bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Cytology in Clinical Practice
Authors: Meltzer Eli O. , Jalowayski Alfredo A.
Published: September 2007

Analysis of the nasal cytology provides information regarding the pathophysiology and response to therapy of the airway. This paper reviews the techniques for obtaining and interpreting specimens. The discussion focuses on the epithelial and inflammatory cells and the patterns seen in allergic, infectious and structural nasal disorders.
Occurrence of Nasal Congestion during Pregnancy
Authors: Bende Mats , Hallgårde Ulf , Sjögren Christer
Published: September 2007

After symptom registration of 39 pregnant women and 23 nonpregnant women during several months, it was possible to conclude that nasal congestion during pregnancy occurs during the last 3 months before delivery. This symptom of pregnancy might be an underestimated problem not dependent on previous pregnancies. Nasal congestion during pregnancy does not seem to be correlated to other common inconveniences such as nausea and gastrointestinal reflux.
Intranasal Ipratropium Bromide to Control the Hypersecretion of Vasomotor Rhinitis: A Dose-Response Study
Authors: Dolovich Jerry , Mukherjee Jyanti , Salvatori Vincent A.
Published: September 2007

Twenty-six adults were enrolled in a randomized, double-blind trial of three conditions for treatment of the watery rhinorrhea of vasomotor rhinitis: ipratropium bromide (IB) 20 μg (IB20) in each nasal cavity qid, IB, 40 μg (IB40) in each nasal cavity qid, and placebo. The severity of nasal discharge in the treatment groups was low in comparison with placebo; for combined day/night data the difference was highly significant for the IB20 (p = 0.0002) and IB40 (p = 0.0014) phases. Local nasal side effects listed included nasal dryness, itch, stuffy nose, sneezing, mild nasal bleeding, and dry sore throat. Of 23 patients at least one such side effect was recorded by 13 patients receiving the IB20 treatment, 13 patients receiving the IB40 treatment, and 6 patients receiving the placebo treatment. Thus, the frequency of these reported side effects for the 2 IB dosages was equal and for both IB doses was significantly greater than for placebo. In contrast, the proportion of patients with a sense of nasal stuffiness was the same for the placebo and IB20 treatments but significantly higher for the IB40 treatment. Pulse and blood pressure were not affected. It was concluded that IB in both dosages was highly effective in controlling the watery rhinorrhea of vasomotor rhinitis. Side effects were entirely local, described as mild to severe, and claimed by about half the treated group. The recommended dose should not exceed 20 μg in each nasal cavity qid.
A Prospective Double-Blind Evaluation of Cocaine, Phenylephrine with Xylocaine and Oxymetazoline with Xylocaine for Topical Intranasal Use
Authors: Lydiatt William M. , Huerter James V. , Nance Patrick N. , Yonkers Anthony J. , Moore Gary F.
Published: September 2007

A prospective, double-blind evaluation using 3 ml of 10% cocaine, 0.5% phenylephrine with 5% Xylocaine, and 0.05% oxymetazoline with 5% Xylocaine was conducted to compare the anesthetic, decongestant, and systemic effects of each of the drugs. Degree of anesthesia was measured by placing a probe on the nasal mucosa in the area of Kisselbach's plexus and passing an electric current until a sensation could just be felt. Decongestant properties were assessed using anterior rhinomanometry. Systemic effects were determined by continuous blood pressure and pulse recordings and by recording subject comments. Cocaine showed better anesthesia, slower onset of vasoconstriction, significant blood pressure elevation, and multiple subjective side effects. Phenylephrine mixtures showed almost no unpleasant side effects, more rapid vasoconstriction than cocaine, and statistically significant anesthesia. Oxymetazoline mixture did not offer any advantages in anesthesia or vasoconstriction and produced the most unpleasant side effects. Cocaine appears to be the drug of choice for long surgical procedures in patients with normal cardiorespitatory systems. Phenylephrine with Xylocaine may be used as the drug of choice for shorter office procedures for those patients with cocaine sensitivity.
The Effect of the Nasal Cycle on the Interpretation of Rhinomanometric Results in a Nasal Provocation Test
Authors: Sipilä Jukka I. , Suonpää Jouko T. , Salmivalli Altti J. , Laippala Pekka
Published: September 2007

A nasal provocation test was carried out in two groups of adults: patients with birch pollen allergy (n = 25) and a group of healthy volunteers with no nasal allergy (n = 25). An endonasal provocation test was performed using increasing concentrations of birch pollen extract. The maximal duration of the test was 1 hour. The physiologic changes in the nasal patency in both groups were studied at a separate session at 10-minute intervals during 1 hour. The nasal patency was recorded with a computerized rhinomanometer using the anterior active method. The statistical analysis of the results shows that modern rhinomanometry is a reliable method of objectively evaluating the alternations in nasal obstruction during a nasal provocation test. The rhinomanometric findings correlate well with the rhinoscopic findings and the subjective symptoms of the patients. The changes in the nasal resistance values during the provocation were significantly larger than the physiologic ones. The individual biologic rhythmicity of nasal airway patency cannot hide the real positive result of a rhinomanometric provocation test, but it must be considered as an important factor in interpreting the results in nasal challenge.
Comparative Multicentric Double-Blind Study between Dexchlorpheniramine and Astemizole in the Treatment of Children with Perennial Allergic Rhinitis
Authors: Naspitz Charles K. , Solé Dirceu , Wandalsen Neusa F. , Prado Evandro , Filho Nelson Rosario , Sano Flavio
Published: September 2007

Fifty-eight children with perennial allergic rhinitis from university centers (SP, RJ, PR—Brazil) were divided into two groups of 29 children each and received, in a double-blind test, astemizole (A) or dexchlorpheniramine (D) for 28 days. Age, sex, time of disease, and characteristics of the initial physical examination were similar in both groups. The improvement of coryza and nasal and eye itching was similar in both groups. Significantly better responses were observed in the children treated with A in relation to sneezing, watering eyes, and nasal obstruction. The increase of appetite and weight was similar in groups A and D. Drowsiness was significantly higher in group D. There was no difference in blood and urine analyses in both groups. In the global evaluation done by the physicians, group A improvement was significantly better on the 21st day of treatment. We conclude that there was a better therapeutic response, with longer duration of action and less drowsiness, in the children treated with astemizole.
Response of Respiratory Epithelial Cells to Inflammatory Stimuli
Authors: Churchill Laurie , Proud David
Published: September 2007

We hypothesize that the respiratory epithelium plays an active role in inflammatory diseases of the airways. In the present study, we have demonstrated that cultured human and guinea pig tracheal epithelial cells produce prostaglandin E2 and F2α, but no other prostanoids. Prostanoid production is significantly enhanced by bradykinin, histamine, and platelet-activating factor but not by substance P. Furthermore, we have shown that cultured epithelial cells have the ability to catabolize inflammatory mediators such as platelet-activating factor. We conclude that cultured tracheal epithelial cells retain receptors for inflammatory mediators and provide a useful model to study pathways of lipid metabolism and interactions of inflammatory mediators with respiratory epithelium.
Effects of Formaldehyde on the Nasal Mucosa
Authors: Holmström M. , Wilhelmsson B. , Hellquist H. , Drettner B.
Published: September 2007

To investigate health effects of long-term exposure to formaldehyde a cross-sectional field study was performed. Seventy formaldehyde-exposed workers were compared with a control group. A higher frequency of symptoms from upper and lower airways, headache, and dermal discomfort was found in the formaldehyde-exposed group. Further, formaldehyde-exposed workers showed disturbances of nasal physiologic conditions, such as slow nasal clearance, impairment of the sense of smell, more pronounced nasal mucosal swelling, and by spirometry lower forced vital capacity than expected was found. Nasal biopsies from the concha media showed more frequent histologic changes such as loss of cilia and metaplasia in the formaldehyde-exposed group. Histologic lesions did not correlate to current or cumulative exposure doses to formaldehyde. In an experimental study of Sprague-Dawley rats exposed to formaldehyde (12.7 mg/m3, 6 hours/day, 5 days/week for 24 months), one rat developed a squamous cell carcinoma in the nose and another nasal dysplasia and in seven other rats pronounced nasal metaplasia was seen in the nasal mucosa. In a control group of rats no significant histologic lesions were found.
Postviral Olfactory Dysfunction
Authors: Jafek B. W. , Hartman D. , Eller P. M. , Johnson E. W. , Strahan R. C. , Moran D. T.
Published: September 2007

Seventeen patients with varying degrees of olfactory dysfunction were studied at the Rocky Mountain Taste and Smell Center in Denver, Colorado. Detailed chemosensory testing was carried out, followed by biopsy of the olfactory mucosa. Ultrastructural study of the biopsies revealed near-complete degeneration of the ciliated olfactory receptors of anosmic patients and reduced populations of ciliated olfactory receptors in the hyposmic patients. Based upon these observations, it is postulated that upper respiratory infection can produce a spectrum of histopathologic change in the olfactory epithelium which can be correlated with afunctional deficit. The clinical implications of these observations are discussed.
Association between HLA Antigens and Birch Pollen Allergy in Japanese Subjects
Authors: Kumai Megumi , Miyokawa Naoyuki , Adachi Toshihide , Katagiri Makoto , Unno Tokuji
Published: September 2007

Birch pollen is a very common cause of nasal allergy (pollinosis) not only in Scandinavia, Europe, Canada, and the northern part of the United States but also in Hokkaido, Japan. Although there are many papers describing the association of HLA antigens and pollinosis caused by many other allergens, there is no report about the association of HLA antigens and birch pollen allergy. In this paper, we performed an HLA population study of birch pollen-allergic patients in Japan and their pattern analysis of HLA-DRB and HLA-DQB gene by the Southern blot hybridization technique. Our population study data indicated that the HLA-DR9 and HLA-DQw3 phenotypes strongly associated with the development of birch pollen allergy in Japanese subjects. By restriction fragment length polymorphism pattern analysis, some restriction fragments of the HLA-DQB gene were detected only in the patient group. These data suggested that there was a significant association between HLA class II antigens and the development of birch pollen allergy in Japanese subjects.
Intranasal Challenge of Cynomolgus Monkeys with Ascaris, Ragweed, Bradykinin, and Histamine
Authors: Tanner Ernest P. , Skoner David P. , Doyle William J. , Fireman Philip
Published: September 2007

Seven feral monkeys with Ascaris hypersensitivity confirmed by intradermal skin test were challenged with single doses of Ascaris extract (105 PNU/nostril), ragweed extract (103 PNU/nostril) and diluent; with increasing doses of bradykinin (0.1, 1, and 5 mg/nostril) and histamine (0.1, 1, and 5 mg/nostril), and with repeated doses of PBS diluent. Total mean nasal resistance (TMNR) was measured by rhinomanometry and eustachian tube function by the forced-response test. For single dose challenges, testing was conducted before and 5, 15, 40, and 50 minutes after the challenge and for multiple dose challenges before, 5 and 15 minutes after each dose, and 40 and 50 minutes after the final dose. Mean TMNR (cm H2O/L/sec) was increased from 28.9 ± 9 at baseline to peak at 124 ± 46 after Ascaris challenge. In contrast, TMNR was unaffected in six of seven monkeys challenged with diluent and in all monkeys challenged with ragweed. Progressive TMNR increases from baseline (25 ± 8) were observed for bradykinin (peak = 64 ± 46) and histamine (peak 108.4 ± 59) challenges. Eustachian tube function data showed no significant changes after intranasal provocation with either allergens or mediators. Provocative intranasal allergen challenge in actively sensitized monkeys is an effective method for evaluating the pathophysiology of allergic rhinitis and the effect of inflammatory mediators on nasal resistance.
Endoscopic Paranasal Sinus Surgery: Results
Authors: Vleming Marleen , De Vries Nico
Published: September 2007

From June 1986 until January 1988, 165 patients underwent endoscopic paranasal sinus surgery, and the results were evaluated. Surgery was performed for a variety of different indications, and 69% of the patients had had prior nasal surgery. Preoperative findings on nasal endoscopy and tomography are discussed. The subjective result, or the patient's opinion of the operation, was considered good in 51%, moderate in 22%, and poor in 27% of patients. Postoperative nasal endoscopy showed a good result for 63% and a poor result for 37% of the sides operated on. These subjective and objective results are correlated to the surgical indications. Minor complications were seen in 1.8% of the patients.
Technique for Endoscopic Endonasal Sinus Surgery
Authors: Moriyama Hiroshi , Ozawa Masashi , Honda Yoshio
Published: September 2007

Endoscopy enables us to avoid complications and achieve complete surgery of the ethmoid sinus, nasofrontal duct, and fontanelle under clear observation. By connecting a CCD camera, a surgeon can carry out an operation while watching the image on a TV monitor. Rigid 0° and 70° endoscopes are used. The 0° endoscope is selected for the ethmoid portion of the operation, and the 70° endoscope is used for treatment of the nasofrontal duct and the fontanelle. Use of various forceps has made it possible to treat the nasofrontal duct and the fontanelle and to establish a wide communication. In practice, intranasal procedures are conducted close to the anatomical location of the ground lamella (gl) in the ethmoid sinus. We discussed our technique for endoscopic endonasal sinus surgery for pansinusitis.
Video Documentation of Office Nasal Endoscopy
Authors: Rao Vittal S.
Published: September 2007

Presented is an inexpensive and easy method for documenting office endoscopic rhinoscopy using lightweight charged coupled device (CCD) cameras attached to a Hopkins telescope, recorded on VHS format videorecorders and displayed on color monitor. Recorded nasal endoscopy can be easily retrieved for patient education, legal documentation, education, and consultation with colleagues.
Some Trends in the History of Sinus Surgery
Authors: Salman Salah D.
Published: September 2007

Some trends in the American and Western European history and literature of sinus surgery for infection are summarized. Maxillary sinus surgery was first limited to drainage; subsequently radical surgery became very popular. With modern antibiotics and antiallergic management and better understanding of respiratory physiology, the indications for radical surgery have been reduced. The dangers of ethmoid surgery have been recognized for a long time. The popularity of the frontal osteoplastic operation is due to the poor results of the other techniques. The introduction of the Hopkins scopes and the functional concept in sinus surgery allow an increasingly popular conservative surgical approach to sinus infection.
Sustained Use of Xylometazoline Nose Drops Aggravates Vasomotor Rhinitis
Authors: Åkerlund Anders , Bende Mats
Published: September 2007

The effect of long-term treatment with nose drops on nasal obstruction was studied by measuring nasal airway resistance (NAR) in 12 patients with vasomotor rhinitis and in 10 healthy persons using anterior rhinomanometry. The dose-response effect on decongestion by xylometazoline was followed by decongestion induced by physical exercise. Measurements were performed before and after a 3-week treatment with nose drops containing xylometazoline. NAR at rest was significantly higher in the vasomotor rhinitis patient group than in the control group on the initial measurement, and the difference increased after the treatment period. No changes from before to after were found in the control group. Similar dose-response curves for xylometazoline were seen before and after the treatment period in both groups. Tolerance to xylometazoline apparently does not develop. Nose drops did not result in complete decongestion in patients with vasomotor rhinitis. These findings indicate that rebound congestion (rhinitis medicamentosa) develops in predisposed individuals, and interstitial edema of the nasal mucosa is a possible contributing pathophysiological mechanism.
The Atelectatic Maxillary Sinus
Authors: Furin Mark J. , Zinreich S. James , Kennedy David W.
Published: September 2007

The atelectatic maxillary sinus is a distinct anatomic variant. It may be identified in a symptomatic patient complaining of recurrent acute or chronic sinusitis or may be found incidentally, presenting as an asymptomatic opacified sinus. Recognition of the disorder is important. Lateral displacement of the posterior fontanelle may lead to the erroneous radiographic diagnosis of an air fluid level. At surgery, the infundibular atelectasis associated with the disorder may give rise to inadvertent orbital entry as the uncinate process is incised. Surgery may be further complicated by lateral displacement of the medial maxillary sinus wall, reducing access to the sinus by the transnasal approach. Although the atelectatic sinus may be identified at any age, its occurrence in childhood and the typical concurrence of sinus hypoplasia suggests sinus hypoventilation from an early age. The characteristic findings of the atelectatic maxillary sinus are presented and its surgery discussed.
Results of Endoscopic Sinus Surgery for Nasal Polyps
Authors: Vleming Marleen , Stoop Anton E. , Middelweerd Rene J. , de Vries Nico
Published: September 2007

Endoscopic sinus surgery (ESS) for nasal polyps was performed on 105 patients, who had a total of 134 operations, on 263 sides. Most patients (84%) had been previously operated on because of recurrent nasal polyps. The subjective results were good in 86% after one or more operations, with a median follow-up of almost 2 years. The objective results, as assessed by nasal endoscopy, show no recurrence in this group in 61%. Preoperative and postoperative lung function was tested in 30 patients with chronic obstructive pulmonary disease (COPD). An improvement was noted in 64%, in 23% the lung function was unchanged, and in 13% it had decreased. A relationship was noted between IgE-mediated allergy and the recurrence of nasal polyps. Patients with an IgE-mediated allergy had significantly more recurrences (50%). The complication rate was 4.3% of the 263 operated sides.
Middle Cranial Fossa Epidural Abscess: An Unusual Complication of Acute Sinusitis
Authors: Hadley James A. , Bakos Robert , Regenbogen Victor
Published: September 2007

Intracranial complications of acute sinusitis usually are manifested as frontal lobe empyemas, and middle cranial fossa epidural abscesses are rare. We present an unusual case of middle cranial fossa epidural abscess as a direct complication of acute pansinusitis in a young man. The etiology of middle cranial fossa epidural abscess formation is similar to that of anterior cranial fossa (frontal lobe) abscess formation, but the treatment and surgical approaches are more complicated. We present the methods of communication of paranasal disease through the fascial planes into the subtemporal space and the lateral pharyngeal space. An evaluation of a patient who presents with fever and severe headache of sinus origin should commence with imaging scans and a team approach to treatment.
Lymphocyte Subsets in the Nasal Mucosa and Peripheral Blood during Experimental Rhinovirus Infection
Authors: Winther Birgit , Innes Donald J. , Bratsch John , Hayden Frederick G.
Published: September 2007

The local cellular response during rhinovirus infection was studied with immunohistochemical staining of lymphocyte subpopulations in the lamina propria of the nasal mucosa (inferior turbinate) in 25 biopsies from volunteers with experimental rhinovirus colds and compared with biopsies from healthy volunteers. Biopsies from rhinovirus infected volunteers, taken either in the early phase of the infection (days 3 and 5) or during convalescence (day 14) were evaluated in a semiquantitative fashion for degree of infiltration. Lymphocyte subpopulations also were counted on coded specimens.

During experimental rhinovirus infection, no change could be observed in the overall degree of lymphocytic infiltration or in the numbers of T and B lymphocytes compared with control specimens. The overall degree of lymphocyte infiltration in the nasal mucosa was mild to moderate and consisted principally of T lymphocytes and only a few scattered B lymphocytes. Few natural killer lymphocytes were seen. These findings are similar to those in normal nasal mucosa and in contrast to the findings after topical application of recombinant interferon, which often results in a heavy lymphocyte infiltration. Lymphocyte subpopulation in the peripheral blood did not change when compared with prechallenge values in nine rhinovirus-infected volunteers.
Solitary Fibrous Tumor of the Sinonasal Tract: Case Report and Review of the Literature
Authors: Namon Ari
Published: September 2007

Nonepithilial tumors of the nasal cavity, paranasal sinuses, and nasopharynx are uncommon. Awareness of the variety of tumors to be found and their distinguishing characteristics allows for proper diagnosis and treatment. We present a case of solitary fibrous tumor of the sinonasal tract with a discussion of its differential diagnosis, evaluation, and treatment.
Acetylcholine Hyperreactivity of the Nasal Mucosa in Allergic Rhinitis: A Mucosal Sensitivity Test Using a Fluorescein-Stained Thread Method
Authors: Makiyama Kiyoshi , Hisamatsu Ken-ichi , Hara Mutsuko , Okazaki Kenji
Published: September 2007

An acetylcholine sensitivity test for nonspecific responsiveness of the nasal mucosa was established using a fluoresceinstained thread to measure the volume of nasal discharge. This test procedure is safe, inexpensive, simple, and therefore, suitable to perform in an outpatient clinic. This sensitivity test was useful to detect nonspecific hyperresponsiveness of the nasal mucosa using acetylcholine chloride at a low concentration level, eliminating the trigeminal nerve triggering. Ten μL of acetylcholine chloride in physiological saline at a concentration of one μg/mL was dripped on the anterior portion of the inferior turbinate after elimination by aspirating retained nasal discharge, and provoked nasal discharge during 1 minute was measured using a fluorescein-stained thread. The mean dye migration distance was 0.87 ± 4.53 mm in normal control subjects, (n = 15), and it was significantly less than that of the house-dust nasal allergy group, 16.90 ± 12.60 mm (n = 16, t = 2.77, P <.01), and the cedar pollinosis group during the pollen-dispersion season, 24.30 ± 8.80 mm (n = 18, t = 6.17, P <.01). A negative correlation was found between the volume of the acetylcholine-induced nasal discharge and the threshold of the histamine sensitivity of the nasal mucosa in patients with nasal allergy (r = –0.451; n = 70; P <.01).
Hemangiopericytoma of the Nasal Cavity: A Review of 15 Cases over a 40-Year Period
Authors: Hughes Kenneth V. , Bard Michael C. , Lewis Jean E. , Kasperbauer Jan L. , Facer George W.
Published: September 2007

Hemangiopericytomas are rare tumors of vascular origin most commonly found in the extremities or retroperitoneal area. When they originate from the nasal cavity and paranasal sinuses, they tend to be less aggressive and generally do not metastasize. The term “hemangiopericytoma-like lesion” has been coined for sinonasal hemangiopericytomas that display more benign histologic and growth characteristics than do those located elsewhere. Fifteen cases of hemangiopericytoma of the nasal cavity and paranasal sinuses were reviewed over the period 1951 to 1990; included are follow-up data on cases reported earlier from this institution. The clinical course, management, and outcome was evaluated and correlated with the histologic characteristics of the tumors. The recurrence rate in our series was 13.3%; the mean follow-up was 11 years. No patients died of their disease or had evidence of metastatic disease. This clinicopathologic review suggests that sinonasal hemangiopericytomas should not be classified as “hemangiopericytoma-like” lesions; rather, they should be expected to have significant local recurrence rates with low rates of distant metastasis and mortality. Long-term follow-up is essential as there can be local recurrence after many years.
Nasal Dorsal Pseudocyst Formation after Rhinoplasty
Authors: Bartels Jeffrey W. , Burgess Lawrence P.A.
Published: September 2007

Nasal dorsal cyst or pseudocyst formation is a rare complication after rhinoplasty. We present what we believe to be the first case in which extensive bony destruction resulted from such a lesion. A review of the literature is provided along with a discussion of possible etiologies of this complication.
Experience with a New Puncture and Irrigation System in the Management of Purulent Maxillary Sinusitis
Authors: Berg Olof , Lejdeborn Lars
Published: September 2007

A study was made of a new system for maxillary sinus puncture and irrigation used on 100 consecutive patients with symptoms and signs indicating acute purulent maxillary sinusitis. The Sinoject™ system was shown to be a reliable, safe, and easily operated device, and with high patient compliance. The system represents a substantial improvement of puncture and irrigation as the primary form of therapy in cases of maxillary sinusitis.
Rhinomanometry before Septoplasty: An Approach to Clinical Material with Diverse Nasal Symptoms
Authors: Sipilä Jukka I. , Suonpää Jouko T. , Kortekangas Aatto E. , Laippala Pekka T.
Published: September 2007

Preoperative and postoperative rhinomanometry was performed on 102 patients referred for septoplasty. Nasal resistance was calculated according to the Broms method at radius 200 and at 150 Pascal pressure gradient. Because the latter could be calculated in only 62% of the recordings during normal nasal breathing, the Broms method is used in the analysis and also recommended for clinical practice. Results show that in cases with airway obstruction as the cause for surgery, the increase of nasal patency achieved with the operation was larger than in cases with other indications. The level of subjective satisfaction was highest among those patients whose nasal resistance was changed to normal limits. Rhinomanometry gives valuable data in cases where the patient's symptom is obstruction, but its value is not as clear in other indication groups. Rhinomanometry clearly shows cases where surgery has failed to correct the nasal obstruction and is, therefore, a good method of quality control. Preoperative rhinomanometry helps to avoid unnecessary septal operations.
Wegener's Granulomatosis: The Role of Endoscopic Sinus Surgery
Authors: Park Albert H. , Stankiewicz James A.
Published: September 2007

Conventional wisdom has dictated that the patient with Wegener's Granulomatosis may benefit from a Caldwell Luc or external ethmoidectomy in the treatment of sinusitis. No studies, however, have specifically evaluated the efficacy of such drainage procedures especially with respect to endoscopic sinus surgery (ESS). Nineteen patients diagnosed with Wegener's Granulomatosis were evaluated to assess the efficacy of medical and surgical treatment of their sinus disease. Four of these patients eventually required ESS after failure to treat their sinus disease medically. ESS was performed to drain the obstructed sinuses (three patients) or a mucocele (one patient). Initially, the sinuses were patent, but two patients developed persistent scarring and crusting associated with the chronicity and activity of their systemic disease. These results underscore the difficulty in treating these patients and the fact that despite adequate endoscopic drainage and meticulous postoperative care the underlying disease process may relentlessly cause scarring and sinus obstruction. These patients require continuous medical and intensive surgical therapy for the best chance for sinus disease control.
A Transsphenoidal Approach to Petrous Apex Lesions Using Endoscopic Sinus Scopes
Authors: Pitman Karen T. , Diaz-Ordaz Ernesto A. , Parker Gregg S.
Published: September 2007

The authors describe biopsy of a petrous apex lesion via a transnasal, transsphenoidal endoscopic approach. Various surgical approaches to the petrous apex are discussed as well as our experience using the endoscopic approach. We propose that this approach can be refined for future use as a method for biopsy and permanent fistulization of cystic petrous apex lesions that encroach on the sphenoid sinus.
Rhinoscleroma: A Case Report and Clinical Update
Authors: Winstead Welby , Connely Thomas V. , Raff Martin J.
Published: September 2007

Rhinoscleroma is a chronic granulomatous inflammatory disease caused by Klebsiella rhinoscleromatis. Initially described as a lesion of the nose, rhinoscleroma may involve any part of the respiratory tract. Although it is endemic in many parts of the world, rhinoscleroma has been rarely recognized in the U.S. In this report, we present a case of rhinoscleroma that illustrates the diagnostic challenge and therapeutic dilemma this disease presents. The significance of laryngeal involvement is emphasized. We review the clinical presentation, diagnosis, and treatment of rhinoscleroma. Ciprofloxacin was found effective in controlling acute symptom; however, longterm, high dose treatment has not been curative.
Effect of Experimental Influenza A Infection on the Nasal Response to Histamine Challenge in Allergic and Non-Allergic Subjects
Authors: Doyle William J. , Skoner David P. , Seroky James T. , Fireman Philip
Published: September 2007

To determine if a viral upper respiratory tract infection can alter the responsiveness of the nasal mucosa, paired intranasal histamine challenge sessions were performed before and after (8 days) intranasal inoculation with influenza A virus in 16 nonallergic and 16 allergic subjects. The nasal response to a 1-mg histamine challenge was measured as symptom scores for rhinorrhea and congestion, counts for sneezing, weight for expelled secretions, and inspiratory conductance for nasal patency. After inoculation, a total of 25 subjects (11 allergic, 14 nonallergic) became infected with influenza A virus. In infected subjects the measured responses to histamine for secretion weight and rhinorrhea symptom score were significantly greater at 8 days postinfection when compared to those responses recorded prior to inoculation. No significant between session differences were observed for the other responses, or for any of the responses in the uninfected subjects. Significant differences between infected allergic and nonallergic subjects were not observed for any response. These results document an increased secretory response of the nose to histamine during the postsymptomatic period of influenza A viral infection in both allergic and nonallergic subjects.
Endoscopic Septal Spur Resection
Authors: Lanza Donald C. , Rosin Deborah Farb , Kennedy David W.
Published: September 2007

A variety of surgical approaches exists for the management of nasal septal spurs in patients who undergo endoscopic sinus surgery (ESS). Treatment of septal spurs in the past has been frequently addressed by septoplasty which can result in increased bleeding and length of surgical procedure as well as mandate postoperative nasal packing. Individually each of these problems can jeopardize the success of endoscopic sinus surgery. An endoscopic approach, which targets the septal spur alone, can minimize perioperative morbidity.

The purpose of this paper is to demonstrate the effectiveness of endoscopic septal spur resection (ESSR) for the management of significant septal spurs in 8 patients who underwent concurrent ESSR during ESS for chronic sinusitis. Surgical technique and postoperative results are discussed and suggest that ESSR is a valuable alternative to more traditional techniques.
Treatment of Acute Frontal Sinusitis: A Survey of Current Therapeutic Practices among Members of the Northwest Academy of Otolaryngology
Authors: Perkins Jonathan A. , Morris Michael R.
Published: September 2007

The treatment of acute frontal sinusitis is extremely important, as the potential for significant morbidity exists. We conducted a survey of 140 members of the Northwest Academy of Otolaryngology to determine how this disease entity is most commonly treated in our region. Eighty-one members responded. From this data it is evident that the surgical treatment of uncomplicated frontal sinusitis is changing, but antimicrobial therapy remains standard. Adjunctive medical therapy is frequently used, but the effectiveness of these agents in reversing underlying disease pathophysiology is unknown.
Schwannomas of the Nose and Paranasal Sinuses
Authors: Wanamaker John R. , Wanamaker Hayes H. , Kotton Bernard , Akers Greg D. , Lavertu Pierre
Published: September 2007

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.
The Acoustic Assessment of Nasal Area in Infants
Authors: Buenting John E. , Dalston Rodger M. , Drake Amelia F.
Published: September 2007

The present study was undertaken to determine whether a modification to commercially available acoustic rhinometry (AR) instrumentation might allow equipment designed for use in adults to accurately determine the nasal cavity configuration of infants and children. The standard wave tube was replaced with a version having a narrow (0.312 cm2) internal diameter. After calibration, this device was used to generate nasal area curves for the nasal cavity of a full term infant cadaver. Direct volume measurements and area measurements of polyvinylsiloxane nasal casts of the same specimen were used to evaluate the accuracy of the acoustic method. AR correlated well with nasal cast data (r = 0.88) for total nasal cavity area. The acoustic method underestimated the total area at the nasal valve by only 1.8 mm2 (22.1 mm2 vs. 23.9 mm2) and overestimated choanal area by 10 mm2 (56.9 mm2 vs 46.9 mm2) compared to data derived from polyvinylsiloxane nasal casts. In addition, AR measured total nasal volume to within 5.2% percent of the value obtained by direct measurement. This is the first report that AR can produce useful nasal area information in infants, and it suggests that the device has utility both in airway research and as a nasal patency screening tool in the pediatric population.
The Case for the Caldwell-Luc Procedure
Authors: Mabry Richard L.
Published: September 2007

The increasing popularity of fiberoptic endonasal sinus surgery has led some to state that a Caldwell-Luc procedure should be performed only to manage tumors involving the maxillary sinus and epistaxis, a procedure that requires exposure of the pterygopalatine fossa for vessel ligation. However, a modern version of the Caldwell-Luc procedure should be considered in instances where failure of endoscopically-controlled endonasal sinus surgery (coupled with appropriate medical management) occurs because of the presence of severely or diffusely diseased or damaged mucosa. This approach is also suggested for suspected fungal sinusitis extensively involving the antrum, for all reoperations for isolated antral disease in which the ostiomeatal complex and ethmoids are clear, and for closure of oro-antral fistulas associated with marked inferior antral mucosal disease.
Mucociliary Clearance of the Maxillary Sinuses in Patients with Recurrent or Chronic Sinusitis
Authors: Penttilä Matti A. , Rautiainen Markus E.P. , Koskinen Matti O. , Turjanmaa Väinö , Laranne Jussi E. , Pukander Juhani S.
Published: September 2007

This is one of the first human studies of maxillary sinus mucociliary activity using human serum albumin labelled with 99m-technetium (99mTc-HSA) as a tracer in patients suffering from recurrent or chronic maxillary sinusitis. The tracer was injected into both maxillary sinuses through small sinus irrigation catheters. Nasal endoscopy and computed tomography were performed in all patients shortly before the injection. The clearance rates of four case report patients with different endoscopic and radiographic findings showed great individual variation. The technique proved to have viability for clinical use when evaluating sinusitis treatment options and results.
Effects of Vasoactive Agents and their Antagonists Measured by Acoustic Rhinometry
Authors: Unno Tokuji , Nagano Etsuji , Nonaka Satoshi , Fujita Taketoshi , Wada Tetsuji , Tanida Mitsuhiro
Published: September 2007

The purpose of this study was to assess the effects of a agonists on the human nasal mucosa. Volumetric changes in the nasal cavity after application of phenylephrine (PNL), oxymetazoline (OMZ), and epinephrine (EPR) were investigated using acoustic rhinometry. The reactions of the nasal mucosa were extremely modified after pretreatment by α1 and α2 antagonists, phenoxybenzamine (POB) and yohimbine (YOH), and local anesthetic, xylocaine (XLC). Decongestion of the nasal mucosa evoked by α stimulants was considered to originate mainly from the direct activation of α1 receptors. Decongestion of the middle and posterior parts began later than the anterior part and was more gradual because of the time necessary to transport the drug particles to the posterior areas. Contralateral volume changes were probably controlled by the afferent signals from the ipsilateral side of the nose.
Dose-Response Study of Formaldehyde on Nasal Mucosa Swelling. A Study on Residents with Nasal Distress at Home
Authors: Falk Jan E. , Juto Jan E. , Stridh Göran , Bylin Gunnar
Published: September 2007

Despite great effort, it has been difficult to demonstrate in an objective way any impact of sick building environment on affected individuals. The aim of this study was to learn whether or not it is possible with rhinostereometry to register changes in the nasal mucosa swelling at exposure to formaldehyde in concentrations 0–0.174 mg/m3. Seven persons, non-allergic, otherwise healthy, and with a history of nasal distress in their homes, participated in the study. Six healthy persons, without nose problems, were controls. Each person was exposed to formaldehyde in different concentrations during two hours in a climate chamber. Increased swelling was recorded al the two highest concentrations (0.073 and 0.174 mg/m3) in the symptomatic group. The control group did not show any mucosal swelling. It was possible to demonstrate an increased mucosal swelling that must be attributed to exposure to formaldehyde. This was possible at formaldehyde concentrations close to the (0.125 mg/m3) upper limit for indoor climate recommended by the World Health Organization (WHO). The study model can be considered useful for further investigations of the impact on the individual from other airborne irritants connected to sick building environments.
The Effect of Viral Infection under Various Mucociliary Transport Rates in the Non-Anesthetized Chicken
Authors: Ukai Kotaro , Sakakura Yasuo
Published: September 2007

The effects of viral infection following nasal mucociliary impairment in the nonanesthetized chicken were investigated by measuring the mucociliary transport rate under physiological conditions. Mucociliary transport rates in chickens’ postnasal fossa were measured by using a video monitor system connected to an otomicroscope, with direct vision through the palatine cleft. The chick was positioned in a specially designed plastic holder with a mouth opener. Changes of the mucociliary transport rates were induced by mechanical stimulation, dehydration, and 20% cocaine. The mucociliary transport rate was accelerated on the postnasal fossa adjacent to the mechanically stimulated side of the palatine cleft. Dehydration for 96 hours produced a progressive deceleration of the mucociliary transport rate. Topical application of 20% cocaine into the postnasal fossa caused ciliary paralysis within 5 minutes that continued for more than 1 hour. The topical inoculation of the Newcastle disease virus into the postnasal fossa induced significant deceleration of the mucociliary transport rate after 4 days. We studied the effect of mucociliary transport rates arising from topical inoculation of the Newcastle disease virus after inducing mucociliary dysfunction by mechanical stimulation, dehydration, and the application of 20% cocaine. Mucociliary transport rates in the dehydration and cocaine groups decelerated significantly 4, 7, 10, and 13 days after the inoculation compared with that before the inoculation. No decrease was seen in the mechanical stimulated group. Additionally, mucociliary transport rates at 10 and 13 days after inoculation were significantly decelerated in the dehydrated and 20% cocaine groups compared with that in the normal control group. These results suggest that the deceleration of the mucociliary transport rate may increase and prolong the severity of a viral infection.
Allergic Fungal Sinusitis: A Review with Four Illustrated Cases
Authors: Goldstein Marc F. , Dunsky Eliot H. , Dvorin Donald J. , Lesser Raymond W.
Published: September 2007

Although paranasal fungal sinusitis is rare, an increased number of Aspergillus and non-Aspergillus related cases of allergic fungal sinusitis have been described since its first report in 1983. The histopathologic findings necessary for a definitive diagnosis rest upon the detection of scattered fungal elements in a matrix of allergic mucin. The clinical spectrum and treatment of allergic fungal sinusitis are detailed within four illustrated case reports. Sinus surgery, followed by meticulous post-surgical care by an allergy and otolaryngology team using oral corticosteroids, and followed by maintenance intranasal steroids and nasal airway irrigations in conjunction with allergy immunotherapy, has resulted in excellent clinical outcomes.
The Maxillary Sinus Ostium: Demystifying Middle Meatal Antrostomy
Authors: Owen R. Glen , Kuhn Frederick A.
Published: September 2007

Locating the maxillary sinus ostium can be a problem in endoscopic middle meatal antrostomy. Patients requiring revision sinus surgery may be found to have the maxillary sinus ostium obstructed, or the previous antrostomy placed in the wrong location. The intricate lateral nasal wall anatomy can be difficult to translate into the two-dimensional endoscopic view. It is therefore understandable how finding the maxillary sinus ostium at times can be tedious. Inability to accurately identify the maxillary sinus ostium may preclude an appropriate middle meatal antrostomy, and predispose the patient to persistent sinus disease. The primary landmarks for identifying the maxillary sinus ostium are the uncinate process and the ethmoid bulla. The initial surgical step in endoscopic ethmoidectomy is uncinectomy. This is usually followed immediately by removal of the bulla, frequently before the maxillary ostium has been accurately identified. After evaluating CT scans of 61 revision sinus surgery patients, and observing a large number of sinus surgeon training in the OR and the dissection lab, we have noted that uncinate removal is often incomplete. An uncinate remnant is commonly left inferiorly. This may lie against the lateral nasal wall obscuring the maxillary sinus ostium. This coupled with loss of the ethmoid bulla, the primary surgical landmark, may make identification of the maxillary ostium quite difficult. We feel that the key to successful middle meatal antrostomy (MMA) and avoidance of persistent maxillary sinus disease is positive visual maxillary ostium identification immediately after removal of the uncinate process. The residual inferior uncinate process typical after incomplete uncinectomy, and its subsequent removal, are demonstrated. An alternate technique is presented for complete uncinate removal, simplifying maxillary ostium identification.
The Efficacy of Budesonide and Beclomethasone Dipropionate, Delivered via a Pressurized Metered Dose Inhaler, in the Treatment of Perennial Rhinitis: A Randomized, Double-Blind, Crossover Study
Authors: Basran G.S. , McGivern D.V. , Hanley S. , Davies D.
Published: September 2007

A total of 28 adult patients (19 women, nine men; mean age 28.5 years, range 15–63 years) with a diagnosis of perennial allergic and nonallergic rhinitis (mean duration of symptoms 4.0 years, range 1–20 years) were recruited into this randomized, double-blind, crossover study. Eighteen patients (64%) were atopic for common allergens. The efficacy of budesonide nasal aerosol (Rhinocort®) and beclomethasone dipropionate (BDP; Beconase®) was compared using nominal doses of 200 μg (b.i.d.) for each drug administered every morning and evening. Following a 2-week run-in period, patients were randomly-divided into two groups and treated for 4 weeks with either BDP or budesonide. After the crossover, patients then received the second drug for the remaining 4 weeks of the trial. Response to the treatment regimens was assessed by subjective symptom scoring and nasal peak expiratory flow rate (PEF) measurements. Budesonide and BDP reduced all nasal symptom scores and improved nasal PEF compared to the run-in period. During budesonide therapy, significantly less sleep disturbance, lower evening and morning nasal blockage scores, and greater nasal PEF values in the evening were recorded than for BDP. Following crossover, patients who were treated with budesonide in the second part of the trial demonstrated significantly improved nasal blockage scores and evening nasal PEF in contrast to those who received BDP during the latter part of the study. The number of adverse events reported during the trial was equal for both drugs and those noted tended to be mild. In conclusion, although the symptoms of perennial rhinitis were well controlled by both budesonide and BDP, the predominant symptom of nasal blockage was managed more effectively with budesonide.
Fungal Sinusitis Presenting as an Ethmoid Mucocele
Authors: Rumans Todd M. , Jones Myron , Ramirez Sylvester G.
Published: September 2007

Fungal sinusitis was first reported in the late 1880s and was due to Aspergillus. Since this initial report, scattered case reports of fungal sinusitis have appeared in the medical literature, with the majority of these cases being due to Aspergillus and Mucormycosis. These case reports have also demonstrated multiple presentations of fungal sinusitis; however, our review of the literature did not demonstrate any previous case reports presenting as an ethmoid sinus mucocele. We now describe what we believe to be the first case of fungal sinusitis that presented as an ethmoid sinus mucocele.