scan and subsequent three-dimensional picture created altered the surgical approach. The first two criteria were assessed in the coronal plane and then in the parasagittal plane.

Results

There was no statistically significant difference between the Bent and Kuhn classification of frontoethmoidal cells on coronal and reconstructed parasagittal images (t-test; p < 0.05). The parasagittal scans were significantly better than the coronal scans for identifying and assessing the size of the frontal sinus ostium (p > 0.001; chi-square test). Assuming an intraobserver change rate (repeat error) of 10% on CT scan observations, an exact binomial test was performed on S-PLUS, which showed that there was a significant (p < 0.001) proportion of observers who changed their rating after looking at the parasagittal scan. There also was significant improvement in observers’ abilities to identify and classify the size of the frontal ostium as reflected by the number of observers who changed from being unsure on the coronal scans to sure on the parasagittal scans. Observers felt that the parasagittal scans improved their three-dimensional understanding of the anatomy of the frontal recess by 58% on a 10-point Lickert scale. In 55% of these observations, the surgical plan was altered by a mean of 70.2% on a 10-point Lickert scale based on additional information obtained by viewing the parasagittal scans.

Conclusions

The three-dimensional understanding of the frontal recess is improved greatly by using both coronal and parasagittal reconstructed images as compared with coronal images alone. This had important implications on the planning of the surgery in the frontal recess.
Effects of Oxymetazoline on the Ventilation of Paranasal Sinuses in Healthy Subjects
Authors: Paulsson Bo , Lindberg Sven , Ohlin Per
Published: August 2018

Background

Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as α2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of α2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date.

Methods

In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects.

Results

No significant effect of oxymetazoline on sinus ventilation was seen in either group.

Conclusions

The results indicate that α2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.
Cystic Fibrosis in Rhinologic Practice
Authors: Krzeski Antoni , Kapiszewska-Dzedzej Dorota , Górski Norbert P. , Jakubczyk Iwona
Published: August 2018

Background

Cystic fibrosis (CF) is the most common genetic lethal disorder that affects white populations. Chronic rhinosinusitis (CRS) with extensive nasal polyposis is one of the manifestations of CF.

Methods

The aim of this study was to determine the prevalence and extent of CRS in CF patients.

Results

The study indicated that the signs and symptoms of CRS were present in all patients with CF and they were more advanced than in the control group. The most severe inflammatory changes in the paranasal sinuses were detected in patients with the dF508 gene mutation type who suffered from CRS for >3 years.

Conclusions

Massive nasal polyposis, dilated base of the nose, mucociliary clearance impairment, and significant radiological changes (frontal and maxillary sinus hypoplasia, bony destruction, and medial bulging of the lateral nasal wall) were identified to be the characteristic signs of the CRS in CF patients.
Skull Base Erosion by Sphenoid Fungus Balls: Diagnosis and Endoscopic Treatment
Authors: Schlosser Rodney J. , Gross Charles W. , Kountakis Stilianos
Published: August 2018

Background

Fungus balls typically are innocuous lesions found in immunocompetent hosts. They are located most commonly in the maxillary sinus but may be life-threatening when found in the sphenoid sinus.

Methods

We review our series of four sphenoid fungus balls with skull base erosion.

Results

Our average patient age was 68.7 years old (56–86 years) with three women and one man. One patient was insulin-dependent diabetic, the other three patients were otherwise healthy. The most common presenting symptoms were headache and dizziness with relatively few sinus-specific complaints. Endoscopy revealed polyps in two of the four patients. Computerized tomography scans revealed thickened osteitic bone in three cases and two of the four computed tomography scans showed microcalcification. All patients had bony erosion over the internal carotid arteries. Additionally, one patient internal carotid artery thrombosis, one patient had erosion of the planum sphenoidale, and a third patient had erosion to the brainstem inferior to the sella turcica. Three patients had magnetic resonance imaging that revealed heterogeneous lesions. Two magnetic resonance images showed hypointense T1 and T2 imaging. The third was isointense on T1 and hypointense on T2. All patients were treated with endoscopic marsupialization and removal of all gross fungal debris without complications. All pathological specimens were diagnostic for fungus balls. One of four cultures was positive for fungus. All patients are asymptomatic at time of last follow-up.

Conclusions

Sphenoid fungus balls present with vague, non-rhinological symptoms, but may have significant local expansion and destruction. These potentially lethal lesions usually can be suspected on preoperative imaging and are best treated with endoscopic removal.
Primary Paranasal Aspergillus Granuloma: Case Report and Review of the Literature
Authors: Currens John , Hutcheson Patricia S. , Slavin Raymond G. , Citardi Martin J.
Published: August 2018

Background

Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the Sudan and India. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements.

Conclusion

We describe the first case of PPAG in the United States in an immunocompetent nonatopic woman who had never left Missouri.
The Comparative Risks of Bacterial Contamination between a Venturi Atomizer and a Positive Displacement Atomizer
Authors: Wolfe Timothy R. , Hillman Todd A. , Bossart Philip J. , Kennedy David W.
Published: August 2018

Introduction

This laboratory study determined the incidence of internal contamination of Venturi principle atomizers and positive displacement atomizers exposed to high external concentrations of Staphylococcal aureus (Staph).

Methods

Atomizer device nozzle tips were immersed into a Staph solution and 1 ml of spray was atomized via compressed wall air (Venturi) or hydraulic pump (positive displacement). The Venturi nozzle was then wiped with 70% isopropyl alcohol while the disposable positive displacement nozzle was replaced. After 30 minutes, 1 ml of atomized fluid was collected and cultured and the process was repeated. After sixteen uses the fluid remaining in the bottles was cultured. The Venturi atomizer also was subjected to a single use trial to determine the location of device contamination.

Results

Venturi atomizers sprays grew Staph in every case (144/144), while positive displacement atomizer sprays never grew contaminants (0/144; p < 0.0001). At the end of 16 uses, 7/9 of Venturi atomizers had Staph within their medication reservoirs while none (0/9; p = 0.002) existed in the positive displacement atomizers. After a single use of the Venturi atomizer, the medication reservoir, the air lumen and the medication lumen of the nozzle were all contaminated with Staph.

Conclusions

External bacterial contamination of the atomizer nozzle tip results in internal bacterial contamination of Venturi devices in as little as one use but not of positive displacement devices. These results warrant further investigation to determine whether a risk of cross-contamination exists in a clinical setting.
Comparison of Endoscopic Sinus Surgery with and without Image Guidance
Authors: Fried Marvin P. , Moharir Vik M. , Shin Jennifer , Taylor-Becker Marta , Morrison Paul , Kennedy David W.
Published: August 2018

Background

Image guidance based on preacquired computed tomography scans of the patient is a technique used to assist the physician during endoscopic sinus surgery (ESS). This study seeks to compare ESS with and without image guidance, analyzing a number of parameters that can impact on efficacy.

Methods

Retrospective chart review took place at a tertiary care referral center. The study group consisted of 97 consecutive patients confirmed to have undergone ESS using an electromagnetic intraoperative image guidance system (IGS). The control group consisted of 61 consecutive patients who underwent ESS, before the IGS was available at the study hospital. The main outcomes measured were analysis of patient profile, including coexisting conditions such as asthma and polyposis, assessment of which specific sinuses underwent surgical treatment; major and minor complications; estimated blood loss (EBL); operative time; and the need for repeat surgery.

Results

The IGS group had 74% of patients with polyposis; more sinuses, on average, which underwent surgical revision; one major and three minor complications; an average EBL of 134 cc, an average procedure time of 154 minutes; and one patient who needed repeat surgery in a 3-month follow-up period. The non-IGS group had 40% of patients with polyposis; seven major complications and one minor complication; an average EBL of 94 cc; and three patients who needed repeat surgery within 3 months.

Conclusions

The use of an IGS for endoscopic sinus surgery may reduce the complications associated with the procedure and allow for a more thorough operation. However, operative time and EBL may be increased.
A Diagnostic Dilemma for Chronic Rhinosinusitis: Definition Accuracy and Validity
Authors: Stankiewicz James A. , Chow James M.
Published: August 2018

Background

The current definition of chronic rhinosinusitis is a symptom-based definition with minimal reliance on objective information. Based on this definition, patients are diagnosed and treated with medical therapy. A computed tomography (CT) scan is obtained only if the patient is not improved after medical therapy. No study is available evaluating in an evidence-based manner the accuracy of the current definition and its impact on diagnosis and treatment.

Methods

This study represents 78 patients evaluated in a prospective fashion who met the subjective criteria for the definition of chronic rhinosinusitis. All patients underwent a complete history with a questionnaire evaluating symptom severity, a physical exam including anterior rhinoscopy and endoscopy, and a CT scan obtained on the day of their initial visit. Objective CT scan findings were compared with the subjective findings and related to the ultimate diagnosis of chronic sinusitis.

Results

Only 37/78 (47%) had a positive (1) CT scan, indicating demonstrable sinusitis. There also was no real difference in symptom severity between patients with positive (1) and negative (2) CT scanning.

Conclusion

The current symptom-based definition of chronic sinusitis poorly predicts whether a patient truly has chronic sinusitis and needs reevaluation.
Endoscopic Management of Benign Sinonasal Tumors: A Decade of Experience
Authors: London Scott D. , Schlosser Rodney J. , Gross Charles W.
Published: August 2018

Background

A variety of benign tumors present in the nasal and paranasal sinuses.

Methods

We review our experience over the last 10 years with endoscopic management of these tumors and discuss presentation, diagnostic considerations, and therapeutic options.

Results

Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years.

Conclusions

With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.
Bacteriology of Chronic Maxillary Sinusitis in Relation to Sinoscopic Appearance
Authors: Jiang Rong-San , Lin Jen-Fu , Hsu Chen-Yi
Published: August 2018

Background

The bacteriology of chronic maxillary sinusitis in relation to different sinoscopic appearances is reported in this study.

Methods

When transantral sinoscopy via an anterior wall puncture was used to examine the maxillary antra in patients with chronic maxillary sinusitis, the sinoscopic appearances were divided into five types. Maxillary antra in which ostia were recognized under the endoscope and no secretion existed were classified as type 1. Maxillary antra in which ostia were not recognized and no secretion existed belonged to type 2. Maxillary antra in which seromucoid secretion existed belonged to type 3. Maxillary antra in which mucopurulent discharge existed belonged to type 4. Maxillary antra in which fungal balls existed belonged to type 5. Swab specimens of these antra were sent for aerobic and anaerobic cultures.

Results

Between 1988 and 1998, 493 sinoscopic appearances of maxillary antra were classified. Among them, 72 were classified as type 1, 59 were type 2, 75 as type3, 227 were type 4, and 60 were type 5. The culture rate of swab specimens from those antra with type 1 sinoscopic appearance was 56.9%. The culture rates were 59.3% for type 2, 48% for type 3, 64.8% for type 4, and 88.3% for type 5. Common cultured bacteria were similar among antra with different types of sinoscopic appearances, except type 5 antra, but less gram-negative aerobes grew from type 1 antra.

Conclusions

This study shows that the bacteriology of noninvasive fungal sinusitis was different from that of ordinary chronic maxillary sinusitis. However, among ordinary chronic maxillary sinusitis, the bacteriology was similar between maxillary antra with different sinoscopic appearances except with mild disease.