bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Intranasal Ciclesonide, Oral Levocetirizine, and Combination Treatment in Patients with Allergic Rhinitis
Authors: Kim Chang‐Hoon , Kim Jin Kook , Kim Hyun Jun , Cho Jin Hee , Kim Young‐Dae , Lee Heung‐Man , Yoon Joo‐heon
Published: September 2014

Objectives:

Ciclesonide is an intranasal corticosteroid for the treatment of allergic rhinitis. To date, concrete evidence to justify a definitive recommendation of intranasal corticosteroid over oral antihistamine has not been demonstrated. This study aimed to evaluate the efficacy and safety of once‐daily ciclesonide in comparison to both levocetirizine alone, and a ciclesonide/levocetirizine combination in patients with seasonal (SAR) and perennial AR (PAR).

Methods:

Subjects exhibiting moderate to severe allergic rhinitis for longer than 1 year were randomized in an open‐label, 3‐arm, parallel group, multicenter study. Subjects received 200 µg ciclesonide, 5 mg levocetirizine, or a combination of both. Changes from baseline until the end‐of‐study visit (2 weeks following) were evaluated by reflective total nasal symptom scores (rTNSS), reflective total ocular symptom scores (rTOSS), physician‐assessed overall nasal signs and symptoms severity (PANS), and rhinoconjunctivitis quality‐of‐life questionnaires (RQLQ).

Results:

Significant improvements in rTNSS, PANS, and RQLQ in the ciclesonide monotherapy group were observed in comparison to the levocetirizine alone group. Three individual symptoms of rTNSS were improved in the ciclesonide‐treated group. rTOSS scores for ciclesonide monotherapy improved from baseline, but no superiority over levocetirizine was shown. Ciclesonide spray was more effective than levocetirizine in reducing nasal symptoms in both SAR and PAR patients. Ciclesonide and levocetrizine were well tolerated alone and in combination.

Conclusions:

Our results provide support for an AR and its Impact on Asthma (ARIA) recommendation stipulating that ciclesonide is superior to levocetirizine for the treatment of AR, with tolerable safety. Addition of levocetirizine to ciclesonide did not give further clinical benefit over monotherapy.
Efficacy of Sublingual Immunotherapy after Early Adverse Events in Allergic Rhinitis
Authors: Hong Seung , Ahn Jae‐Cheul , Han Doo Hee , Lee Sang Yeon , Kim Dong‐Young , Lee Chul Hee , Rhee Chae‐Seo
Published: September 2014

Objectives:

Sublingual immunotherapy (SLIT) has recently received much attention around the world as a treatment of allergic rhinitis (AR). However, some patients experience early adverse events (EAE) during SLIT. This study aimed to investigate the predisposing conditions of EAE and the influence of EAE on treatment outcomes in the house dust mite (HDM) SLIT for AR.

Methods:

As a retrospective cohort study, 226 patients diagnosed with AR and sensitized to HDM started HDM‐SLIT in 2010. The symptomatic improvement was measured by a total nasal symptom score (TNSS) before and 6 months after SLIT. EAE were divided into 3 categories, local and systemic EAE and aggravation of nasal symptoms. The TNSS in the 3 groups of EAE were compared. The medical records and diaries of 125 patients were reviewed.

Results:

TNSS decreased from 9.7 to 3.9 six months after SLIT. There were 28 patients (22.4%) who experienced EAE. TNSS was improved in both non‐EAE and EAE groups 6 months after SLIT, and there was no difference in the 6‐month changes of TNSS between the non‐EAE and EAE groups. Significant improvement of TNSS was found in local EAE or early aggravation of the symptoms. The rescue medication score in the group of local EAE stayed relatively low both 1 month and 6 months after SLIT.

Conclusions:

Even though HDM‐SLIT sometimes caused EAE, it did not affect SLIT. The cumbersome local EAE in SLIT was self‐limited and neither gave an adverse influence to the symptomatic improvement nor elevated the frequency of the rescue medication.
Endoscopic versus Traditional Headlight Approach for Septal Surgery: A Prospective Controlled Study
Authors: Martellucci Salvatore , Pagliuca Giulio , Gallipoli Camilla , Rosato Chiara , De Vincentiis Marco , Greco Antonio , Gallo Andrea
Published: September 2014

Objectives:

(1) Describe a totally endoscopic‐assisted technique for septoplasty. (2) Assess the outcomes of endoscopic‐assisted technique according to subjective and objective criteria. (3) Compare the outcomes of the endoscopic‐assisted approach with those obtained with the traditional headlight technique.

Methods:

This prospective, randomized, controlled trial was conducted from September 2010 to September 2013 at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome. A total of 160 patients undergoing surgery for septal deviation meeting strict inclusion/exclusion criteria were recruited. Patients were randomly assigned to either the endoscopic (Group A) or the conventional group (Group B). Endoscopic evaluation and anterior rhinomanometry were carried out pre‐ and postoperatively. Nasal Obstruction Symptom Evaluation (NOSE) scale was used to measure the nasal obstruction before and after surgery. At the end of each procedure the junior residents compiled a 10 cm visual analog scale (VAS) which evaluated their overall understanding of the surgical procedure. Surgical times and complications were recorded.

Results:

All patients showed a significant improvement of nasal obstruction (P <. 05) in both subjective and objective evaluation without a statistically significant difference between the 2 groups. The overall incidence of peri‐ and postoperative complications was significantly lower in Group A than in Group B (P <. 05) without differences in surgical time. The VAS score regarding understanding of the surgical steps was significantly higher for endoscopic‐assisted septoplasty (P <. 001).

Conclusions:

The endoscopic approach represents a viable alternative to traditional headlight septoplasty. Furthermore, endoscopic‐assisted septoplasty may be considered to be better than the traditional approach in a teaching perspective.
Histamine Promotes the Release of IL‐6 in Nasal Fibroblasts
Authors: Park Il‐Ho , Shin Jae‐Min , Cho Jung Sun , Um Ji‐Young , Lee Heung‐Man
Published: September 2014

Objectives:

Based on the close relationship between histamine and IL‐6, we hypothesized that histamine plays a role in the production of cytokines such as IL‐6 and is involved in the microenvironmental controls of the allergic inflammatory process. We describe in nasal fibroblasts the effect of histamine on the production of IL‐6, the major histamine receptors, and the related underlying mechanisms.

Methods:

Nasal fibroblasts from eight normal patients were incubated. Reverse transcriptase polymerase chain reaction was performed for histamine receptors (H1R, H2R, H3R, and H4R) to identify which histamine receptor is expressed in nasal fibroblasts. The fibroblasts were treated with histamine with or without a histamine‐receptor antagonist, and IL‐6 production was measured using ELISA. Three MAP kinases (p38, ERK, and JNK) and NF‐κB were evaluated as downstream signaling molecules by Western blot analysis and Luciferase reporter assay.

Results:

Expression levels of all histamine receptors were elevated. The level of IL‐6 protein expression increased significantly with histamine stimulation. Among the histamine‐receptor specific antagonists, only H1R antagonist significantly decreased IL‐6 production in histamine‐stimulated nasal fibroblasts. Histamine increased the level of phosphorylated p38 (pp38), pERK, pJNK expression, and NF‐κB induction. H1R antagonist reversed the increased expression of pp38 and NF‐κB in histamine‐induced nasal fibroblasts, but not pERK and pJNK. p38 inhibitor markedly suppressed the increased production of IL‐6 in histamine‐stimulated nasal fibroblasts.

Conclusions:

The results of the present study suggest that antihistamines could be involved in the regulation of cytokines such as IL‐6, beyond the blockage of the histamine effect as an inflammatory mediator in nasal fibroblasts.
Histone Deacetylase Regulates IL‐4 Gene Expression in Mast Cells by Oxidative Stress
Authors: Nakamaru Yuji , Takagi Dai , Fukuda Satoshi
Published: September 2014

Objectives:

Many pro‐inflammatory cytokines are regulated by acetylation and deacetylation of core histone. Since dysregulation of Th2 cytokine production is a key for the pathogenesis of allergic diseases, we examined the role of histone deacetylase (HDAC) on expression of IL‐4 gene in mast cells. We also examined whether oxidative stress has some impact on HDAC activity.

Methods:

RBL‐2H3 cells, a rat mast cell line, were sensitized overnight with DNP‐specific IgE. The cells were then treated with HDAC inhibitors (trichostatin A) for 15 min and stimulated with DNP‐antigen. After 2 hour incubation, total RNA was isolated to determine the level of IL‐4 gene transcription by real‐time reverse transcriptase polymerase chain reaction (Taqman system). After incubated with H2O2 for 0 to 24 hours, HDAC activity was measured in nuclear extracts obtained from the RBL‐2H3 cells with HDAC Fluorescent activity assay kit (BIOMOL) as well as the detection of IL‐4 mRNA.

Results:

IL‐4 mRNA expression was induced with antigen in IgE‐sensitized RBL‐2H3 cells. Pretreatment of trichostatin A and H2O2 enhanced IL‐4 mRNA expression with dose‐dependent manner. There is 5‐fold induction of IL‐4 mRNA by HDAC inhibitors. HDAC activity of RBL‐2H3 cells were reduced with H2O2 treatment.

Conclusions:

Our results suggest that oxidative stress may up‐regulate IL‐4 gene expression in mast cell via decrease of HDAC activity.
Kinin Upregulates CXCL1 and CXCL8 Chemokine Expression in Human Nasal Mucosa–Derived Fibroblasts
Authors: Tsai Yih‐Jeng , Hao Sheng‐Po , Wu Wen‐Bin
Published: September 2014

Objectives:

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease involving the mucosa of the nasal cavity and sinuses. It can be classified into CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). It is often described as a chronic inflammatory condition of the sinonasal mucosa and followed by a continuous tissue remodeling process. The CXC chemokine such as CXCL1 and CXCL8 are primarily chemotactic for endothelial cells and neutrophils, whch are potent promoters of angiogensis and inflammation.

Methods:

In this study, we examined the effects of kinin on CXC chemokine expression in human nasal fibroblasts from mucosa specimens of patients with CRSsNP.

Results:

We found kinin increased CXCL1 and CXCL8 release in a concentration‐ and time‐dependent manner, as determined by enzyme‐linked immunosorbent assay. In parallel, reverse transcriptase polymerase chain reaction analysis showed the kinin increased CXCL1 and CXCL8 mRNA level, suggesting this process involved transcriptional regulation. The increased CXCL chemokines appeared to have chemoattractive ability toward monocyte. We found monocyte migration increased as monocytes and fibroblasts were cocultured and the fibroblasts were stimulated with kinin in an indirect transwell co‐culture system.

Conclusions:

Our results suggest that kinin may play a role in causing chemokine release and recruit leukocytes infiltration in the nasal inflammation microenvironment during chronic rhinosinusitis.
Local Immunoglobulin Class Switch Recombination in Chronic Rhinosinusitis with Nasal Polyposis
Authors: Hernandez David , Hulse Kathryn E. , Norton James E. , Tan Bruce K. , Kern Robert C. , Schleimer Robert P.
Published: September 2014

Objectives:

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is characterized by B cell inflammation. We sought to determine whether immunoglobulin class switch recombination (CSR) occurred locally within polyps and to quantify the expression of proteins involved in regulating CSR. Germline transcripts (GLTs) are produced during CSR, and activation‐induced cytidine deaminase (AICD) is an enzyme that is required for CSR. Thus, GLT and AICD expression can be used as markers for CSR.

Methods:

Polyp (n = 12‐37), tonsil (n = 7), and uncinate tissue (UT) from patients with CRSwNP (n = 9), CRSsNP (n = 10), and normal controls (n = 11‐12) were collected. Quantitative reverse transcriptase polymerase chain reaction for GAPDH, GUSB (housekeeping genes), AICD, IL‐15, iNOS, BAFF, and A1, A2, G1, G4, and E GLT was performed using cDNA from tissue. Relative expression was calculated in relation to a housekeeping gene.

Results:

AICD expression was significantly increased in tonsils compared with all other groups (P <. 05), and polyp AICD expression was significantly elevated compared with UTwNP and UTsNP (P <. 01). Tonsils expressed significantly more A2 GLT than all other groups (P <. 05). E GLT was significantly increased in polyps versus UTnl (P <. 05). G1 GLT was increased in polyps compared with all other groups (P <. 05 vs UTwNP). G4 GLT was also increased in polyps compared with all other tissues, but this did not reach significance. Only IL‐15 showed significantly increased expression in polyps versus UTnl and UTwNP (P <. 01).

Conclusions:

These results suggest that local CSR is occurring in polyps of patients with CRSwNP.
The Nasal Mucosa after Airway Deprivation: An Electron Microscopic Study
Authors: Abdel‐Aziz Mahmoud F.
Published: September 2014

Objectives:

The aim of this study is to depict changes in the nasal mucosa by studying transmission and scanning electron microscopic pictures.

Methods:

This study was performed on 50 consecutive patients from the Department of Otolaryngology at Tanta University, Egypt between October 2008 and January 2013. Patients were candidates for total laryngectomy for advanced laryngeal cancer. Each patient was subjected to a biopsy from the nasal mucosa 1 cm behind the anterior end of the inferior turbinate using Blakseley forceps. Specimens were subjected to scanning as well as transmission electron microscopic examination.

Results:

All patients after total laryngectomy demonstrated at least 1 histopathologic abnormality. Focal or total atrophy in the nasal mucosal epithelium was found. The epithelial cells showed vacuolation, loss of cilia, and few short microvilli, as well as separation of epithelial cells with loss of junctional complexes. Widening of the binter‐cellular spaces as well as focal disruption of the basement membrane, clear separation of epithelial cells from each other were also noted in some patients. In some patients marked thickening of basement membrane and angiogenesis of the lamina propria were seen. An increase in the number of active fibroblasts with increased collagen deposition, and swelling and degeneration of mitochondria was also evident.

Conclusions:

Changes in the nasal mucosa after total laryngectomy would eventually result in lack of mucus synthesis and consequently, inadequate mucus secretion, and could disturb the mucociliary transport
Olfaction after Endoscopic Sinus Surgery of Chronic Rhinosinusitis
Authors: Kim Byung Guk , Hwang Se Whan , Kim Dong Hyun , Kim Doo Ri , Kim Sung Won , Park So Young
Published: September 2014

Objectives:

Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory dysfunction. After endoscopic sinus surgery (ESS), olfactory function may improve in most cases, but may not in others. The purpose of this study was to investigate the prognostic factors for olfaction improvement after endoscopic sinus surgery in CRS.

Methods:

A total of 103 patients (175 nostrils) with CRS who underwent ESS were studied. We performed olfactory function test for all patients using the butanol threshold test (BTT) and Cross Cultural Smell Identification test (CC‐SIT) preoperatively and postoperatively. The patients’ subjective symptoms were also recorded using the visual analog scale (VAS) pre‐ and postoperatively. We also analyzed the duration of disease and preoperative computed tomography by Lund‐Mackay score.

Results:

The improvement of olfactory function after ESS in patients with longer duration of symptoms was not significantly lower than in patients with shorter duration. In multivariable study, anosmics had better improvement than hyposmics in recovery of olfaction. There were significant differences in anterior ethmoid involvement between responder and non‐responder group.

Conclusions:

The improvement of olfaction after ESS mainly depends on the degree of preoperative olfactory function and involvement of anterior ethmoid involvement. Therefore, for the better outcome of ESS especially in olfactory function, early and proper treatment (including ESS) for CRS will be necessary.
Pathological Comparison of Nasal Manifestation of IgG4‐Related Disease and Allergic Rhinitis
Authors: Suzuki Masanobu , Nakamaru Yuji , Homma Aya , Takagi Dai , Fukuda Satoshi
Published: September 2014

Objectives:

Immunoglobulin (Ig) G4‐related disease has been widely known to affect many organs including the lacrimal gland, salivary gland, pancreas, retroperitoneal, etc. There are a few reports concerning the nasal lesion of this disease. However, the difference between the nasal manifestation of IgG4‐related disease and allergic rhinitis (AR) has not been clarified. We compared the pathological findings in nasal specimens of IgG4‐related disease with those of allergic rhinitis.

Methods:

Nasal mucosa was obtained from patients with IgG4‐related disease and AR. We examined the infiltration of IgG4 positive cells and other infiltrating cells. These infiltrating cells in IgG4‐related disease group were compared with those in the AR group. We also assessed the number of nasal glands in IgG4‐related disease and the AR group.

Results:

The number of IgG4‐positive plasma cells was significantly higher in the IgG4‐related disease group than that in the AR group. CD3 and CD4 positive cells were also significantly higher in the IgG4‐related disease group than in the AR group. The number of nasal glands was decreased in the IgG4‐related disease group less than the AR group.

Conclusions:

The number of IgG4, CD3, and CD4 positive cells was significantly higher in the IgG4‐related disease group than that in the AR group. There is a possibility that the nasal manifestations of IgG4‐related disease might be different from AR.
Hearing Aid Use Prevents and Reverses Loss of Speech Understanding in Adults with Hearing Loss
Authors: Astrachan David I. , Davis Michael
Published: September 2014

Objectives:

Determine in subjects with hearing loss if speech discrimination declines over time and, if so, whether it could be maintained or restored with the use of hearing aids.

Methods:

A prospective study of age‐related hearing loss performed over 6 years concluding in February of 2013 in a private physician's office. Subjects: 39 male, 44 female, mean age of 72 years, reporting difficulty hearing who agreed to have repeat audiometric evaluation at least 6 months following the initial audiogram, whether or not they obtained amplification. Subjects were given an initial hearing examination to measure tone threshold and speech discrimination. Forty‐seven of the subjects received amplification shortly after this initial test and were tested a final time 27.7 months later. Twenty‐five of the subjects did not receive amplification immediately after the initial test but did receive amplification after a second test (36 months later) and were then given a final test 19.5 months later. Eleven of the subjects never received amplification but were tested a final time 39.1 months after their initial hearing exam. Outcome measures: Tone threshold and speech discrimination.

Results:

Subjects who never received amplification showed significant loss in speech discrimination (P <. 5). Amplification significantly increased speech discrimination (P <. 001). In subjects given 3 tests, there were significant decreases in speech discrimination without amplification (P <. 05), which was restored after 19.5 months of amplification (P <. 05).

Conclusions:

Progressive hearing loss is associated with a loss of speech discrimination. Speech discrimination can be maintained or restored by the use of hearing aids.
Post‐radiation CSF Leak of Skull Base
Authors: Thornton Blakely N. , Sorenson Jeffrey M. , Shires Courtney B.
Published: September 2014

Objectives:

(1) Describe the presence of a skull base cerebrospinal fluid (CSF) leak that occurred in a patient after receiving radiation therapy for a residual pituitary adenoma. (2) Analyze possible factors contributing to this rare occurrence.

Methods:

Case report with a retrospective chart review.

Results:

A 49‐year‐old African American female received 23.4 Gy in 13 fractions of definitive external beam radiotherapy for a residual nonfunctioning pituitary adenoma involving the left parasellar area for 16 days prior to developing a CSF leak. Cisternogram demonstrated a small focus of dehiscence in the right tuberculum sella, measuring 1.5 mm in diameter with a small amount of contrast present anterior to this dehiscence. This also demonstrated fluid in the right lateral aspect of the sphenoid sinus in communication with the intracranial CSF. CSF leak may occur after radiation as a tumor shrinks and leaves defects in the skull base and dura at the tumor site. Interestingly, the CSF leak in this patient occurred at a different location than that of the pituitary tumor. This suggests that radiation may weaken the skull base at sites other than tumor sites.

Conclusions:

CSF leak is known to occur after skull base surgery, but has not previously been reported after radiation in regions of the skull base away from previous sites of surgical manipulation. This case report identifies a middle skull base CSF leak in a post‐radiation patient.
Postviral Anosmia: Lack of Response to Corticosteroids
Authors: Espitia Elizabeth A. , Hernández‐García Estefanía , Eisenberg Gustavo , GarcÍa‐Peces Victoria , Plaza Guillermo
Published: September 2014

Objectives:

(1) Describe the clinical caracteristics of postviral anosmia, comparing with anosmia related to chronic rhinosinusitis (CRS). (2) Analyze its response to corticosteroid treatment.

Methods:

A retrospective study was performed on 66 patients with olfactory loss. Olfactory function was assessed at baseline using the Connecticut Chemosensorial Clinical Research Center test. Clinical records were reviewed to discharge CRS, post‐traumatic and other certain etiologies. Computed tomography and magnetic resonance imaging were reviewed. Topical, oral corticosteroids, or both were used on postviral cases for at least 6 months.

Results:

Patients were evaluated after 6 and 12 months of follow‐up. The mean age at diagnosis was 53.8 (standard deviation 12.92). There were 74.2% females (49/66) and 25.8% males. The most frequent etiology was postviral anosmia, 51.5% of cases (34/66). At the time of diagnosis, the mean combined olfactometry (threshold test + identification test/2) was 2.75 (standard deviation 2.36). After 12 months, the mean was 4.70 (standard deviation 3.21), a significant improvement compared to baseline. No significant differences between the improvement obtained with topical corticosteroid therapy and/or oral were found. No differences were found comparing to treatment response of anosmia related to CRS.

Conclusions:

Postviral anosmia occurs most often in women. Olfactory recovery is uncommon, and topical or systemic corticosteroids were similarly ineffective.
The Results of Propylen Mesh Usage for Nasal Septal Perforation Repair in a Rabbit Model
Authors: Yucebas Kadir , Taskin Umit , Oktay Mehmet F. , Aydin Salih , Altınay Serdar , Balur Mehmet B. , Erdil Mehmet
Published: September 2014

Objectives:

Evaluate the effectiveness and biocompability of propylene mesh in an animal model of nasal septal perforations on rabbits.

Methods:

A nasal septal perforation model was created on rabbits, then nasal septal perforations were closed via 2 different methods with open rhinoplasty technique. Some perforations were closed with mucosal flaps and propylene mesh as interpositional graft. The others were repaired with bilateral mucosal flaps. After 4 weeks, nasal septums were totally removed and histopathological evaluation was done for acute rejection, infection, inflammatory response, fibrosis, and granuloma formation.

Results:

No septal perforation was repaired in the mucosal flap‐only group. In the second group, all perforations were repaired completely. Of 5 samples of study group, 1 showed +1 (62.5%) inflammatory response, 1 (12.5%) sample showed +2 and 2 samples showed +3 (25%), respectively. A total of 3 (37.5 %) samples of group 2 did not show any fibrosis, 4 (50%) samples showed mild fibrosis, and 1 (12.5%) sample showed moderate fibrosis. A total of 7 (87.5%) samples showed mild fibrosis at most. We did not see any severe fibrosis at all. We observed 6 (75%) samples that showed no granuloma formation as foreign body reaction and 2 (25%) samples showed few giant cells. Heavy vascular and epithelial proliferation was seen along borders of propylene mesh.

Conclusions:

Propylene mesh showed good biocompability with septal mucosa and can be used for repair of septal perforation as interpositional graft safely.
Time‐of‐Day Predominance of Allergic Rhinitis Symptoms during Treatment with Intranasal Ciclesonide 200 mcg qd
Authors: Salas Maria del Carmen C. , Vargas Jose Antonio , Medina Estefania Torres , Ugalde Jazmin Chiu , Alvarenga Juan Carlos Lopez
Published: September 2014

Objectives:

(1) Effectiveness of intranasal ciclesonide 200 mcg qd (CIC). (2) Time‐of‐day predominance (TDP) of nasal and nonnasal AR symptoms. TDP is the main focus of this report.

Methods:

Phase IV, open‐label, noninterventional study. Patients aged 12 years with at least a 2‐year history of AR were eligible; 1526 patients with active AR were enrolled and received CIC during 4 weeks. TDP was recorded by patients and classified as: Morning, noon, afternoon, night or none. TDP was evaluated at T0 (basal), once daily during the first treatment‐week, and once a week during the rest of the study (weeks 2 to 4). Relative frequencies of AR symptoms were calculated with corresponding 95% confidence intervals. Differences between basal TDP‐relative frequency and at treatment‐days 7 and 28, were calculated using z test.

Results:

All symptoms were of morning predominance at baseline, for example, runny nose 51%, nasal congestion 51%, sneezing 49%. Morning predominance remained the highest for all evaluated symptoms during CIC‐treatment period, but its frequency decreased after 7 and 28 treatment‐days; as a result, the no‐predominance category increased in frequency during the follow‐up. Symptoms showed relative lower probability density after treatment as compared with basal evaluation: Between 0.53 and 0.57 at treatment day 7, and between 0.34 and 0.38 at day 28. All P values (z test) were <.001.

Conclusions:

In this study, TDPs for individual AR symptoms are described in a Mexican population. Treatment with CIC helps to reduce morning predominance of AR symptoms, and increases the asymptomatic state after 4 weeks of treatment.
Treatment of Iatrogenic Septal Perforation with Conchal Cartilage
Authors: Basutcu Ibrahim S.
Published: September 2014

Objectives:

Septal perforation is one of the unwanted complications of septal surgery. The effects of perforation may change according to the location of the perforation, but anterior septal perforation may give rise to crusting and bleeding. Sometimes minor perforations may cause a whistling sound while breathing.

Methods:

We included 9 patients who had septal perforation caused by septal surgery. All perforations were located anteriorly and their diameter was between 2 and 3 cm. In one case, the septum was almost totally perforated, and we closed the perforation with auricular conchal cartilage. This study was done in Canakkale Military Hospital between 2010 and 2013. All subjects were males between the ages of 20 and 23 years. All had previously been operated on for septal deviation. Their main complaint was nasal stuffiness and epistaxis. An open approach rhinoplasty was done. In order to expose both septal perforation flaps, we separated upper lateral cartilages. The cartilage graft harvested from conchal cartilage was trimmed and sutured transseptally that fits perforation dimensions.

Results:

Nasal tamponade for stabilizing the graft were kept in place for 10 days. The graft stability was examined monthly for 3 months. The main criteria for surgical success was mucosal integrity and postoperative crusting in nasal passages. Eight of 9 cases were fully closed by conchal graft. In 1 case, the partially posterior part of the perforation was left open, but this perforation was asymptomatic.

Conclusions:

Auricular conchal graft usage in treatment of large septal perforations is an effective method.
Vitamin D Decreases In Vitro Secretion of Matrix Metalloproteinase 2 and 9 from Nasal Polyp–Derived Fibroblasts
Authors: Wang LingFeng
Published: September 2014

Objectives:

In order to study the role of vitamin D in the pathogenesis and manifestation of chronic rhinosinusitis with nasal polyposis, we designed the following study. In vivo: We tried to determine if serum vitamin D level was lower in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and if low serum vitamin D level correlated with the severity of CRSwNP. In vitro: We used the cultured nasal polyp–derived fibroblasts to investigate the in vitro effect of vitamin derivatives (calcitriol and tacalcitol) on the production of matrix metalloproteinase (MMP)‐2 and MMP‐9.

Methods:

Patients with latest diagnosis of CRSwNP undergoing elective endoscopic sinus surgery were recruited, and patients with malignancies or asthma were excluded. The severity of CRSwNP was assessed with the Lund‐Mackay score and polyp grading system. Vitamin D status was assessed by measuring circulating 25‐hydroxyvitamin D (25OHD) by using commercial chemiluminescence immunoassay. Resected polyps were used for primary fibroblast culture. The fourth to eighth passage of human fibroblasts were used for the experiments.

Results:

Serum 25OHD levels (ng/mL ± SD) were significantly lower in patients with CRSwNP (21.4 ± 5.7) than in those with CRSsNP (28.8 ± 6.2) (P <. 001). A significantly negative relationship was found between serum 25OHD level and polyp grade (r = –0.63, P =. 001), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM score and total IgE level as well. However, statistical significance was not found. In the in vitro study, we demonstrated that TNF can significantly induce the secretion of MMP‐2 and‐9 from nasal polyp fibroblasts and this effect was significantly suppressed by adding calcitriol and tacalcitol.

Conclusions:

A significantly lower vitamin D level was found in a group of Taiwanese CRSwNP patients, which revealed an association with greater nasal polyp size. The study on the influence of vitamin D on inflammatory processes in NP may shed a light not only on the mechanism of its etiology but also prove its potential use in the pharmacology of NP.
Ambulatory Surgical Management of Obstructive Sleep Apnea: Is It Safe?
Authors: Weisstuch Adam , Butrymowicz Anna , Kidwai Sara M. , Parnes Steven M.
Published: September 2014

Objectives:

Determine the safety of ambulatory oropharyngeal surgery in adults with obstructive sleep apnea.

Methods:

Retrospective cohort study. Relevant data were collected from patients aged 18+ years with obstructive sleep apnea (OSA) receiving head and neck airway surgery between September 1, 2005, and September 15, 2012.

Results:

Out of 315 patients with complete data, 243 (77.14%) were managed as inpatients and 72 (22.86%) in an ambulatory manner. The mean Apnea/Hypopnea Index (AHI) for the inpatient and ambulatory groups were 35.99 and 18.43, respectively (P <. 00). The mean body mass index (BMI) for the inpatient and ambulatory groups was 34.12 and 30.79, respectively (P <. 0002). When calculating the incident risk ratio of changes in AHI or BMI, AHI exhibited a significantly increased contribution. There were no complications in the ambulatory cohort.

Conclusions:

When evaluating body habitus and polysomnographic data, OSA patients who underwent oropharyngeal procedures and were discharged on the same day were significantly different than those who were admitted to the hospital. It appears from this data that patients with mild‐moderate sleep apnea, even for patients with mild obesity, are safe to have these procedures performed in an ambulatory setting. This data could potentially assist practitioners in determining which procedures could be safely planned for an ambulatory setting and therefore decrease health care expenditures and patient inconvenience while maintaining patient safety. Future studies investigating what, if any, inpatient interventions were provided for those patients that were admitted to the hospital could potentially further expand the group of patient who could be safely managed in an ambulatory setting.
Cardiovascular Autonomic Function in Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael
Published: September 2014

Objectives:

Prospectively investigate the cardiovascular autonomic function in patients with obstructive sleep apnea (OSA) and examine the relationship with OSA severity, since impaired cardiovascular autonomic response is independently associated with cardio‐ and cerebro‐vascular disease.

Methods:

Ninety‐one subjects with symptoms of sleep‐disordered breathing who underwent full‐night polysomnography were recruited. Standard autonomic parameters which include heart rate response to deep breathing, Valsalva ratio, baroreflex sensitivity (BRS), and heart rate variability were obtained for further analysis and correlated to severity of OSA.

Results:

Seventy‐three patients with OSA (apnea/hypopnea index, AHI ≥5/h) and 18 simple snore patients (AHI <5) as normal control were compared in this study. BRS was the only parameter with significant difference among the 2 groups (3.6 ± 1.2 in simple snore and 2.8 ± 1.4 in OSA patients, P =. 03). Further association analysis revealed significant correlation between BRS and AHI.

Conclusions:

This study shows OSA patients have blunted baroreceptor function compared to patients without OSA. Baroreceptor dysfunction may contribute to an increase in cardiovascular morbidity in OSA patients.
Clinical Analysis of Drug‐Induced Sleep Endoscopy for the OSA Patient
Authors: Golbin‐Hallett Dina , Musgrave Brandon , Yaremchuk Kathleen L.
Published: September 2014

Objectives:

Determine if performing drug‐induced sleep endoscopy (DISE) and trans‐oral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to traditional surgical procedures without DISE.

Methods:

A retrospective, nonrandomized chart review. Patients with OSA who underwent uvulopalatopharyngoplasty (UPPP) in 2011 were compared with a prospective, nonrandomized group of patients with OSA who underwent DISE with other indicated procedures from 2012‐2013 at a major tertiary care center. The pre‐ and postoperative apnea‐hypopnea index (AHI), pre‐ and postoperative Epworth Sleepiness Scale (ESS), and major complication rate were compared.

Results:

Forty patients underwent UPPP without DISE. These patients showed a significant reduction in AHI –20.1 (P =. 001) and a complication rate of 3% (P =. 001). There was no significant change in ESS –2.2 (P =. 734). Fifty‐nine patients underwent DISE with other indicated procedures. These patients showed a significant reduction in AHI –21.4 (P =. 001) and a complication rate of 34.7% (P =. 001). There was no significant difference in ESS +0.1 (P =. 734) or AHI (P =. 092) between the 2 groups.

Conclusions:

There was no significant difference in AHI or ESS in patients who underwent UPPP without DISE compared to patients who underwent DISE with other indicated procedures including TORS. Patients who had DISE and TORS surgical interventions for OSA demonstrated an increase in the rate of major complications.
Early Detection of Brain White Matter Damage in Patients with Severe OSA
Authors: Lin Hsin‐Ching , Friedman Michael
Published: September 2014

Objectives:

Obstructive sleep apnea (OSA) is commonly associated with neuropsychological sequelae, presumably induced by brain injury resulting from intermittent hypoxia. Newer magnetic resonance imaging modalities allow a more accurate examination of fiber integrity of the brain microstructure. Diffusion tensor imaging (DTI) is sensitive to the microstructure of brain tissue. This study is to evaluate the integrity of white matter in OSA patients with DTI.

Methods:

The subjects underwent a polysomnography study to determine the severity of OSA and DTI scans to detect fiber integrity. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA map. The FA maps were compared using voxel‐based statistics to determine differences between severe OSA and control groups, with age and sex as a covariate. The correlation between FA value and clinical severity was performed.

Results:

Twenty patients with severe OSA (apnea/hypopnea index, AHI >30/h) and 14 sex‐ and age‐matched healthy volunteers (AHI <5/h) were recruited. The exploratory group‐wise comparison showed that severe OSA patients exhibited reduced FA values in several brain clusters, including the white matter underlying amygdala, superior temporal gyrus, inferior parietal lobule, precuneus, postcentral gyrus, anterior cingulate gyrus, claustrum, insula, basal ganglia, tapetum, and cerebral peduncle compared with controls. The FA values were negatively correlated with clinical disease severity.

Conclusions:

This study indicates that OSA patients have impaired white matter integrity in vulnerable regions, associated with increased disease severity. The findings likely represent the pathological process of the brain in OSA patients.
The Effect of Upper Airway Surgery on Sleep Quality and Obstructive Sleep Apnea
Authors: Ng Raymond H. W. , Chow Theodore , Fang Chia Yin Joy , Zhang Fan Bruce , Zhang Yu Hai
Published: September 2014

Objectives:

Obstructive sleep apnea (OSA) is a common sleep disorder due primarily to upper airway obstruction. Certain ethnic groups, particularly Chinese, are more susceptible to a severe degree of OSA irrespective of body weight due in part to inherent narrow upper airway anatomy. In this study, we investigated the treatment outcome of combined upper airway surgeries: septoplasty (SP), turbinate reduction (TR), tonsillectomy, and uvulopalatoplasty (UVPP) on OSA in this ethnic group who have clinical identifiable upper airway anatomical obstruction and are unable to tolerate continuous positive airway pressure (CPAP) treatment.

Methods:

A retrospective study to analyze the effect of either: (1) SP and TR (inferior turbinectomy) only or (2) in combination with UVPP (partial uvulectomy and lateralization of palatal pillars) and standard tonsillectomy, on Chinese patients diagnosed with OSA. Outcome measures were obtained from pre‐ and postoperative polysomnographs (PSG) where sleep parameters, AHI, and oxygen saturation were analyzed.

Results:

Patients with only SP and TR (n = 20) failed to produce significant changes in sleep efficiency, sleep arousal (either spontaneous or respiratory related), or AHI measures. Conversely, patients with UVPP and tonsillectomy in combination with TR and SP (n = 16) had nearly 50% reduction or more in all categories of AHI (supine, non‐supine, REM, and non‐REM) observed (P <. 002). The degree of respiratory arousals was also reduced in this group.

Conclusions:

The current study supports a greater role of upper airway and palatal surgery as a primary treatment of choice for this ethnic group with definable upper airway obstruction who failed or are unable to tolerate CPAP treatment.
Expansion Sphincter Pharyngoplasty for Obstructive Sleep Apnea: Outcome Evaluated by Pre‐ and Postoperative Polysomnography
Authors: Pinto Jose A. , Kohler Rodrigo , Hirsch Lina Ana M. , Godoy Luciana B. M. , Martins Laila P. M. , Nunes Heloísa dos S. S.
Published: September 2014

Objectives:

(1) Determine the effectiveness of expansion sphincter pharyngoplasty (ESP) in the treatment of moderate and severe obstructive sleep apnea (OSA). (2) Be able to analyze the effects of the ESP on the sleep stages of patients with moderate and severe OSA. (3) Confirm changes in oxygen saturation after surgery.

Methods:

A retrospective review of a prospective data set of 20 patients with moderate and severe OSA who underwent ESP. Patients studied were adults with small tonsils, body mass index less than 30 kg/m2, Friedman stage II or III, and type I Fujita. Charts between 2010 to 2014 were reviewed, and preoperative and postoperative polysomnographic values were analyzed.

Results:

Eighteen patients (90%) undergoing ESP showed some improvement. The surgery was effective in the treatment of severe and moderate obstructive sleep apnea syndrome (OSAS; P <. 001). Patients with severe OSAS had better results with ESP than patients with moderate OSAS (P <. 001). After surgery there were significant changes in sleep stages (P <. 05). Minimum oxygen saturation improved in the moderate and severe OSAS groups.

Conclusions:

ESP is a valid therapeutic option for the treatment of OSA, and showed better results in severe cases rather than moderate ones. There are variations in the sleep stages that must be considered after this surgery. The surgical technique can bring benefits in oxygen saturation in patients with OSAS.
Hypopharyngeal Airway Surgery for Obstructive Sleep Apnea: Morbidity in the Early Postoperative Period
Authors: Nelson Ryan E. , Carter John M. , Anand Akash G.
Published: September 2014

Objectives:

Determine if hypopharyngeal surgery for obstructive sleep apnea is associated with significant morbidity in the early postoperative period.

Methods:

Medical records review and retrospective telephone survey of patients who underwent hypopharyngeal surgery for obstructive sleep apnea between November 2012 and September 2013 at a tertiary care facility.

Results:

Twenty‐two patients underwent hypopharyngeal surgery for obstructive sleep apnea. No patient experienced intraoperative complications, postoperative O2 desaturation <90%, prolonged admission for inadequate pain control, pulmonary edema, or airway compromise requiring re‐intubation. Postoperative complications included 1 episode of nasal hemorrhage, 1 infection requiring hospitalization, and 1 episode of dehydration treated with IV fluids. Twenty‐five percent of patients experienced some degree of postoperative dysphonia, and 87.5% of patients experienced postoperative dysphagia. The average rating for postoperative pharyngeal pain was 3.5 by week 3 and 1.75 by week 4. Most patients described decreased snoring (93.75%), improved feeling of overall health (75%), and increased daytime energy (62.5%). All patients undergoing hypopharyngeal airway surgery were discharged within 23 hours.

Conclusions:

Hypopharyngeal surgery is a safe and well‐tolerated procedure for the treatment of OSA. Our findings suggest that hypopharyngeal surgery may be performed on an outpatient basis.
Morphometric Analysis of Swallowing Mechanics after Surgery for Obstructive Sleep Apnea
Authors: Pate Mariah B. , Ellis Mark , Reyes Stephanie , Pearson William G. , Brown Jimmy J.
Published: September 2014

Objectives:

Apply a new method of analyzing swallowing biomechanics on postoperative obstructive sleep apnea (OSA) patients using parameters of the modified barium swallow (MBS) imaging.

Methods:

This novel biometric analysis involved two patients following uvulopalatopharyngoplasty, relocation pharyngoplasty, and base of tongue resection for OSA. Postoperative MBS indicated mild swallowing impairment in both patients. Coordinates mapping 10 anatomical landmarks were collected from every frame of the oropharyngeal swallow using ImageJ software. A canonical variate analysis was performed using MorphoJ software with data pooled by subject (S1, S2) and swallowing phase (OP = oral phase, PP = pharyngeal phase). The Mahalobonis distances (D) of the pooled means from each group were defined. Eigenvectors of shape change in these patients were compared to previously published subjects (non‐surgical) to document changes in swallowing mechanics.

Results:

Significant differences in shape change were found for all values: OP versus PP of S1(D = 9.2, P <. 0001) and S2 (D = 10.7, P <. 0001); OP of S1 versus S2 (D = 45.4, P <. 0001); PP of S1 versus S2 (D = 39.2, P <. 0001). Eigenvectors indicated reduced pharyngeal shortening and reduced tongue base retraction compared to published data of normal subjects.

Conclusions:

Tongue base retraction and reduced pharyngeal shortening was noted in this small cohort of patients. These observations are consistent with the postoperative goal of necessary tightening in these areas to avoid collapse. Future controlled studies should be performed to determine whether these changes in swallowing mechanics are specific to surgical interventions or the underlying morphology of OSA patients. This method could potentially be used to quantify the effectiveness of sleep surgical techniques.
A New Philosophy in Surgical Management of Snoring: Tolerability and Effectiveness of the Barbed Roman Blinds Technique
Authors: Mantovani Mario , Rinaldi Vittorio , Salamanca Fabrizio , Carioli Daniela , Torretta Sara , Pignataro Lorenzo
Published: September 2014

Objectives:

Evaluate the tolerability and effectiveness of the Barbed Roman Blinds Technique (BRBT), a new non‐resective procedure in which the tenso‐structural modifications of the fibro‐muscular tissues of the soft palate and the lateral pharyngeal walls, created by means of barbed sutures (QUILL), reduce the collapsibility of the retro‐palatal space.

Methods:

A prospective study was carried out at the Ospedale Maggiore Policlinico University of Milan, Italy, from September 2012 to June 2103. Twelve snoring patients with mild obstructive sleep apnea syndrome (OSAS; AHI <20) underwent drug‐induced‐sleep‐endoscopy and contextual BRBT under general anesthesia. Patient satisfaction was measured with visual analog scale (VAS), snoring with linear‐analog‐scale (LAS) and snoring‐scale‐score (SSS), daytime sleepiness with Epworth Sleepiness Scale (ESS). Polysomno‐graphy was repeated 6 months postoperatively.

Results:

Eight males and 4 females, median age 47.5 years (range, 38‐61 months) had no significant postoperative morbidities or complications. The most common complaint was mild swallowing pain with spontaneous resolution within 5 to 7 days. After a median follow‐up of 10 months (range, 15‐8 months), a stable space‐structural remodeling of the velo‐uvulopharyngeal tissues was observed; improvement of snoring was confirmed by reduction in LAS and SSS; high VAS satisfaction values and reduction of ESS and AHI were recorded.

Conclusions:

BRBT represents an effective, nonresective, reversible, repeatable and well‐tolerated procedure to relieve snoring. Considering the observed reduction of AHI and ESS, the role of BRBT in moderate‐severe OSAS is currently under study.