bluuebunny/crossref_metadata_2025 huggingface dataset:
Propagation of Human Nasal Chondrocytes in Microcarrier Spinner Culture
Authors: Shikani Alan H. , Fink David J. , Sohrabi Afshin , Phan Phong , Polotsky Anna , Hungerford David S. , Frondoza Carmelita G.
Published: August 2018

Objective

The aim of this study was to test the effectiveness of nasal septal chondrocytes, propagated in microcarrier spinner culture, as an alternative tissue source of chondrocytic cells for cartilage grafts for head and neck surgery and for articular cartilage repair.

Methods

We harvested chondrocytes from 159 patients, ranging in age from 15 to 80 years and undergoing repair of a deviated nasal septum, and propagated the cells in a microcarrier spinner culture system. The nasal chondrocytes proliferated and produced extracellular matrix components similar to that produced by articular chondrocytes.

Results

In microcarrier spinner culture on collagen beads, chondrocyte numbers increased up to 14-fold in 2 weeks. After a month, the microcarriers seeded with nasal chondrocytes began to aggregate, producing a dense cartilage-like material. The newly synthesized extracellular matrix was rich in high molecular weight proteoglycans, and the chondrocytes expressed type II collagen and aggrecan but not type I collagen.

Conclusion

These studies support the feasibility of engineering cartilage tissue using chondrocytes harvested from the nasal septum. Injectable and solid formulations based on this technology are being evaluated for applications in craniomaxillofacial reconstructive surgery and for plastic and orthopedic surgery practices.
Acute Effects of 1,1,1-Trichloroethane on Human Olfactory Functioning
Authors: Muttray Axel , Moll Bertram , Faas Michael , Klimek Ludger , Mann Wolf , Konietzko Johannes
Published: August 2018

Background

Animal experiments indicate that 1,1,1-trichloroethane can cause degeneration of the olfactory epithelium. The effects of 1,1,1-trichloroethane on human odor perception still have not been investigated. The goal of this study was to learn more about acute effects of 1,1,1-trichloroethane.

Methods

Twelve healthy, nonsmoking students were exposed to 200 and 20 ppm (control) 1,1,1-trichloroethane in an exposure chamber for 4 hours according to a crossover design. Olfactory functioning was investigated with the Sniffin’ Sticks. The test includes the determination of the detection threshold for n-butanol and an odor identification test.

Results

After 1 hour of exposure to 200 ppm 1,1,1-trichloroethane, no effects on olfactory functioning were observed. After 4 hours, the olfactory threshold for n-butanol was slightly (p = 0.04) elevated.

Conclusion

The threshold shift may be caused by different mechanisms, including inflammation of the olfactory mucosa or degeneration of receptor cells.
Endoscopic Sinus Surgery in Geriatric Population
Authors: Ramadan Hassan H. , Vanmetre Ray
Published: August 2018

Background

With the baby boomers getting older, endoscopic sinus surgery (ESS) is being performed more on elderly people than before. We compared patients undergoing ESS who were >65 years of age with those <65 years.

Materials and Methods

We reviewed our database of cases who had ESS between 1992 and 2002. Demographics and patient characteristics and complications encountered intraoperatively and immediately postoperatively were reviewed.

Results

Forty-six (8.1%) patients were older than 65 years of age compared with 522 patients who were 18–64 years old. The older group had a 24% revision rate compared with 34% in the younger group. Complication rates were 21.7% for the elderly compared with 12.8% for the younger group. There was a significantly higher complication rate in the older group of people who were having revision ESS.

Conclusion

The elderly people who were having revision surgery had a higher risk for complications compared with those having primary surgery or those <65 years old.
Multi-Use Venturi Nasal Atomizer Contamination in a Clinical Rhinologic Practice
Authors: Dubin Marc G. , White David R. , Melroy Christopher T. , Gergan Maria T. , Rutala William A. , Senior Brent A.
Published: August 2018

Introduction

Cross-contamination of Venturi atomizers has been reported.

Methods

In phase I, 16 atomizers were sterilized and refilled with either 1% lidocaine or 0.1% Tyzine (day 0). During phase II, atomizers were wiped with isopropyl alcohol wipes between uses. In both phases, on days 7, 14, 21, and 28, the contents of the atomizer were sprayed onto two culture media. If a culture was found positive, cultures from the nozzle, lumen, and solution were taken and cultured in depth.

Results

Twelve lidocaine bottles and three Tyzine bottles were initially positive. There were more positive cultures from lidocaine bottles than Tyzine bottles at 2 weeks (p = 0.02). After wiping with isopropyl alcohol, contamination was significantly reduced in the lidocaine bottles at 2 weeks (p = 0.02).

Conclusion

Microbial contamination of questionable clinical significance may occur with nasal atomizers. Regardless of this significance, wiping the devices with isopropyl alcohol can eliminate microbial growth for a 2-week interval.
Evaluation of Telomerase Activity in Nasal Polyps
Authors: Bruno Ernesto , Bonmassar Enzo , Di Girolamo Stefano , Adamo Riccardo , Alessandrini Marco , Ottaviani Fabrizio , Rosati Faustino , Franzese Ornella
Published: August 2018

Background

The objective of this study was to assess if nasal polyps express telomerase activity and whether a difference could be found between the polyp and the surrounding mucosa of the middle meatus and between different portions of the polyp itself.

Methods

Nine patients affected by nasal polyposis were included in this study; four of these patients had recurring polyposis. Telomerase activity was measured by telomeric repeat amplification protocol assay. In six patients, the telomeric repeat amplification protocol assay was performed on the polyp and on the mucosa from the ipsilateral middle meatus. In a polyp, we were able to investigate telomerase activity of its different portions, corresponding to pedicle and fundus.

Results

Telomerase activity observed in nasal polyps was higher than that observed in samples from the ipsilateral middle meatus mucosa. High or intermediate telomerase activity was found to be related to predominant recurring polyposis.

Conclusion

Therefore, it could be postulated that telomerase activity could be related with the tendency of polyps to recur.
Software-Enabled Computed Tomography Analysis of the Carotid Artery and Sphenoid Sinus Pneumatization Patterns
Authors: Batra Pete S. , Citardi Martin J. , Gallivan Ryan P. , Roh Hwan-Jung , Lanza Donald C.
Published: August 2018

Background

The critical relationship of the carotid artery with the sphenoid sinus has been long established. Sophisticated imaging software in conjunction with three-dimensional high-resolution computed tomography (CT) imaging now facilitates detailed analysis of these anatomic relationships.

Methods

Siemens VolumeZoom CT scanner was used to obtain high-resolution computed tomography data that was subsequently transferred to the CBYON Suite Doctor Station version 2.6 for analysis. Various surgical planning tools were used for evaluating the CT scans. The relationship of the carotid artery with the sphenoid sinus was delineated.

Results

One-hundred twenty-eight sides in 64 cadaveric specimens were reviewed. Pneumatization of the sphenoid sinus was classified into four categories: conchal, presellar, sellar, and postsellar. The incidence of these four types was 4.7, 4.7, 25, and 65%, respectively. Carotid artery exposure was categorized as follows: no exposure, <90°, >90 to <180°, and >180°. The incidence of the carotid exposure was 12.5, 32.8, 50, and 4.7%, respectively. Septal insertions onto the carotid artery were noted in 37.5% and dehiscences in 19.5% of the specimens.

Conclusion

Computer-aided CT analysis allows for a detailed study of the critical relationship of sphenoid pneumatization and carotid artery position. Such technology can be invaluable in surgical planning and navigation during endoscopic sinus surgery. In lieu of these findings, sinus surgeons must exercise extreme caution when operating in this region to prevent unintentional injury to the carotid artery.
Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature
Authors: Dufour Xavier , Kauffmann-Lacroix Catherine , Roblot France , Goujon Jean Michel , Breux Jean Philippe , Ferrie Jean Claude , Michel Klossek Jean
Published: August 2018

Background

Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India).

Methods and Results

We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria.

Conclusion

Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.
Prognostic Factors of Maxillary Sinus Malignancies
Authors: Nazar Gonzalo , Rodrigo Juan P. , Llorente José L. , BaragaNto Lucía , Suárez Carlos
Published: August 2018

Background

Analysis of a series of tumors of the maxillary sinus show contradictory outcome data. The purpose of this article was to study the prognostic factors that may have implications for patient management.

Methods

We present a retrospective review of 57 patients who underwent a maxillectomy over a 20-year period.

Results

At the time of presentation, 86% of patients had advanced local disease (T3–T4). The 5-year disease-specific survival rate of this series was 39%. No significant differences on survival were observed according the histology of the tumor (p = 0.213), extension to the infratemporal fossa (p = 0.314), and postoperative radiotherapy (p = 0.723). Factors that revealed a significant reduction of survival were skull base involvement (p = 0.013), involvement of the orbit (p = 0.043), and recurrent disease (p = 0.048). Multivariate analysis confirmed that the skull base and orbital involvement were significantly associated with disease-specific survival.

Conclusion

Advanced T stage, base of skull involvement, orbital extension, and local recurrence are highly predictive of poor survival.
Transforming Growth Factor β1 in Nasal Remodeling: Differences between Chronic Rhinosinusitis and Nasal Polyposis
Authors: Watelet Jean-Baptiste , Cindy  , Perez-Novo Claudina , Gevaert Philippe , Van Cauwenberge Paul , Bachert Claus
Published: August 2018

Background

Chronic rhinosinusitis (CRS) and nasal polyposis (NP) are histopathologically characterized by different gross morphological aspects. Transforming growth factor (TGF) β1 plays an important role in tissue remodeling, which is poorly understood in chronic diseases of the sinuses.

Methods

The expression of TGF-β1 was analyzed by enzyme-linked immunosorbent assay, quantitative reverse-transcription polymerase chain reaction, and immunohistochemistry in nasal tissue from controls (n = 6), CRS (n = 19), or NP (n = 19).

Results

CRS presented significantly higher concentrations of TGF-β1 at protein (p = 0.0008) and mRNA levels (p = 0.025) when compared with NP samples. In CRS, TGF-β1+ staining of the extracellular matrix was found abundantly and related to fibrosis. In contrast, no TGF-β1 staining was found in the pseudocyst areas in NP.

Conclusions

CRS was histologically characterized by fibrosis, which was reflected by a significantly higher expression of TGF-β1 at RNA and protein levels when compared with NP. We show that TGF-β1 expression is related to fibrosis, differentiating CRS without polyps from NP.
Nasal Toxicity of Benzalkonium Chloride
Authors: Riechelmann Herbert , Deutschle Tom , Stuhlmiller Anja , Gronau Silke , Bürner Harald
Published: August 2018

Background

Benzalkonium chloride (BAC) is added to nasal preparations to prevent microbial contamination. Adverse effects of BAC on human nasal mucosa should be evaluated.

Methods

The ciliotoxicity of BAC was assessed in isolated human nasal epithelia from 15 donors. The effects of nasal BAC 0.05% (4 X 200 μL/day for 8 days) on nasal saccharin transport time, inflammatory cells and cytokine levels in nasal secretions, and nasal symptom scores were assessed in a randomized, double-blind crossover trial in 16 healthy volunteers.

Results

In vitro, BAC was ciliotoxic (p < 0.0001). In vivo, BAC did not alter saccharin transport time in healthy individuals (p > 0.8). No BAC-associated proinflammatory effects were observed. The staining index for myeloperoxidase was 4.8% in the placebo period and 6.3% (p = 0.42) in the BAC period. Also, nasal secretion levels of cytokines and the neuropeptide substance P revealed no BAC-associated differences. Concentrations for interleukin (IL)-6 in the placebo period were 41.5 pg/mL (0.9–91.7 pg/mL) and in the BAC period were 17.6 pg/mL (3.2–65.9 pg/mL; p = 0.46), and concentrations for substance P were 119 pg/mL (58–293 pg/mL) and 131 pg/mL (80–330 pg/mL; p = 0.31), respectively. Immediately after application, BAC caused nasal irritation (p = 0.001), a burning sensation (p = 0.0003), and hypersecretion (p = 0.006). Moreover, BAC caused a persistent sensation of nasal irritation (p < 0.01).

Conclusion

BAC in concentrations used in nasal preparations is ciliotoxic. In healthy individuals, the ciliotoxic effect of BAC is neutralized, probably by components of nasal secretions. No BAC-related proinflammatory effects have been observed. At higher doses than normally used therapeutically, BAC caused significant nasal irritation. (American Journal of Rhinology 18, 291–299, 2004)
The Role of Mitomycin C in Preventing Synechia and Stenosis after Endoscopic Sinus Surgery
Authors: Anand Vijay K. , Tabaee Abtin , Kacker Ashutosh , Newman Jason G. , Huang Clark
Published: August 2018

Background

Synechia and stenosis formation after endoscopic sinus surgery (ESS) represents a potential source of surgical failure. Mitomycin C (MMC) has been used successfully in other fields to decrease postoperative scar formation. We hypothesize that the topical application of MMC reduces the incidence of stenosis and synechia formation after ESS.

Methods

This study is a randomized, controlled, single-blinded study based in a tertiary care teaching hospital. After routine ESS, a pledget soaked in MMC (0.5%) was randomly placed into the middle meatus of one nasal cavity for 5 minutes and a pledget soaked in saline was placed in the contralateral side in each patient. A blinded observer followed the patients for any evidence of stenosis or synechia formation. The medical records of enrolled patients were reviewed for demographics, diagnosis, prior surgery, type of sinus surgery, complications, incidence of stenosis/synechia, and need for further procedures.

Results

Twenty-nine patients were included in the final analysis. The mean follow-up period was 15 months (range, 3–32 months). There were no complications in this series. Eight patients experienced 10 episodes of synechia formation and one patient experienced 1 episode of synechia formation and 1 episode of stenosis of the maxillary sinus ostium. Seven of the 12 episodes of synechia/stenosis occurred on the side of the MMC application and the remaining 5 episodes occurred on the side opposite to the MMC application. This difference was not statistically significant.

Conclusion

The topical application of MMC did not decrease the incidence of stenosis and synechia formation after ESS. (American Journal of Rhinology 18, 311–314, 2004)
The Expression of Human Antimicrobial Peptide LL-37 in the Human Nasal Mucosa
Authors: Chen Po-Hsu , Fang Sheen-Yie
Published: August 2018

Background

LL-37, an antimicrobial peptide, has been discovered to be produced by a number of epithelial cells. It is identified as a key element in the innate host defense mechanism. Because little is known about the expression of LL-37 in human sinonasal tract, we conducted this study to investigate the expression of LL-37 in human nasal mucosa.

Methods

We investigated the expression of LL-37 gene by the reverse transcription polymerase chain reaction (RT-PCR) and localization of LL-37 peptide by immunohistochemistry in the inferior turbinate mucosa of 7 normal subjects and the nasal polyps of 12 patients with chronic paranasal sinusitis.

Results

The transcripts of the LL-37 gene were detected in all human nasal tissues analyzed by RT-PCR. There is a significant increase of LL-37 mRNA expression in nasal polyps as compared with the normal nasal mucosa. Using immunohistochemistry, LL-37 peptide was localized in surface epithelial cells and submucosal glands.

Conclusions

Our findings suggest that LL-37 is expressed by nasal mucosa and is upregulated during inflammation.
Nasal Obstruction and Sleep-Disordered Breathing: A Study Using Acoustic Rhinometry
Authors: Morris Luc G. , Burschtin Omar , Lebowitz Richard A. , Jacobs Joseph B. , Lee Kelvin C.
Published: August 2018

Background

The relationship between nasal airway function and sleep-disordered breathing (SDB) remains unclear. Although correction of nasal obstruction can significantly improve nighttime breathing in some patients, nasal obstruction may not play a role in all cases of SDB. An effective method of stratifying these patients is needed. Acoustic rhinometry (AR) is a reliable, noninvasive method of measuring the dimensions of the nasal airway.

Methods

In 44 patients, we performed acoustic rhinometric measurements of nasal airway cross-sectional area, followed by hospital-based polysomnography and nasal continuous positive airway pressure (nCPAP) level titration. We compared anatomic nasal obstruction to perceived nasal obstruction, as well as respiratory distress index and nCPAP titration level, using the Pearson correlation and multiple linear regression analysis within body mass index groups.

Results

Perceived nasal obstruction correlated significantly with objective anatomic obstruction as measured by AR (r = 0.45, p < 0.01). For certain subgroup analyses inpatients with a body mass index below 25, AR measurements correlated significantly with both nCPAP titration pressure (r = 0.85, p < 0.01) and respiratory distress index (r = 0.67, p = 0.03).

Conclusion

Nasal airway function may be a significant component of SDB in some patients, perhaps playing a larger role in patients who are not overweight. The best responders to nasal surgery for SDB may be nonoverweight patients with nasal obstruction. AR along with nasal examination may be helpful in the evaluation and treatment of the SDB patient.
Effect of Using Multiple Culture Media for the Diagnosis of Noninvasive Fungal Sinusitis
Authors: Collins Melanie M. , Nair Salil B. , Der-Haroutian Vanik , Close David , Rees Guy L. , Grove David I. , Wormald Peter-John
Published: August 2018

Background

This study was designed to assess the relative efficiency of three different culture media for isolating fungi in patients suspected of having noninvasive fungal sinusitis.

Methods

A prospective study was performed of 209 operative samples of sinus “fungal-like” mucin from 134 patients on 171 occasions and processed for microscopy and fungal culture in Sabouraud's dextrose agar, potato dextrose agar, and broth media.

Results

Ninety-three (69%) of 134 patients had evidence of fungal infection. Two-thirds of patients had negative microscopy samples yet 56% of these went on to positive cultures. Forty-five percent cultured Aspergillus genus. Discrepancy between the fungi cultured in different media and on different occasions was common. With a single culture medium up to 19% of patients and 15% of samples would have been falsely labeled fungal negative.

Conclusion

Increasing the number and type of fungal culture media used increases the number and range of fungal isolates from mucin in patients with the features of fungal sinusitis. Negative specimen microscopy is unreliable. All specimens should be cultured in multiple media and on multiple occasions when fungal sinusitis is suspected.
Correlation between Preoperative Symptom Scores, Quality-of-Life Questionnaires, and Staging with Computed Tomography in Patients with Chronic Rhinosinusitis
Authors: Wabnitz David A.M. , Nair Salil , Wormald P.J.
Published: August 2018

Background

This study evaluates the correlation between preoperative symptoms, quality-of-life questionnaires (chronic sinusitis survey and 20-Item Sinonasal Outcome Test [SNOT-20]), and staging on computer tomography (CT). It consisted of a prospective cohort study of all consecutive patients undergoing surgery for medically nonresponsive chronic sinusitis, which took place at a tertiary care center.

Methods

Two hundred twenty-one patients completed the Chronic Sinusitis Survey (CSS) questionnaire and the SNOT-20. A visual analog scale (VAS) symptom score was completed also. The average age of the patients was 44.5 years and the male/female ratio was 1.3:1. The symptom scores of all three questionnaires were compared with the Lund-MacKay CT scan score of the sinuses.

Results

The median Lund-MacKay CT score was 12 (mean ± SD, 12.7 ± 5.7). There was no significant correlation between the SNOT-20 questionnaire and the Lund-MacKay CT score (p = 0.026; p = 0.764) and between the CSS and the Lund-MacKay CT score (p = —0.158; p = 0.058). Furthermore, there was no significant correlation between a single VAS symptom score relating to overall sinonasal symptom severity and the Lund-MacKay CT scan score (p = 0.135; p = 0.121). However, a weak but statistically significant correlation was found between the VAS score based on the sum of five sinonasal symptoms and the Lund-MacKay CT scan score (p = 0.197; p = 0.020).

Conclusion

The score, based on the sum of five sinonasal VAS symptoms, correlates to the disease severity as measured by the Lund-MacKay CT scan score. The SNOT-20 questionnaire and the CSS symptom score do not correlate to the Lund-MacKay CT scan score, although a correlation was found between the CSS score and the Lund-MacKay CT score in various subgroups of our patient population.
Choanal Stenosis: An Unusual Late Complication of Radiation Therapy for Nasopharyngeal Carcinoma
Authors: Shepard Peter M. , Houser Steven M.
Published: August 2018

Background

Choanal stenosis, usually a congenital anomaly in children, recently has been recognized as a late complication of radiation therapy (RT) for nasopharyngeal carcinoma (NPC).

Methods

We described the clinical history, preoperative evaluation, surgical management, and postoperative course of a case of acquired choanal stenosis after RT.

Results

The patient, a 39-year-old woman, presented with a history of NPC 16 years before presentation that had been successfully treated with RT. On presentation, the patient complained of decreased nasal airflow. Bilateral choanal stenosis was confirmed per rigid nasal endoscopy. Transnasal endoscopic repair with mitomycin application was performed, and nasal stents were left in place for 6 weeks. Postoperative endoscopic examination showed patent choanae and a patent nasopharynx without stenosis. The patient continues to have good airflow 20 months postoperatively.

Conclusion

Choanal stenosis can occur as an unusual complication of RT for NPC secondary to postradiation fibrosis. This is the first report of such a complication in the West.
Expression of Interleukin-5, Interleukin-8, and Interleukin-10 mRNA in the Osteomeatal Complex in Nasal Polyposis
Authors: Chen Yue-Shih , Arab Sonja F. , Westhofen Martin , Lorenzen Johann
Published: August 2018

Background

Several cytokines are expressed in chronic sinusitis with and without underlying allergy. Their local production and regulation in the osteomeatal complex, the key area of paranasal sinuses, still is not fully understood. This study was performed to investigate differences of cytokine messenger RNA (mRNA) expression between the medial and the lateral part of the middle turbinate and anterior ethmoid mucosa of allergic and nonallergic patients.

Methods

Using the LightCycler system for real-time reverse-transcription polymerase chain reaction, we investigated the content of interleukin (IL)-5, IL-8, and IL-10 mRNA in tissue samples from middle turbinates and anterior ethmoids of 18 patients with chronic sinusitis and nasal polyps. Inferior turbinate mucosa of six control subjects without sinusitis and allergy served as control.

Results

IL-5 mRNA was detectable in 32 (60%) of 54 samples (two of six controls) in significant different amounts between the various locations (p ≤ 0.001). Anterior ethmoid mucosa (0.96 ± 0.99) expressed the highest amount of IL-5 mRNA followed by the lateral (0.37 ± 0.54) and the medial portion of the middle turbinate (0.12 ± 0.29) with no difference between allergic and nonallergic subgroups. IL-8 was detected in significant higher amounts in all three origins with no significant difference in concentrations between the examined locations as compared with controls. Patients expressed either IL-5 or IL-8 or both cytokine mRNA. IL-10 was expressed in all three specimens from five of eight allergic patients. All five individuals with clinical symptoms of allergy at the time of operation expressed IL-10 in at least one specimen.

Conclusions

IL-5 cytokine expression in the osteomeatal complex is linked to the presence of nasal polyps, whereas IL-8 is up-regulated without distinct correlation to nasal polyps. IL-10 expression was detectable in five of eight allergic patients.
Nasal Mycology of Chronic Rhinosinusitis
Authors: Jiang Rong-San , Su Mao-Chang , Lin Jen-Fu
Published: August 2018

Background

Ponikau used a novel collection and culturing method to recover fungi from nasal secretion in patients with chronic rhinosinusitis. The same method had been used previously in Europe with a similar result. However, the use of Ponikau's method has not been reported in Asia.

Methods

Fifty-one patients with chronic rhinosinusitis who were scheduled for functional endoscopic sinus surgery were enrolled in this study. One day before functional endoscopic sinus surgery, swab specimens were obtained from middle meatuses and were sent to the microbiology laboratory for routine bacterial and fungal cultures. Then, the same nasal cavity was lavaged with 20 mL of sterile water. The exhaled fluid was collected and processed using the Ponikau method. Skin testing with Candida extract was done also in all patients. The results obtained by different culture methods were compared.

Results

Bacteria grew from 45 of 51 swab specimens. The culture rate was 88.2%. Fungi were cultured from 6 of 51 swab specimens (11.8%) and from 25 of 51 lavage specimens (49%). The fungal culture rates were significantly different between swab and lavage specimens (p < 0.001). Candida was the most common cultured fungi in the lavaged specimens.

Conclusions

The study showed that Ponikau's method resulted in a higher fungal culture rate than that obtained with the swab method, but the culture rate was lower than the bacterial culture rate. Additional study is needed to investigate the role of fungi in the pathogenesis of chronic rhinosinusitis.
Correlation between Preoperative Clinical Diagnosis and Histopathological Findings in Patients with Rhinosinusitis
Authors: Busaba Nicolas Y. , de Oliveira Luciano Vilela , Kieff David L.
Published: August 2018

Background

The diagnosis of chronic rhinosinusitis (CRS) or chronic rhinosinusitis with polyposis (CRSP) is typically clinical and based on the combination of medical history, physical examination, and imaging. The recommendation to perform surgery and the type of surgery is tailored to the diagnosis. The objective of this study is to determine the accuracy of preoperative clinical CRS or CRSP diagnosis in patients who underwent endoscopic sinus surgery.

Methods

This is a retrospective review of a case series of 380 consecutive patients who underwent endoscopic sinus surgery for the preoperative clinical diagnosis of CRS or bilateral CRSP. Data regarding symptoms, nasal endoscopy, computed tomography findings, preoperative diagnosis, and postoperative histopathology results were collected.

Results

The preoperative diagnoses were CRS (n = 180) and CRSP (n = 200). Two of the 180 patients (1.1%) with the preoperative diagnosis of CRS had a different postoperative histopathological diagnosis. The histopathology in both patients showed noncaseating granulomata, leading to a diagnosis of sarcoidosis. Nine of the 200 patients (4.5%) with the preoperative diagnosis of CRSP had a different postoperative histopathological diagnosis. Of these nine patients, five had inverted papilloma (bilaterally in one instance); one had adenocarcinoma; one had squamous-cell carcinoma; one had chronic invasive granulomatous fungal sinusitis; and one had sinonasal sarcoidosis.

Conclusion

The preoperative clinical diagnosis can be inaccurate in patients with CRS and bilateral CRSP. The misdiagnosis is more common in CRSP, including patients with recurrent polyposis.
Utility of Sagittal Reformatted Computerized Tomographic Images in the Evaluation of the Frontal Sinus Outflow Tract
Authors: Kanowitz Seth J. , Shatzkes Deborah R. , Pramanik Bidyut K. , Babb James S. , Jacobs Joseph B. , Lebowitz Richard A.
Published: August 2018

Background

Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established.

Methods

A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus.

Results

Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images.

Conclusion

Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images.
Association of Radiological Evidence of Frontal Sinus Disease with the Presence of Frontal Pain
Authors: DelGaudio John M. , Wise Sarah K. , Wise Justin C.
Published: August 2018

Background

Rhinosinusitis is a common cause of frontal pain. We evaluated the relationship between frontal pain and the type and degree of frontal sinus disease in chronic rhinosinusitis (CRS) patients.

Methods

Inclusion criteria were presence of frontal sinusitis or frontal recess obstruction on computed tomography scan. Office notes and operative reports were reviewed to determine the presence and location of frontal pain and categorization of sinus disease.

Results

Two-hundred seven patients were identified with frontal recess obstruction and/or frontal sinus disease. Thirty-one of 37 frontal mucocele patients (84%) had frontal pain. Twenty of 70 polyp patients (29%) had frontal pain, with only 7 of 38 patients (18%) with complete frontal opacification having pain. In patients with CRS without polyps or mucocele, 59 of 100 (59%) had frontal pain, with 21 of 38 (55%) with complete opacification having pain. This difference between the distribution of frontal pain was significant (p < 0.005) among the mucocele, polyp, and nonpolypoid CRS groups. Additionally, among nonmucocele CRS groups exhibiting complete opacification, there was a significant difference in proportion of patients exhibiting frontal pain (p < 0.005). When the nonmucocele groups (i.e., polypoid and nonpolypoid CRS patients) were combined and stratified for disease extent, a difference in the distribution of frontal pain was found (p < 0.025), with the mild-to-moderate thickening group showing the highest proportion of pain.

Conclusion

Frontal pain was more common in nonpolypoid CRS patients than in polyp patients. Furthermore, in nonmucocele CRS, patients with mild-to-moderate thickening exhibited more frontal pain.
The Incidence of Complications after Canine Fossa Puncture Performed during Endoscopic Sinus Surgery
Authors: Robinson Simon R. , Baird Robert , Le Tong , Wormald Peter John
Published: August 2018

Background

Patients with extensive disease affecting the maxillary sinus may require a canine fossa approach for complete removal of disease. This study was designed to determine the complications associated with this procedure.

Methods

We performed a retrospective study of 21 patients who had undergone a canine fossa puncture at an academic hospital complex in Adelaide, Australia.

Results

A total of 37 canine fossa punctures were made in 21 patients. Twenty-eight of the 37 (75.7%) sides in which a canine fossa puncture was performed experienced a complication. The most common complaint was of cheek swelling in 14 (38%) followed by facial pain in 12 (32%), facial numbness in 11 (30%), cheek pain in 10 (27%), dental numbness in 10 (27%), gingival complications in 9 (24%), and facial tingling in 6 (16%) of sides. Most complications (75.5%) resolved within the 1st month after surgery. Six patients (28.6%) had persistent complications with facial tingling in 3 patients (50%) followed by facial numbness and tingling in 1 patient (11%), facial numbness alone in 1 patient (8.3%), and facial pain in 1 patient (7.1%).

Conclusion

Canine fossa antrostomy is a technique that provides additional access to the maxillary sinus. Surgeons need to be aware that, although minor, a significant number of patients will experience both transient and long-term complications.
Challenges in the Management of Sphenoid Inverted Papilloma
Authors: Fakhri Samer , Citardi Martin J. , Wolfe Stephen , Batra Pete S. , Prayson Richard A. , Lanza Donald C.
Published: August 2018

Background

Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus.

Methods

We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus.

Results

A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10–79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection.

Conclusions

Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.
Expression of TLR2 and TLR4 Messenger RNA in the Epithelial Cells of the Nasal Airway
Authors: Dong Zhen , Yang Zhanquan , Wang Chengshuo
Published: August 2018

Background

Epithelium of nasal mucosa is the first line of defense against invading pathogens. This study investigated the expression of Toll-like receptor (TLR) 2 and TLR4 in epithelial cells of nasal mucosa and understood the role of TLRs in the innate immunity of nasal mucosa.

Methods

Human nasal epithelial cells were obtained by scraping the middle one-third of inferior turbinates from 30 patients with chronic rhinosinusitis and 20 healthy adult volunteers. The epithelial cells are made into smears. In situ hybridization was performed for TLR2 and TLR4 messenger RNA (mRNA).

Results

TLR2 and TLR4 mRNA were expressed in the nasal epithelial cells. The expression of the two genes was significantly higher in the chronic rhinosinusitis group than in the normal control (TLR2, t = 8.605, p < 0.0005; TLR4, t = 9.050, p < 0.0005).

Conclusion

This study is the first to establish the presence of both TLR2 and TLR4 mRNA on epithelial cells of nasal mucosa, and their expression can be up-regulated in infectious conditions. These results show that TLR2 and TLR4 may play a important role in local host defense of nasal mucosa.
Endoscopic Sinus Surgery: Advantages of the Bimanual Technique
Authors: Briner Hans Rudolf , Simmen Daniel , Jones Nick
Published: August 2018

Background

The orthodox endoscopic sinus surgical technique is “one-handed,” which means that the surgeon holds the endoscope in one hand and uses the free hand for other instruments or suction. This technique has its limitations. When there is a lot of bleeding or when tension needs to be kept on tissue so that it can be cut cleanly, this is best done using both hands. This “bimanual” technique was described >10 years ago, and although it offers several advantages, it is rarely used. The main reason is the requirement for two trained endoscopists. In a prospective randomized interventional study, the duration of the operation using the one-handed technique as opposed to the bimanual technique was compared.

Methods

Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis were evaluated. One side of the nose underwent the conventional one-handed technique, while the other side had the bimanual technique. The operation time for each side was noted.

Results

Fifty patients (31 men and 19 women) with a mean age of 47.6 years (22–80 years) were evaluated. The mean operation time with the one-handed technique was 39.3 minutes (9–93 minutes). With the bimanual technique, the mean operation time was 31.0 minutes (6–78 minutes). The reduction in operation time with the bimanual technique was 21% and was highly significant (p < 0.001).

Conclusion

The bimanual endoscopic sinus surgery technique leads to a significant reduction in operation time. The patient may benefit from a shorter operation time and the surgeon has better visibility that may reduce the incidence of complications. Furthermore, there are potential economic advantages because of the increased efficiency of surgical time.
Endoscopic Power-Assisted Orbital Exenteration
Authors: Batra Pete S. , Lanza Donald C.
Published: August 2018

Background

Orbital exenteration can be accomplished by either an external eyelid-sparing or eyelid-sacrificing approach. The purpose of this study was to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods.

Methods

A retrospective analysis at a tertiary care referral center was performed. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (one case) are reported. Intraconal involvement was evident in all patients by imaging and surgical pathology. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were used for resection in all cases.

Results

The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30–45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity “mucosalization” within 8 weeks. Two patients are alive without disease at 15-month follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy.

Conclusion

This preliminary experience showed endoscopic power-assisted orbital exenteration to be an effective technique for exenteration of the orbit. Endoscopic power-assisted orbital exenteration offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen and (2) the ability to preserve the uninvolved superior and lateral periorbita. This can facilitate mucosal coverage of the exenterated space and obviate the need for tissue grafts and/or packing. Additionally, intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.
Anatomic Risk Factors for Sinus Disease: Fact or Fiction?
Authors: Caughey Robert J. , Jameson Mark J. , Gross Charlie W. , Han Joseph K.
Published: August 2018

Background

Sinonasal anatomic variants have been postulated as a risk factor for sinus disease. Therefore, a study was conducted to examine the correlation of sinus disease to septal deviation, concha bullosa, and infraorbital ethmoid cells.

Methods

Two hundred fifty consecutive sinus and orbital computed tomography scans were examined at the University of Virginia over a 2-year period. Coronal, sagittal, and axial views were examined for the presence and size of concha bullosa and infraorbital ethmoid cells. Septal deviations were measured by examining the width of the nasal cavity at the level of the maxillary sinus ostium. The severity of mucosal thickening in the maxillary, ethmoid, and frontal sinuses was recorded. The correlation between mucosal disease of the sinuses to the anatomic variants was then compared.

Results

Computed tomography images were reviewed in 250 consecutive studies (500 sides). Of the 500 sides, 67.2% of sides had some level of mucosal thickening. Concha bullosa and infraorbital ethmoid cells were both present in 27% of the sides. Concha bullosa was associated with maxillary sinus disease (p < 0.01). Infraorbital ethmoid cells were associated with both ethmoid (p < 0.05) and maxillary (p < 0.01) mucosal disease. Frontal sinus disease had no significant correlation with these anatomic variants (p > 0.05). For sinuses with infraorbital ethmoid cells or concha bullosa, there were a higher number of diseased sinuses with larger anatomic variants (p < 0.01). Narrow nasal cavities were associated with maxillary sinus disease (p < 0.01).

Conclusion

Septal deviations, concha bullosa, and infraorbital ethmoid cells, which contribute to the narrowing of the osteomeatal complex, are associated with mucosal disease.
Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes
Authors: McMains K. Christopher , Kountakis Stilianos E.
Published: August 2018

Background

The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS).

Methods

We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up.

Results

The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis.

Conclusion

Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.
Luffa Operculata Affects Mucociliary Function of the Isolated Frog Palate
Authors: Menon-Miyake Mônica Aidar , de Oliveira Regiani Carvalho , Lorenzi-Filho Geraldo , Saldiva Paulo Hilário Nascimento , Butugan Ossamu
Published: August 2018

Background

Luffa operculata is a medicinal plant used in homeopathic and alternative medicine. In the United States, it is sold in a purified spray form, whereas a homemade L. operculata dry fruit infusion (DFI) is commonly used in Latin America. The L. operculata DFI is applied intranasally, inducing profuse mucous secretion and relieving nasal symptoms. Nevertheless, this medication may cause irritation of the nasal mucosa, as well as epistaxis or anosmia. Given the growing popularity of alternative medicine, a decision was made to evaluate the effects of this substance on mucous membranes.

Methods

The effects of L. operculata DFI on mucociliary transport velocity, ciliary beat frequency, and transepithelial potential difference (PD) were evaluated in an isolated frog palate preparation. We tested 46 palates immediately before immersion and again at 5 and 20 minutes after immersion. Four groups (n = 10) were tested in frog Ringer: control; L. operculata DFI, 60 mg/L; 600 mg/L; and 1200 mg/L. An additional group was tested using L. operculata DFI prepared with water (600 mg/L of H2O, n = 6). Epithelial samples were harvested for ultrastructural study.

Results

In treated palates, mucociliary transport velocity and ciliary beat frequency decreased significantly (p < 0.001 and p < 0.008, respectively). There was a dose-dependent decrease in PD modulus (p < .007). Our PD findings indicated ion-fluid transport abnormalities, which were confirmed by transmission electron microscopy that showed enlargement of interepithelial spaces.

Conclusion

In this ex vivo model, the L. operculata DFI infusion promoted significant changes in the mucociliary function of the epithelium, suggesting that it is potentially noxious to human nasal mucosa.