bluuebunny/crossref_metadata_2025 huggingface dataset:
Gustatory Rhinitis
Authors: Raphael Gordon D. , Hauptschein-Raphael Mindy , Kaliner Michael A.
Published: September 2007

Gustatory rhinitis is a syndrome characterized by the profuse watery rhinorrhea produced by consumption of certain spicy, hot foods. In order to investigate the pathogenesis of this common disorder, 18 subjects underwent food challenges with control (bland) foods and positive (spicy) foods. Positive foods, but not control foods, produced rhinorrhea and increased the secretion of albumin and total protein into nasal lavage fluid. Nasal pretreatment with atropine clinically blocked the positive food-induced rhinorrhea and significantly reduced albumin and total protein secretion. Thus, gustatory rhinitis is produced by spicy foods which stimulate atropinesensitive muscarinic receptors, and this syndrome can be prevented by pretreatment with topical atropine.
Allergic and Nonallergic Rhinitis. Classification and Pathogenesis: Part II. Nonallergic Rhinitis
Authors: Zeiger Robert S.
Published: September 2007

Part I of this review classified and defined the causes of chronic rhinitis, describing in detail the etiology and pathophysiology of allergic rhinitis. Part II focuses on the nonallergic (non-IgE) causes of chronic rhinitis, concentrating on their clinical presentations, differential characteristics, and known or speculative pathophysiology. A comprehensive understanding of the allergic and nonallergic conditions associated with symptomatic rhinitis should aid the clinician in the appropriate diagnosis and treatment of patients with chronic rhinitis.
Eicosanoid Products in Nasal Rinses Obtained after Acute and Chronic Allergen Stimulation
Authors: Brooks Carter D. , Karl Kathleen J. , White Gordon J.
Published: September 2007

To explore biochemical relationships between naturally occurring allergic rhinitis and a nasal provocation model, we measured PGD2 and LTC4 content of nasal rinses obtained before and after nasal allergen challenge, in and out of the allergy season. Both PGD2 and LTC4 contents rose after challenge. The rise in season was substantially greater than that seen out of season, and the amounts of eicosanoids present after acute challenge out of season were greater than those recovered when the patients were symptomatic in season. Eicosanoid response is quantitatively different with chronic environmental exposure and with acute laboratory provocation.
Magnetic Resonance Imaging of the Nasal Airways
Authors: Cole Philip , Haight James S. J. , Naito Kensai , Kucharczyk Walter
Published: September 2007

Magnetic resonance imaging was used to demonstrate both erectile tissues and airway lumen of the nasal cavities together with their responses to lateral recumbent postures and to topical decongestant. The inferior turbinate and the anterior septal body responded to lateral recumbency by swelling in the inferior nasal cavity and reciprocal shrinking in the superior side and both responded to topical decongestant by shrinking. Converse changes in airway lumen took place in each case. In the untreated nose erectile tissues of the lateral nasal wall appeared to adapt to septal irregularities and to maintain a uniform width of the airway lumen in the more patent side. Erectile tissues on the lateral nasal wall anterior to the inferior turbinate and medially on the anterior septum were seen to intrude on the constricted region of the nasal valve where their potential to exert a critical influence on airflow resistance was evident.
“Hairy Polyp” of Infancy—Pathology, Embryology, and Differential Diagnosis
Authors: Heller Debra S. , Brandwein Margaret S. , Klein Michael J. , Biller Hugh
Published: September 2007

“Hairy polyp,” or dermoid polyp, of the nasopharynx is a rare tumor of early life composed of ectodermal and mesodermal derivatives. We present a case, consider its embryological origins, and discuss the differential diagnosis of nasopharyngeal polypoid masses in infancy.
Microscopic Endonasal Surgery: Clinical Update for Treatment of Chronic Sinusitis with Polyps
Authors: Amedee Ronald G. , Mann Wolf J. , Gilsbach Joachim M.
Published: September 2007

Microscopic endonasal surgery has been routinely used over the past 5 years in treating over 450 patients with various paranasal sinus pathologic conditions. The main advantages of this technique are wide-field stereoscopic vision, bimanual dissection, and simplified resident instruction. Disadvantages include the need for specialized instrumentation, general anesthesia, and sometimes difficult visualization of angular views. Despite these shortcomings, the precision offered allows for decreased operative morbidity with enhanced preservation of normal tissues. Operative hemorrhage, which often presents a formidable problem during telescopic sinus surgery, is easily controlled by selective bipolar cautery, hypotensive anesthesia, and use of the semi-Fowler's position, which allows blood and mucus to flow out of the operative field. The aim of this manuscript is to detail our operative experience in a group of 325 patients who were treated for chronic sinusitis with polyposis nasi using microscopic endonasal surgery.
D- and L-Lactic Acid in Chronic Sinusitis as a Marker of Leukocyte and Bacterial Metabolism
Authors: Stierna Pontus , Söderlund Karin
Published: September 2007

The anaerobic environment in purulent sinusitis is reflected by the accumulation of lactic acid in the secretion. L-Lactic acid originates mainly from leukocytes and the D-form is exclusively produced by growing bacteria. In this study the latter was used as a marker of bacterial metabolism. Secretion was aspirated from 24 patients with either purulent or nonpurulent chronic sinusitis and frozen in liquid nitrogen. Samples were assayed for both isomers of lactic acid by an enzymatic method. In chronic purulent and nonpurulent sinusitis L-lactic acid concentration was 16.3 and 1.1 mmol/kg w/w, respectively. D-Lactic acid was only detected in two purulent and three nonpurulent secretions and in small concentrations (0.7 and 0.3 mmol/kg w.w., respectively). This indicates that the increased lactate concentration in purulent sinusitis is of leukocytic origin and that the bacteria in chronic sinusitis are metabolically inactive, and thus in a stationary growth phase.
Cylindrical Cell Papilloma of the Maxillary Sinus
Authors: Kennedy CDR Kevin S.
Published: September 2007

The cylindrical cell papilloma is considered to be a form of Schneiderian nasal papilloma. This form of papilloma is rare. There are clinical and histologic differences between an ordinary inverting papilloma and a cylindrical cell papilloma. Both forms of papillomas present as ragged or papillary growths in the maxillary sinus or in conjunction with lesions of the adjacent lateral nasal wall or ethmoid sinus. An unusual case of cylindrical cell papilloma and a review of the literature concerning this lesion is presented. Magnetic resonance imaging (MRI) scan is advantageous in evaluating this lesion, especially in distinguishing these lesions from cysts and in defining the extent of the problem. Medial maxillectomy via lateral rhinotomy or a facial degloving approach partial maxillectomy is usually curative for this problem, although more aggressive lesions require more extensive maxillectomy.
Bone Erosion in Allergic Fungal Sinusitis
Authors: Handley Guy H. , Visscher Daniel W. , Katzenstein Anna-Luise A. , Peters Glenn E.
Published: September 2007

Allergic fungal (Aspergillus) sinusitis was initially described in 1983. Histologic identification of fungal hyphae, eosinophils, and Charcot-Leyden crystals in allergic mucin from the involved sinus is considered diagnostic. The fungus is felt to incite the allergic response. The histologic similarity of this disease to allergic bronchopulmonary aspergillosis prompted the name, allergic aspergillus sinusitis. However, in the absence of definitive cultures or laboratory tests indicating Aspergillus as the organism involved, the more appropriate term would be allergic fungal sinusitis. Bone erosion frequently has been described in invasive fungal sinusitis, especially in immunocompromised hosts. However, bone erosion has been seen in only 4 of 21 previously reported cases of allergic fungal sinusitis and is considered unusual. We report 11 additional cases diagnosed over the last 52 months. Seven were noted on computed tomographic scan to have marked multifocal bone destruction. Histologically, this appears to be caused by bone resorption and remodeling rather than tissue invasion by fungal organisms.
Functional Endoscopic Sinus Surgery—Experience with the Initial 100 Patients
Authors: Hoffman Dieter F. , May Mark , Mester Sara J.
Published: September 2007

Although the theory, indications, and technique of endoscopic sinus surgery have been well described, the results are only recently becoming apparent. Despite practicing classic sinus surgery for over 20 years, the senior author is now nearly exclusively utilizing the endoscopic approach. A retrospective study on the first 100 patients operated on utilizing the endoscopic approach was performed in order to review the transition period from classic sinus surgery to endoscopic sinus surgery. Trends noted included diminished blood loss, shorter hospitalization, and diminished use of an external procedure. Early results and complications are also reviewed.
Endoscopic Microsurgery of the Ethmoid Sinus
Authors: Ohnishi Toshio , Esaki Shiro , Iwasaki Mitsuo , Tachibana Toshiro
Published: September 2007

Magnification of the operative field by endoscopes and a closed circuit television system enables precise and meticulous surgery of the ethmoid sinus via an endonasal approach. Endoscopic microsurgery of the ethmoid sinus utilizing meticulous technique improves the final results and offers greater safety than conventional surgery. Clear visualization enables a precise technique and facilitates the prevention of serious surgical complications. The authors’ technique of endoscopic sinus operation is described in a step-by-step description and the results of a patient survey and postoperative evaluation confirm excellent symptomatic improvement with minimal complications.
Local Cell Flux and Cell Activation in Provoked and Naturally Occurring Allergic Rhinitis
Authors: Pipkorn Ulf
Published: September 2007

Several new techniques for atraumatic harvesting of cells from the nasal mucosa in vivo in humans have been utilized in allergen challenge experiments and during natural allergen exposure. Using biochemical techniques to monitor the release of substances or mediators, suggestive evidence has been provided for the participation of specific cells in these conditions. After a local challenge with allergen, a release of histamine indicates the activation of mast cells in the initiating part of the allergic response. This initial response to allergen is followed by a late inflammatory phase characterized by late occurring symptoms, a local influx of granulocytes, and a change in mucosal responsiveness to specific as well as unspecific stimuli. The interrelationship between these different manifestations of the postallergen inflammatory response remains to be sorted out. The most prominent finding is the increase in the number of eosinophilic granulocytes. Biochemical evidence has also been provided that these cells together with basophilic granulocytes also appearing during the late phase are activated. Similar evidence for the participation of mast cells in hay fever during natural allergen exposure has been provided through the demonstration of changes in the distribution of these cells, a change in intracellular histamine content and ultrastructural findings of cell activation. In addition, seasonal allergen exposure was accompanied by a prominent increase in eosinophils on the surface of the nasal epithelium, an increase that correlated strongly to the degree of pollen exposure and symptoms experienced by the patients. Thus, human in vivo data point to, at least to some extent, similar cellular changes in the laboratory following a local challenge and the clinical disease of hay fever.
Induction, Course, and Recovery of Maxillary Sinusitis: A Bacteriological and Histological Study in Rabbits
Authors: Westrin Karl Magnus , Stierna Pontus , Kumlien Jan , Carlsöö Bengt , Nord Carl Erik
Published: September 2007

A bacteriological and histological study of acute pneumococcal sinusitis in rabbits was performed. The sinus ostium was blocked unilaterally and on the second day 108 Streptococcus pneumoniae type 3 were injected into the sinus cavity. The bacteriology of the sinus secretion and the morphological alterations of the sinus mucosa was determined 1, 2, 3 and 4 weeks after initiation of infection. Initially a pronounced mucosal infiltration of granulocytes and lymphocytes was found. Squamous cell metaplasia as well as areas of desquamated epithelium were also evident. This heavy inflammatory reaction gradually declined and after 4 weeks the epithelium appeared more normal, although goblet cells and subepithelial thickening, both associated with a more chronic infection, were found in certain areas. After 2 weeks, the initially reisolated pneumococci were replaced by a nonfermentative Gram-negative flora as well as anaerobic bacteria.
Endoscopic Sinus Surgery for Ostiomeatal Disease
Authors: Jacobs Joseph B. , Gittelman Paul , Holliday Roy
Published: September 2007

The advent of endoscopic sinus instrumentation and high-resolution computed tomographic (CT) scanning enables otolaryngologists to delineate precisely the anatomy of the middle meatus. We have utilized a staging system for chronic sinusitis based on endoscopic and CT criteria. This system provides a means of evaluating and standardizing the surgical approach and provides a basis for institutional comparison. In this system Stage I disease includes patients with a history of recurrent sinusitis and anatomic findings which narrow and impinge upon the ostiomeatal complex. We are reporting on 25 patients with Stage I disease who underwent surgical treatment for ostiomeatal complex disease. The endoscopic and CT findings will be presented, as well as follow-up defining control of symptomatology.
Effect of Cold Dry Air on Nasal Airway Resistance
Authors: Bende Mats , Angesjö Per , Hultsten Kjell , Voog Lennart
Published: September 2007

The effect of provocation with cold dry air in the nose on nasal airway resistance was evaluated in patients with vasomotor rhinitis and in healthy volunteers in different body positions in order to determine whether this provocation test could be used to distinguish between normal subjects and those with vasomotor rhinitis. Cold dry air did not seem to be of any use in this respect, and the problem of finding a method suitable for practical clinical assessment of vasomotor rhinitis still remain to be solved.
Total Inferior Turbinectomy: Benefits and Complications
Authors: Campbell J. B. , Morgan D. W. , Snow D. G. , Simons R. M.
Published: September 2007

Between 1975 and 1987, 115 patients underwent inferior turbinectomy and 87% were available for review. The nature and extent of their pre- and postoperative symptoms were determined, and rhinoscopy was undertaken to establish the completeness of turbinectomy and the presence of intranasal complications. Of these patients, 88% reported improvements in nasal obstruction and 50 to 78% of the patients who had experienced other troublesome nasal symptoms reported improvements in these. Primary hemorrhage occurred in two patients and during the early postoperative months three patients experienced crusting, three had spotty bleeding, and one had discomfort caused by increased airway patency. On examination nine patients had mild asymptomatic crusting, seven had incompletely resected turbinates, and 12 had intranasal adhesions. None had atrophic rhinitis.
The Pathogenetic Theories on Formation of Nasal Polyps
Authors: Tos Mirko
Published: September 2007

Various pathogenetic theories on polyp formation have been reviewed and critically analyzed. The authors’ theories have been discussed. It has been argued that demonstration of formation of mucosal edema and tissue pressure does not explain why the polyps arise in one particular place but not in another.
The Internal Carotid Artery as it Relates to Endonasal Sphenoethmoidectomy
Authors: Kennedy David W. , Zinreich S. James , Hassab Mohammed H.
Published: September 2007

A better understanding of the pathogenesis of chronic sinus disease has led to an increased performance of endonasal sphenoethmoid surgery. Approaching the sphenoid sinus via this route mandates that the surgeon be aware of the anomalies which may be encountered in this region, if injury to the related neurovascular structures is to be avoided. This study was therefore undertaken to evaluate a critical anatomic variation, the incidence of bony dehiscence over the carotid artery. Following cadaver sphenoethmoidectomy, the lateral wall of the sphenoid sinus was examined endoscopically and gently palpated in 188 sphenoid sinuses. An apparent dehiscence of bone was found over the carotid artery in 41 sinuses (22%), a significantly higher incidence than reported in other studies. In 3 specimens the carotid artery was exposed in the posterior ethmoid sinus. The study highlights the importance of considering this anatomic variation and of careful evaluation of the patient's computed tomographic scan, before this kind of surgery is attempted. Management of injury to the internal carotid artery in this area is also discussed.
Allergy and Fungal Screens in Chronic Sinusitis
Authors: Corey Jacquelynne P. , Bumsted Robert M. , Panje William R. , Shaw Gary Y. , Conley David
Published: September 2007

Thirty-three patients with chronic sinusitis severe enough to warrant surgery were prospectively screened for atopic disease and fungal sensitivity by history, total IgE levels, an allergen-specific IgE screen panel and fungal IgE levels. Total IgE was elevated in 10 of 31 patients measured. A positive “screen” panel (milk, Candida, house dust, white ash, timothy grass, ragweed) was noted in 57.5%. Fungal sensitivity to one or more of the following molds, Aspergillus, Mucor, Alternaria, Candida, Cladosporium, Penicillin notatum, Helminthosporium, or Curvularia, was noted in 51.5%. Seventeen patients had both positive atopic and fungal screens. All those with positive fungal screens also had positive atopic screens. The predictive value of allergy screens may be useful when the incidence in the population to be tested is 50% or greater. This study suggests that use of allergy screens and/or screens for fungal IgE may have a predictive value of 90% or greater with chronic sinus disease. Measurements of total IgE do not appear to add useful information and have a low predictive value as a test. Preliminary conclusions suggest that the incidence of atopy and elevated fungal IgE is high in patients with chronic sinusitis. Screens for allergies and fungal IgE may be useful to identify patients for further evaluation.
Anticholinergic Treatment of Watery Rhinorrhea
Authors: Mygind Niels , Borum Peter
Published: September 2007

When the anticholinergic drug ipratropium bromide is given as a nasal spray, it can reach the glandular cholinoceptors and block the secretory response to methacholine. Nine placebo-controlled clinical trials have shown that the treatment significantly reduces watery rhinorrhea in patients with perennial rhinitis not responsive to other types of treatment. To avoid a sensation of nasal dryness as a side effect from spraying, it is important in the individual patient to match the dosage to the severity of hypersecretion. Ipratropium has no effect on sneezing or on nasal blockage.
The Microenvironmental Differentiation Hypothesis of Airway Inflammation
Authors: Denburg Judah A. , Dolovich Jerry , Ohtoshi Takayuki , Cox Gerard , Gauldie Jack , Jordana Manel
Published: September 2007

We have observed clinically relevant increases and fluctuations in metachromatic cell and eosinophil progenitors in response to antigenic challenge in patients with upper and lower respiratory tract disease. Based on this we have developed in vitro models to assess cytokine and microenvironmental influences on nasal mucosal inflammation. Purified structural cells (nasal epithelial cells or fibroblasts) grown from nasal polyps and atopic or nonatopic inferior turbinate secrete known (GM-CSF, G-CSF, and IL-6) and possibly novel (basophil differentiation factor) hemopoietic cytokines capable of inducing neutrophil, monocyte-macrophage, eosinophil, and metachromatic cell differentiation, as well as influencing their activation and survival. Nasal polyp structural cells are phenotypically different from those derived from allergic rhinitis or normal control subjects, having increased proliferative potential and constitutively producing higher levels of cytokines and extracellular matrices capable of supporting cell growth. These studies emphasize the importance of microenvironmental influences on allergic and nonallergic airway inflammation, and point out potentially new approaches to the diagnosis and therapy of nasal polyposis, allergic rhinitis, and asthma.
Ciliary Activity of Nasal Polyp and Mucosa in Chronic Sinusitis
Authors: Saito Hitoshi , Tsubokawa Toshihito
Published: September 2007

Ciliary activity of mucosal cells of nasal polyps and the maxillary sinus mucosa in chronic sinusitis cultured in vitro were measured by a photoelectric method. The findings were compared with those of normal maxillary sinus and inferior turbinate mucosae. The ciliary beating of edematous type of nasal polyp, 955 ± 130 beats/min (mean ± SD), did not differ significantly from the normal control, whereas both the duration and rate of ciliary beating were significantly decreased with cystic and fibrous type polyps. Ciliary activity in chronic sinusitis was significantly inhibited in the order of fibrous, purulent, and edematous types. The total area of ciliated mucosa also was decreased and varied with the type of chronic sinusitis, showing the most marked decrease with fibrous type. The ciliary activity in chronic sinusitis showed impairment with respect to both decreased ciliary rate of beating and reduced ciliated area.
Combined Endoscopic Sinus Surgery and Aesthetic Rhinoplasty: A Pilot Study
Authors: Shemen Larry J. , Matarasso Alan
Published: September 2007

Traditionally, surgeons have avoided performing an aesthetic rhinoplasty in the presence of acute or chronic sinus disease. In most instances, the acute or chronic infection is first rectified through either medical or surgical treatment, after which the rhinoplasty is performed as a staged procedure. However, with the advent of endoscopic sinonasal surgery, this adage need not necessarily apply; the sinuses may be treated at the same time as the rhinoplasty without undue risk. Two patients requesting rhinoplasty presented with chronic sinusitis. Their clinical features, surgical treatment, and results are reviewed. Six additional patients with sinusitis undergoing endoscopic sinus surgery have had cosmetic procedures simultaneously performed with similar results. The benefits of the combined procedure are discussed.
Risk Factors in the Development of Acute Sinusitis in Immunocompromised Patients
Authors: Shaw Gary Y. , Panje William R. , Corey Jacquelynne P. , Kaminer Lynn A. , Scher Natan , Faust Robert
Published: September 2007

Twenty-six patients diagnosed as having hematologic neoplasms were evaluated clinically and radiographically for the presence of sinus disease before receiving immunosuppressive therapy. Evaluations included basic clinical information, a thorough otolaryngologic history and endoscopic examination of the nasal cavity. Plain sinus films and paranasal sinus computed tomography (CT) scans were obtained on all patients. These patients were then followed for 1 year. Ten patients ultimately developed acute sinusitis, as documented by their symptoms and by CT scan: five of these patients required surgery, and three ultimately died. Potential risk factors for sinusitis were analyzed statistically. We found a significant correlation between preimmunosuppression CT scans indicating either chronic sinusitis or anatomic abnormalities and the development of sinusitis. Also multiple anatomic abnormalities on endoscopic diagnostic nasal examinations tended to identify individuals susceptible to sinusitis. Such patients who subsequently became neutropenic and had acute episodes of sinusitis tended to have a poor outcome. Those who developed fungal sinus infections were prone to have a fatal outcome. This study suggests that patients with hematologic neoplasms who are susceptible to the development of acute sinusitis should be identified before receiving immunosuppressive chemotherapy.
Comparison of Subjective and Objective Nasal Patency before and after Decongestion of the Nasal Mucosa
Authors: Naito Kensei , Cole Philip , Humphrey Donna
Published: September 2007

In an attempt to determine whether human subjects can sense acute change of nasal patency, we compared measured values of nasal resistance with degree of subjective sensation of nasal stuffiness before and after decongestion of the nasal mucosa in 86 adult patients referred to our laboratory for objective assessment of nasal patency.

Only half the subjects recognized the change of sensation appropriately. Moreover, in these subjects the degree of subjective change after decongestion was poorly correlated with reduction of nasal resistance. The remaining subjects were unaware of any change although nasal resistance values were reduced significantly after decongestion of the nasal mucosa.
Uses and Misuses of Intranasal Corticosteroids and Cromolyn
Authors: Mabry Richard L.
Published: September 2007

Corticosteroids modulate the effect of the allergic event but do not prevent mast cell degranulation and the release of vasoactive kinins. Cromolyn, on the other hand, prevents such reactions from occurring. Confusion still exists in the minds of many physicians as to when and how each of these treatment modalities should be used in the management of allergic rhinitis.

Cromolyn should be a first-line drug for allergic rhinitis because of its safety, effectiveness, specificity, and the protective mechanism against acute challenges. Aerosol nasal corticosteroids are more nonspecific and thus can be helpful in situations where other factors such as rebound rhinitis and rhinitis of pregnancy coexist with nasal allergy. However, the local effects and potential systemic absorption of nasal corticosteroids must be considered.

Both cromolyn and nasal corticosteroid aerosols are important tools in the management of allergic rhinitis, but they must be properly employed for maximum effectiveness.
Immunologic Evaluation of Nasal Polyps
Authors: Yaremchuk Kathleen , McCullough Judith , Ownby Dennis R.
Published: September 2007

Forty-seven patients undergoing nasal polypectomy and 27 adult tonsillectomy patients were studied regarding history of allergy, duration of symptoms, and previous polypectomies. At surgery, samples of serum, tissues, and nasal washes were obtained for evaluation of total and allergen-specific IgE.

Serum IgE levels were not significantly higher in polypectomy patients. The IgE/mg of protein was significantly greater in polyp than tonsil tissue. Allergen-specific IgE levels did not differ in polyp and tonsil patients, nor was bacterial specific IgE detected in polyp patients. Allergen-specific IgG4 levels and the ratios of specific IgG4 to specific IgE did not differ between the patient groups.
Cefixime for Treatment of Maxillary Sinusitis
Authors: Fiscella Richard G. , Chow James M.
Published: September 2007

We evaluated cefixime versus amoxicillin in the treatment of acute or acute exacerbations of chronic maxillary sinusitis in adults. Cefixime 400 mg once daily produced favorable clinical responses in patients compared with amoxicillin 500 mg three times daily. Cefixime appears to be well tolerated with few side effects reported by patients.
Comparison of Accuracy of CT and Routine Radiography in Chronic Hyperplastic Rhinosinusitis
Authors: Katsantonis George P. , Maas Corey , Cusumano Joe , Friedman William H.
Published: September 2007

In this retrospective study, the computer tomographic scans (CT) and routine sinus x-rays of 57 patients with chronic hyperplastic rhinosinusitis who subsequently underwent surgical intervention were reviewed by the otolaryngologist and the radiologist. The diagnostic accuracy of these modalities for each sinus (maxillary, ethmoid, sphenoid, and frontal) were determined by comparison with the operative findings and histopathology. The diagnostic accuracy of CT for the maxillary, ethmoid, sphenoid, and frontal sinuses approached 100%. The diagnostic accuracy of conventional radiographs was 85.59% for the maxillary, 86.84% for the sphenoid, 84.84% for the frontal, and 60.57% for the ethmoid sinuses. The accuracy of routine x-rays for ethmoid sinus disease was even lower when only partial or “patchy” involvement was present. We discuss the importance of CT scans in diagnosing early stages of sinusitis.
Teratoid Carcinosarcoma of the Nasal and Paranasal Cavities: A Case Report
Authors: Christensen Eric C. , Fu Yao Shi , Wilson Lori J. , Hoover Larry A.
Published: September 2007

We report on a patient with a teratoid carcinosarcoma of the lateral nasal wall with extension into the paranasal sinuses. This exceedingly rare tumor is characterized by a combination of malignant epithelial and atypical mesenchymal cells showing aggressive features with invasion of soft tissue and bone. The patient in this report was treated with a neurosurgical and midface approach combined with postoperative radiation.
Endoscopic Intranasal Ethmoidectomy Complicated by CSF Rhinorrhea and Maxillary Sinus Encephalocele
Authors: Kane William J. , Olsen Kerry D. , Ebersold Michael J.
Published: September 2007

Intranasal sphenoethmoidectomy is one of the most frequently performed operations in otorhinolaryngology. Surgical indications and techniques have evolved with advances in medical technology. Clinical reports describing complications relating to sphenoethmoidectomy, either by traditional or endoscopic technique, have elucidated the potentially dangerous nature of this procedure.1–6 Intraoperative complications are avoided through a detailed knowledge of anatomy and a technique guided by structural landmarks. We present a case of sphenoethmoidectomy complicated by cerebrospinal fluid (CSF) rhinorrhea and a nasal encephalocele.
Massive and Multiple Posttraumatic Nasal and Frontal Sinus Mucoceles
Authors: Klausner Robert D. , Bolger William E. , Kennedy David W.
Published: September 2007

Canalis et al. in 19781 defined the term mucocele as “a chronic, expansile, cyst-like lesion of the paranasal sinuses which contains sterile, mucoid secretions and is limited by the mucosa of the affected cavity.” The lesions are lined by pseudostratified low columnar epithelium containing goblet cells. Typically they expand slowly and concentrically and may take many years before they become symptomatic. As they expand, bony erosion occurs, and they can extend outside of their sinus of origin. The location and extent of bony erosion thus determines the clinical findings associated with the mucocele.
Sinus Disease in the Immunocompromised Host
Authors: Kohan Darius , Skorina Jane-Marie G. , Jacobs Joseph B. , Lebowitz Arthur , Rothstein Stephen G.
Published: September 2007

Sinusitis in the immunocompromised person can be a fulminant or even fatal illness. Aggressive treatment with intravenous antibiotics and surgery is often warranted. We report 13 cases of sinusitis in immunocompromised patients who, having failed medical treatment, required surgical management of their sinus disease. Among the patients whose sinuses were cultured intraoperatively, 63% grew Staphylococcus aureus. Most of the patients showed improvement in their infections, and none had complications of surgery.
The Effect of Nose Drops on an Acute Sinusitis: An Experimental Study in the Rabbit
Authors: Bende Mats , ÅKerlund Anders , Intaglietta Marcos , Arfors Karl E.
Published: September 2007

An animal model was developed to study the effect of nose drops on an acute sinusitis. Leukocyte-stimulating n-formylmethionyl-leucyl-phenylalanine (FMLP) was added to polyvinyl sponges and placed bilaterally into the maxillary sinuses of the rabbit. Oxymetazoline nose drops were applied in one nasal cavity, on the contralateral side, using the application of saline as control. After 2 hours, the animals were killed, and the sponges were removed for analysis of leukocyte content by light microscopy and determination of myeloperoxidase (MPO), an intracellular enzyme in polymorphonuclear leukocytes. The sinus mucosa was dissected bilaterally and prepared for whole-amount light microscopy. There was a reduced number of leukocytes in the sinus mucosa on the side treated with oxymetazoline nose drops compared with the contralateral side. No significant differences were found in the number of leukocytes or MPO in the sponges. The effect of oxymetazoline may be due to its blood-flow-reducing effect or an effect on the endothelium in the microvascular bed.
Scedosporium Apiospermum: Fungal Sinusitis in an Immunocompetent Patient
Authors: Terris David J. , Steiniger Joseph R.
Published: September 2007

Scedosporium apiospermum (also known as Pseudallescheria boydii) is a well-recognized cause of mycetoma and, more recently, pulmonary fungomas. We describe the sixth occurrence of S. apiospermum sinusitis in an otherwise healthy adult. This patient is unique in her history of invasive fungal disease. She initially underwent transseptal sphenoidotomy for presumed aspergillosis and had no other therapy. She did well but 14 months later developed recurrent symptoms. Examination revealed fungal mycelium protruding through the surgically enlarged sphenoid ostium. An endoscopic approach was used to remove the fungoma and strip the sphenoid mucosa. Cultures grew S. apiospermum as well as Serratia liquefasciens. No invasion was seen on pathology. Postoperatively, the patient received ciprofloxacin. This patient has been observed for 11 months and shows no evidence of infection. Previous approaches to treatment have included primarily surgical debridement. Antifungal chemotherapy has been added only to patients who clearly demonstrated invasion or patients with immune compromise. This represents the first report of this pathogen in which an endoscopic approach was used.
Rhinitis, Sinusitis, and Their Relationships to Allergies
Authors: Benninger Michael S.
Published: September 2007

To investigate the relationship between allergic rhinitis and sinusitis, a review of all patients seen at an outpatient suburban otolaryngology clinic was performed. Three hundred ninety-three of the 1846 (21.3%) new patients seen over an 18-month period presented with nasal complaints. Ninety-two patients had documented allergy associated rhinitis. Thirty-seven patients had strong allergic histories without allergy testing. Two thirds had worsening nasal-sinus symptoms with allergen exposure; 82% of those with seasonal symptoms noted such a relationship compared with 32% of those with nonseasonal symptoms. There was 100% correlation of the onset of acute sinusitis with worsening allergies in the allergic group, although patients with chronic sinusitis and allergies noted worsening of sinusitis with allergen exposure in only 50%. Hyposmia/anosmia or asthma were good predictors of allergies in patients presenting with nasal or sinus complaints. Sixty percent of the confirmed allergic patients responded well to medical management alone. Patients with chronic sinusitis, with or without nasal polyps, tended to respond more poorly than did the entire group to medical management alone but did better with surgical therapy.
111Indium-Labeled White Blood Cell Scan in Diagnosis of Occult Sinus Infection
Authors: Lalwani Anil K. , Chang Ching-Yen J. , Lalwani Rene B.
Published: September 2007

111Indium-labeled white blood scan is a highly sensitive imaging technique using radiolabeled leukocytes in the detection of occult infection. We present two cases of occult sinusitis identified with the use of the white blood cell scan. The literature on the subject is reviewed, and indications for the use of white blood cell scans in the detection of sinusitis are discussed.
An Assessment of Radiologic Discrepancies in Patients with Paranasal Sinus Disease
Authors: Mann Wolf J. , Amedee Ronald G. , Jemma Maurizio
Published: September 2007

The importance of computerized tomographic (CT) imaging of the paranasal sinuses in patients with chronic or recurring sinusitis is well documented. Nevertheless, the accuracy and reliability of this examination is not absolute. In this study of 80 cases, a considerable percentage of CT scans (57.5%) failed to detail accurately the extent of pathology in the sinus cavities. In 39 cases the extent of disease was underestimated using CT, and in seven cases it was overestimated. Discrepancies in pathology were encountered most commonly in the posterior ethmoid sinus. In our opinion, the primary role of CT in the assessment of patients with paranasal sinus disease is to detail precisely the complicated anatomy of this region. This radiologic information along with a thorough understanding of the lateral nasal wall anatomy should allow the surgeon to perform functional procedures and, at the same time, to avoid injury to important adjacent structures.
Anesthetic Choice for Functional Endoscopic Sinus Surgery
Authors: Fornadley John A. , Kennedy Kevin S. , Wilson Joseph F. , Galantich Peter T. , Parker Gregg S.
Published: September 2007

Controversy continues concerning the optimal anesthetic technique when completing endoscopic sinus surgery. To attempt to investigate the results using different anesthetic techniques, experience with endoscopic sinus surgery over 12 months (233 cases) was retrospectively reviewed. The use of local anesthetic injection with or without regional blocks (specifically ethmoid and greater palatine) was evaluated, as was the choice of general anesthesia versus local technique in a context of blood loss, patient comfort, and complications. Regional block technique appears to add morbidity for little additional benefit. Endoscopic sinus surgery may be performed safely in appropriately selected patients using either general anesthesia or local infiltration with sedation.
Atypical Facial Neuralgia Associated with Pleomorphic Adenoma of the Nasal Septum: A Clinical Review
Authors: Roth Yehudah , Creter Doras , Horowitz Ada , Tadmor Rina , Kronenberg Jona
Published: September 2007

A clinical review of pleomorphic adenoma of the nasal septum is presented and coincidental atypical facial neuralgia is reported.
Rheologic Properties of Nasal Mucus from Patients with Chronic Sinusitis
Authors: Majima Yuichi , Sakakura Yasuo , Hattor Masahiko , Hirata Keisuke
Published: September 2007

The rheologic properties of nasal mucus from the patients with chronic sinusitis was determined by the oscillating sphere magnetic rheometer. The increase in the elastic modulus (G’) and the decrease in the dynamic viscosity (η’) of mucoid and mucopurulent nasal mucus indicate that both types of nasal mucus possess the network of transient cross-links between macromolecules. The G’ and the η’ of 12 mucopurulent nasal mucus was significantly high compared with those of 13 mucoid mucus (p < 0.01), and those of mucopurulent mucus were out of the optimal range for mucociliary transport. Results suggest that abnormally high viscoelasticity of nasal mucus is one of the causes of reduced nasal mucociliary clearance in chronic sinusitis.
Sarcoidosis Presenting as Nasal Obstruction
Authors: Shikowitz Mark J. , Alvi Aijaz
Published: September 2007

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. The histology of this disease was first reported by Boeck in 1899. Since that time many reports of multiple organ involvement have been published. Symptoms relating to the upper respiratory tract are not uncommon. Nasal obstruction as the presenting and primary complaint in sarcoidosis however is a rare but important symptom as it may lead to the diagnosis of this treatable disease. We present three patients whose initial complaint of progressive nasal obstruction heralded the diagnosis of sarcoidosis upon further workup. The clinical presentation, diagnostic workup, histology, and management of nasal sarcoidosis are discussed.
Evaluation of a Test for Objective Diagnosis of Nonallergic Nasal Hyperreactivity
Authors: Hallén Hans C. , Juto Jan E.
Published: September 2007

A model for objective diagnosis of nonallergic nasal hyperreactivity has previously been reported. In that study rhinostereometry was used to record the nasal mucosal congestion during challenge with histamine in healthy subjects and in patients with nonallergic nasal hyperreactivity. The aim of this study is to record and compare the nasal mucosal response with histamine challenge, in terms of congestion, in patients with nonallergic nasal hyperreactivity suffering from different main symptoms (sneezing, blockage, or enhanced secretion). Eleven women and seven men entered the trial. The patients were divided into three categories, sneezers, blockers, and runners. The nasal mucosal congestion during challenge with histamine was recorded with rhinostereometry and the results from each category were compared with each other. There is an increasing mucosal congestion during the challenge without significant difference between the three categories. The results suggest that the model can be useful as a method for objective diagnosis of nonallergic nasal hyperreactivity independent of main symptoms.
Antigen-Specific IgE Antibody and Cytogram in Mucosa of the Nose and Sinus
Authors: Liu Chia-Ming , Shun Chia-Tung , Song Hue-Ching , Lee Shiann-Yann , Hsu Mow-Ming , How Shu-Wen
Published: September 2007

Maxillary sinus mucosa from sinusitis patients (n = 60) and nasal mucosa from the inferior turbinates of hypertrophic rhinitis patients (n = 31) were collected to detect the appearance of tissue dust mite-specific IgE antibody and increase in eosinophils, mast cells, and plasma cells. The serum levels of total IgE and dust mite-specific IgE antibody were significantly greater in atopic patients than in nonatopic patients, whereas tissue specific IgE antibody was elevated in turbinate mucosa but not in sinus mucosa. Eosinophils and basophilic cells in epithelial scrapings from the inferior turbinates, assessed by Hansel stain, increased in about 85% of atopic patients with hypertrophic rhinitis (n = 16) and 60% of atopic patients with chronic sinusitis (n = 12). The increase in eosinophils, mast cells, and plasma cells was more prevalent in the turbinate mucosa of atopic patients than in that of nonatopics, but there was no such increase in sinus mucosa. We conclude that the maxillary sinuses may not be the target organ of type I allergic reaction and antigen-specific IgE antibody is probably produced by the local lymphoid tissue.
Two-Year follow-up after Limited Anterior Functional Endoscopic Sinus Surgery (FESS)
Authors: Austin Mitchell B. , Hicks Julius N.
Published: September 2007

This paper describes clinical outcomes in patients who underwent FESS. The subjects included 64 patients with chronic sinusitis, ranging in age from 11 to 66 years. A total of 44 (68%) underwent bilateral FESS, 16 (25%) underwent unilateral FESS, and 4 (7%) had anterior-posterior removal of tissue. No major complications occurred and minor complications occurred in eight patients (12.3%). At 6 months follow-up, 86% of 57 patients were better, 12% were unchanged, and one patient (1.7%) was worse. After 2 years, 80% of 31 patients available for follow-up were better. The three main complaints of sinus disease in these patients were nasal airflow obstruction, chronic pain, and nasal discharge. Of these symptoms, nasal discharge was the most difficult to reverse. The results of this investigation suggest that limited surgery of the sinuses is efficacious.
Once- versus Twice-Daily Fluticasone Propionate Aqueous Nasal Spray for Seasonal Allergic Rhinitis
Authors: Dockhorn Robert J. , Paull Barry R. , Meltzer Eli O. , van As Andre , Weakley Suzanne , Woehler Thomas R. , Krai Kenneth M. , Rogenes Paula R.
Published: September 2007

A new potent topical corticosteroid, fluticasone propionate aqueous nasal spray, has proved effective when administered twice daily for seasonal allergic rhinitis. The purpose of this study was to compare the efficacy and safety of a once-daily dosage with twice-daily administration of fluticasone propionate. A multicenter, double-blind, randomized, placebo-controlled study was conducted in adults with moderate to severe symptoms of allergic rhinitis during the autumn pollen season. Patients were treated for 4 weeks with fluticasone propionate aqueous nasal spray, 200 μg once daily or 100 μg twice daily or matching placebo. Fluticasone propionate administered once daily in the morning was as effective as the twice-daily dosage regimen, and both regimens were more effective than placebo. Nasal symptoms were improved by the second day of treatment and continued to improve throughout the study. Nasal eosinophils were reduced in more patients treated with either regimen of fluticasone propionate compared with placebo. Adverse events were similar in frequency and nature in all three groups. There was no evidence of hypothalamicpituitary-adrenal axis effects; mean morning plasma cortisol concentrations and response to cosyntropin stimulation remained within normal ranges and were similar across groups. We conclude that fluticasone propionate aqueous nasal spray administered once daily is safe and as effective as a twice-daily dosage regimen for treating seasonal allergic rhinitis.
Microscopic Endonasal Surgery for Repair of CSF Leaks
Authors: Amedee Ronald G. , Mann Wolf J. , Gilsbach Joachim
Published: September 2007

This manuscript will detail our experience using a microscopic endonasal surgery (MES) approach in the repair of spontaneous, traumatic, and/or iatrogenic cerebrospinal fluid (CSF) fistula into the ethmoid and sphenoid sinuses. The location of the fistula in 22 patients was determined by a direct endoscopic or microscopic visualization, intrathecal fluorescein, or computed tomography (CT) with metrizamide. Several of these patients had been treated unsuccessfully with previous neurosurgical, intracranial, and extracranial approaches to stop the leak. The CSF fistulas in all these patients were repaired with a MES approach, packing the leak with either a septal mucosal graft, or abdominal fat and fascia, and no external incisions were utilized. Furthermore, this approach allowed for an overall closure rate of 95% and offered a direct means to locate the fistula at the time of surgery. It also allowed for precise placement of grafts to cover the defect, an opportunity to perform bimanual dissection, and in general afforded an excellent field of vision.
The Efficacy of Turbinate Surgery for the Relief of Nasal Obstruction
Authors: Kimmelman Charles P. , Jablonski Robert D.
Published: September 2007

To study the role of turbinate surgery 60 consecutive patients complaining of nasal airway obstruction were evaluated. All patients had a deviated nasal septum and turbinate hypertrophy and had received medical therapy of at least 8 weeks duration. Plain x-rays or computerized tomography scans of the paranasal sinuses excluded sinusitis. Each patient was randomized into one of three groups. Group I underwent septoplasty for correction of the deviated nasal septum. Group II underwent bilateral anterior turbinectomy, and Group III underwent both septoplasty and bilateral anterior turbinectomy. All patients were evaluated preoperatively and on at least one postoperative visit for their subjective perception of improvement or worsening of nasal obstruction. Likewise, all patients underwent anterior rhinomanometry preoperatively and postoperatively. The data revealed no significant difference in reduction of the nasal airway resistance as measured by rhinomanometry for Groups I and II. The patients’ own perceptions of improvement, however, were augmented when turbinectomy was performed (Groups II and III). We conclude that anterior turbinectomy is a useful operation in alleviating the sense of nasal obstruction in patients with hypertrophied inferior turbinates.