bluuebunny/crossref_metadata_2025 huggingface dataset:
Up-Regulation of Heparanase in the Ethmoid Sinus Mucosa of Patients with Chronic Sinusitis
Authors: Kim Tae Hoon , Lee Heung Man , Lee Seung Hoon , Choi Whan , Kim Ha Kyun , Lee Jung Hoon , Oh Kyoung Ho , Lee Sang Hag
Published: February 2010

Background

Heparanase (HPA) is known to be involved in tissue remodeling of various organs with inflammatory diseases. The aim of this study was to investigate the level of expression and the pattern of distribution of HPA in normal human sinus mucosa, inflammatory sinus mucosa, and nasal polyps to evaluate the possible effect of HPA on the tissue remodeling of chronic inflammatory sinus mucosa and nasal polyps.

Methods

Normal sinus mucosa was obtained from the ethmoid sinus during endoscopic reduction in 25 patients with blowout fractures. Inflammatory sinus mucosa and nasal polyps were obtained from 25 patients undergoing endoscopic sinus surgery for chronic sinusitis with nasal polyps. The levels of expression and the pattern of distribution of HPA were evaluated in normal human sinus mucosa, inflammatory sinus mucosa, and nasal polyps, using reverse transcriptase-polymerase chain reaction, immunohistochemical analysis, and Western blot analysis.

Results

HPA mRNA and protein were detected in inflammatory sinus mucosa and nasal polyps but not in normal sinus mucosa. HPA was mainly localized in the vascular endothelium, epithelium, submucosal glands, and inflammatory cells of inflammatory sinus mucosa. In nasal polyps, inflammatory cells and vascular endothelium showed immunopositivity in the entire portion, whereas glands and epithelial cells did not show positivity.

Conclusion

Our results indicate that HPA is not constitutively expressed in normal sinus mucosa and is upregulated in chronic inflammatory sinus mucosa and nasal polyps, suggesting that HPA may play an important role in the tissue remodeling in chronic sinusitis.
Endoscopic Endonasal Repair of Difficult-To-Access Cerebrospinal Fluid Leaks of the Frontal Sinus
Authors: Becker Samuel S. , Duncavage James A. , Russell Paul T.
Published: February 2010

Background

Cerebrospinal fluid (CSF) leaks located within the frontal sinus can be difficult to repair effectively. Additional challenges arise from the need to simultaneously repair the leak or defect and to ensure the future patency of the sinus itself.

Methods

The cases of two patients who underwent surgical repair of CSF leaks and skull base defects located in difficult to access locations within their frontal sinuses were reviewed.

Results

Two patients with CSF leaks in the frontal sinus underwent surgery to repair the leaks. The leaks were in the superomedial and superolateral locations within the sinus. One leak (in the superolateral location) was secondary to iatrogenic surgical trauma during craniotomy. The second leak (in the superomedial location) was secondary to congenital encephalocele. Surgical approach to ensure adequate exposure was via endoscopic modified Lothrop procedure. Successful repair was undertaken via underlay technique. At follow-up (27 and 7 months, respectively), frontal sinuses remained patent without evidence of CSF leak.

Conclusion

CSF leaks located in medial and lateral areas of the frontal sinus may be successfully repaired via endonasal approach with endoscopic modified Lothrop. Repair in this manner requires that attention be paid both to achieving a complete repair and to maintaining a patent sinus drainage pathway.
Endoscopic Ligation of the Sphenopalatine Artery and the Maxillary Artery for the Treatment of Intractable Posterior Epistaxis
Authors: Seno Satoshi , Arikata Masahiko , Sakurai Hironori , Owaki Shigehiro , Fukui Jun , Suzuki Mikio , Shimizu Takeshi
Published: February 2010

Background

Intractable posterior epistaxis sometimes requires intensive treatment, such as surgery or embolization. Maxillary artery ligation has been widely used for the treatment of intractable posterior epistaxis. It is highly effective, but significant complications may occur, including an oroantral fistula and damage to the infraorbital nerve. Embolization is less invasive and can be performed in poor surgical candidates. However, it has more serious complications, such as facial nerve paralysis and hemiplegia. This investigation evaluates the effectiveness and complications of endoscopic ligation of the sphenopalatine or maxillary artery for the treatment of intractable posterior epistaxis.

Methods

Between April 2003 and March 2007, 46 patients were hospitalized for the treatment of severe posterior epistaxis in our University Hospital. Thirty patients were successfully treated by anterior and/or posterior nasal packing, and five patients were treated by electrocoagulation. Endoscopic ligation was performed under general anesthesia in 11 patients (6 men and 5 women; age range, 50-80 years).

Results

Eight patients underwent endoscopic ligation of the sphenopalatine artery, and three patients underwent endoscopic ligation of the maxillary artery through the middle meatus and posterior antral wall opening. There were no complications, and the patients’ postoperative courses were uneventful. Recurrent epistaxis occurred in one patient on oral anticoagulants 15 months after ligation of the sphenopalatine artery, and it was successfully treated by anterior nasal packing.

Conclusion

Endoscopic ligation of the sphenopalatine or maxillary artery is safer than arterial embolization and is less invasive than transantral ligation of the maxillary artery. This technique appears to be a simple and highly effective surgical treatment for patients with intractable posterior epistaxis.
Minitrephination of the Frontal Sinus: Indications and uses in Today's Era of Sinus Surgery
Authors: Seiberling Kristin , Jardeleza Camille , Wormald Peter-John
Published: February 2010

Background

This study reviews the role of frontal sinus minitrephination in today's era of endoscopic sinus surgery. Retrospective chart review was performed of 163 patients undergoing a total of 149 bilateral and 39 unilateral frontal sinus minitrephinations.

Methods

Charts were reviewed for patient demographics and outcomes. Details obtained from the chart included type of surgery performed, reason for minitrephine placement, pathology, Lund score, complications, and endoscopic patency.

Results

One hundred eighty-eight minitrephines were placed during 80 modified Lothrop and 108 frontal sinusotomies. Trephines were placed when there was difficulty finding the frontal recess, severe edema/polyps, obstructing frontal cells (type 3/type 4 frontoethmoidal cells and intersinus septum cell), and to aid the dissection and postoperative irrigation during the modified Lothrop. Twelve complications occurred with infection at the trephine site being the most common. Follow-up ranged from 2 to 122 months (average, 25.5 months) with 92% showing endoscopic patency at last visit.

Conclusion

Frontal sinus trephination is a safe useful procedure that can be extremely helpful in identifying the pathway to the frontal sinus. Fluorescein flushes through the trephine help guide the dissection in a modified Lothrop. Lastly, it may be used in the postoperative period to flush the sinus with saline and steroids to promote patency of the frontal sinus.
Do Single-Photon Emission Computerized Tomography Findings Predict Severity of Chronic Rhinosinusitis: A Pilot Study
Authors: Saylam Güleser , Gorgülü Orhan , Korkmaz Hakan , Dursun Engin , Ortapamuk Hülya , Eryilmaz Adil
Published: February 2010

Background

Chronic rhinosinusitis (CRS) is basically an inflammatory disease of the mucosa and periosteum of the sinuses. The possibility of local osteitis can cause persistent mucosal inflammation and lead to failure of treatment. Bone scintigraphy is the gold standard procedure for detecting the bone involvement. This study was designed to evaluate whether single-photon emission computerized tomography (SPECT) findings predict severity of chronic sinusitis and subjective response to medical treatment. A prospective case control study was done.

Methods

Twenty-four patients with CRS were involved. SPECT findings for bone involvement and computed tomography-based staging (limited disease, stage 1; extensive disease, stages 2 and 3) were compared. These data were also analyzed in terms of subjective response to medical treatment and prognosis.

Results

SPECT uptakes were positive in 79.2% (19/24) and negative in 20.8% (5/24) of the patients. SPECT was positive in 4/8 of the patients with limited disease and 15/16 of the patients with extensive disease. In subjective assessment of medical treatment 5/8 of the limited disease versus 1/16 the extensive disease patients had good response; whereas 5/5 of SPECT− patients versus 1/19 of SPECT+ patients had good response.

Conclusion

Bone SPECT results were found to be correlated with the stage of CRS. Poorer subjective response was observed in patients with positive SPECT.
Contribution of Nasal Biopsy to Leprosy Diagnosis
Authors: Naves Marcell Melo , Patrocinio Lucas Gomes , Patrocinio José Antonio , Naves Mota Flávia Marques , De Souza Antônio Diniz , Fleury Raul Negrão , Bernardes Goulart Isabela Maria
Published: February 2010

Background

The nasal mucosa plays the main role as the entry and the exit of leprosy bacilli and the nasal involvement may precede the skin lesions by several years. Nasal biopsy has been used in research but its clinical application has not been described. We evaluated the contribution of the nasal biopsy for the diagnosis of leprosy and its correlation to skin biopsy and skin smear in untreated patients.

Methods

We evaluated changes in nasal biopsy in 227 leprosy patients. Patients were clinically classified and skin and nasal biopsies and skin smear were performed.

Results

Nasal biopsy showed positivity in 100% of the lepromatous spectrum decreasing toward the tuberculoid (TT) pole. Patients with TT or indeterminate forms did not present any nasal alterations, showing that they are the true paucibacillary forms. Also, the nasal biopsies of two patients were the only exam to show positivity. The bacillary index of the nasal biopsy was strongly correlated to skin biopsy and slit-skin smear. Additionally, the agreement among the exams was good, revealing the reliability of the nasal biopsy in leprosy diagnosis.

Conclusion

The present study showed a rate of 48% of positivity in nasal biopsy of untreated patients, correlating well with skin biopsy and skin smear. Thus, the method in leprosy diagnosis and clinical form classification has shown great reliability.
Influence of the Turbinate Volumes as Measured by Magnetic Resonance Imaging on Nasal Air Conditioning
Authors: Lindemann Joerg , Tsakiropoulou Evangelia , Vital Victor , Keck Tilman , Leiacker Richard , Pauls Sandra , Wacke Florian , Wiesmiller Kerstin M.
Published: February 2010

Background

Changes in nasal airflow caused by varying intranasal volumes and cross-sectional areas affect the contact between air and surrounding mucosa entailing alterations in nasal air conditioning. This study evaluates the correlation between nasal air conditioning and the volumes of the inferior and middle turbinates as measured by magnetic resonance imaging (MRI).

Methods

Fourteen healthy volunteers were enrolled. Each volunteer had been examined by rhinomanometry, acoustic rhinometry, intranasal air temperature, and humidity measurements at defined intranasal sites as well as MRI of the nasal cavity and the paranasal sinuses. The volumetric data of the turbinates was based on the volumetric software Amira.

Results

Comparable results were obtained regarding absolute humidity values and temperature values within the nasal valve area and middle turbinate area for both the right and the left side of the nasal cavity. No statistically significant differences were found in the rhinomanometric values and the acoustic rhinometry results of both sides (p > 0.05). No statistical correlations were found between the volumes of the inferior (mean, 6.1 cm3) and middle turbinate (mean, 1.8 cm3) and the corresponding humidity and temperature values. Additionally, the air temperature and humidity values did not correlate with the rhinometrical endonasal volumes (0–20 mm and 20–50 mm from the nasal entrance).

Conclusion

The normal range of volumes of the inferior and middle turbinate does not seem to have a significant impact on intranasal air conditioning in healthy subjects. The exact limits where alterations of the turbinate volume negatively affect nasal air conditioning are still unknown.
Current Management of Juvenile Nasopharyngeal Angiofibroma: A Tertiary Center Experience 1999–2007
Authors: Bleier Benjamin S. , Kennedy David W. , Palmer James N. , Chiu Alexander G. , Bloom Jason D. , O'Malley Bert W.
Published: February 2010

Background

Over the past 10 years, the management of juvenile nasopharyngeal angiofibroma (JNA) has been redefined because of the improvement of transnasal skull base techniques. However, the limits of endoscopic resection still have to be fully defined. The purpose of this study was to report on a series of patients presenting with JNA in an effort to further define an optimal treatment algorithm and improve outcomes.

Methods

A retrospective review was performed of 18 patients presenting to a tertiary care institution with JNA from 1999 to 2007. Patients were categorized by Andrews stage and data were collected on presentation, operative technique, and postoperative course.

Results

All patients underwent preoperative embolization. Stages 1, 2, and one 3a lesions were approached endoscopically while the remainder underwent open resection. In the endoscopic group the intraoperative blood loss was almost half that of the open group (506 versus 934 mL) and the average hospital stay was 1 day less (3 vs. 4 days).

Conclusion

Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and a shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection.
Indications for External Frontal Sinus Procedures for Inflammatory Sinus Disease
Authors: Hahn Samuel , Palmer James N. , Purkey Michael T. , Kennedy David W. , Chiu Alexander G.
Published: February 2010

Background

In the modern age of endoscopic sinus surgery (ESS), there is an undefined role for external approaches in the treatment of inflammatory disease. This study examines the frontal sinus surgery practices of three experienced rhinologists with a focus on those who underwent an external approach. Our goal was to characterize these patients and propose indications for the use of an external approach alone or in combination with functional ESS (FESS) for frontal sinus inflammatory disease.

Methods

A retrospective review was performed of frontal sinus procedures performed for inflammatory disease at one institution from 2004 to 2007.

Results

Seven hundred seventeen procedures were performed, 38 (5.3%) of which were external alone (14 procedures) or in combination with FESS (24 procedures). Osteoplastic flap with obliteration (12/14) made up the majority of external alone procedures and the most common indication was neo-osteogenesis of the frontal recess. Trephination was the most common external adjunct to FESS (12/24), and often was performed for type 3 frontal recess cells or in the initial management of acute frontal bone osteomyelitis (FOM). Twenty-eight of 38 (74%) patients had a history of previous surgery. Of the 10 patients with no history of previous surgery, 6 (60%) had an external adjunct for frontal recess neo-osteogenesis. There were no major complications but 9/38 (23.7%) patients required revision surgery for persistent/recurrent symptoms.

Conclusion

External approaches alone and in combination with FESS are predominantly secondary to neo-osteogenesis of the frontal recess. Factors associated with neo-osteogenesis include previous trauma, endoscopic surgery, and FOM. External frontal sinus surgery provides adequate management of inflammatory disease but has a high revision rate.
Efficacy of Targeted Medical Therapy in Chronic Rhinosinusitis, and Predictors of Failure
Authors: Lal Devyani , Scianna Joseph M. , Stankiewicz James A.
Published: February 2010

Background

No standardized medical therapy for chronic rhinosinusitis (CRS) is universally accepted. Success of medical therapy is reportedly 50% to 88%, but studies differ in inclusion criteria, medications, duration of therapy, and defining “success.” The objectives of this study were to determine efficacy of a standardized targeted medical therapy (TMT) regimen in CRS and to analyze factors associated with failure of therapy.

Methods

Retrospective analysis of prospectively collected data was performed. CRS was diagnosed based on CRS Taskforce guidelines. TMT was defined as a minimum 4-week treatment with oral antibiotics, oral steroids, topical nasal steroids, topical nasal decongestant rotation, and saline nasal douching. “Failure” was defined as relapse/persistence of signs/symptoms or need for surgery. One hundred forty-five patients that received TMT, with a minimum 2-month follow-up, were identified. The results of therapy were reviewed to determine efficacy and analyze factors associated with failure.

Results

Seventy-four patients (51.03%) were successfully treated. Failures included 26 patients (17.8%) with only partial improvement and 45 (31.03%) who underwent surgery. Only history of facial pressure/pain (p = 0.049), presence of mucosal inflammation (p = 0.013), and higher endoscopic severity grade (p = 0.011) were associated with failure of TMT.

Conclusions

TMT was unequivocally successful in 51% of patients. Failures included 31% who underwent surgery and 18% with partial benefit. Surgery was avoided in 69%. Facial pressure/pain, mucosal inflammation, and higher endoscopic severity grade were associated with failure of medical therapy.
Overexpression of the Superoxide Anion and NADPH Oxidase Isoforms 1 and 4 (NOX1 and NOX4) in Allergic Nasal Mucosa
Authors: Moon Joon Hwan , Kim Tae Hoon , Lee Heung Man , Lee Seung Hoon , Choe Whan , Kim Ha Kyun , Lee Jung Hoon , Oh Kyoung Ho , Lee Sang Hag
Published: February 2010

Background

The purpose of this study was to investigate the expression and distribution of superoxide anion, NADPH oxidase (NOX)1, and NOX4 in healthy, allergic nasal mucosa and nasal polyps to evaluate the possible influence of oxidative stress on the development of allergic rhinitis and nasal polyps.

Methods

The expression and distribution of superoxide anion, NOX1 and NOX4 were evaluated in healthy and allergic nasal mucosa and nasal polyps, using dihydroethidium fluorescence, semiquantitative reverse transcriptase-polymerase chain reaction, immunohistochemistry, and Western blot.

Results

NOX1 and NOX4 were localized mainly in the epithelial layer, submucosal glands, vascular endothelium, and inflammatory cells in healthy and allergic nasal mucosa and nasal polyps. The cellular source that generated superoxide anion is also localized in the epithelial cells, submucosal glands, vascular endothelium, and inflammatory cells, demonstrating the similar sites of expression of NOX1 and NOX4 in healthy and allergic nasal mucosa and nasal polyps. NOX1 and NOX4 mRNA and proteins and superoxide anions had increased levels of expression in allergic nasal mucosa and nasal polyps compared with healthy nasal mucosa.

Conclusions

These results indicate that NOX1 and NOX4 may play an important role in reactive oxygen species production, contributing to the oxidative stress in allergic rhinitis and nasal polyp tissues.
Liquid-Based Cytology in Diagnosing Nasopharyngeal Carcinoma
Authors: Jan Yee-Jee , Chen Su-Ju , Wang John , Jiang Rong-San
Published: February 2010

Background

Liquid-based cytology (LBC) has achieved great success in cytological diagnosis of various cancers when compared with conventional smear methods. However, its application in diagnosing nasopharyngeal carcinoma (NPC) has never been studied.

Methods

Eighty-four consecutive patients who underwent nasopharyngeal biopsy for suspicious NPC or a nasopharyngeal mass under nasopharyngoscopy were enrolled in this prospective study. Brush samples were taken from the same site before punch biopsy and processed with the Thin Prep test.

Results

The adequacy, accuracy, sensitivity, specificity, false-negative rate, and false-positive rate of LBC in diagnosing NPC were 92.9% (78 of 84), 93.6% (73 of 78), 84.2% (16 of 19), 96.6% (57 of 59), 15.8% (three of 19), and 3.4% (two of 25), respectively. There were four inadequate specimens from patients with NPC and two inadequate ones from those without NPC.

Conclusions

Our study showed that the adequacy, accuracy, sensitivity, specificity, and diagnostic rate of LBC were equivalent to those using conventional smear methods. Although the diagnostic rate of NPC was lower using brush cytology than by punch biopsy, further improvements in the sampling technique could make brushing cytology a potential tool for NPC screening.
Serum Levels of Resistin in Allergic Rhinitis and its Relationship with Disease Severity
Authors: Hsueh Kai-Chung , Lin Ching-Yuang , Lin Ying-Ju
Published: February 2010

Background

Resistin, a recently discovered adipokine, has been shown to have proinflammatory properties in humans. The purpose of this study was to evaluate serum resistin levels in children with allergic rhinitis (AR) and to investigate its association with clinical disease severity, parameters of atopy and pro-/anti-inflammatory cytokines.

Methods

A case-controlled study was performed on 50 pediatric patients with persistent AR and 30 healthy controls with similar age, sex, and body mass index. Serum levels of resistin, parameters of atopy, and cytokines were analyzed. The nasal symptom scores were evaluated and patients were classified into mild (n = 20) and moderate-severe (n = 30) persistent AR.

Results

Serum levels of resistin were significantly increased in children with AR compared with controls (p < 0.001). Serum levels of resistin went hand in hand with disease severity as they were significantly higher in moderate-severe than mild persistent AR. In addition, they correlated positively with nasal symptom scores (r = 0.74; p < 0.001). A significant positive correlation was observed between serum levels of resistin and IL-6 (r = 0.358; p = 0.011).

Conclusion

Patients with persistent AR were found to have higher serum levels of resistin, and resistin levels increased with the progress of disease severity. Resistin may represent a novel link between inflammation and AR.
KTP/532 YAG Laser Treatment for Allergic Rhinitis
Authors: Yaniv Eitan , Hadar Tuvia , Shvero Jacob , Tamir Rami , Nageris Ben
Published: February 2010

Background

The purpose of this study was to investigate the efficacy of the KTP/532 YAG laser to reduce nasal congestion and discharge in patients with allergic rhinitis.

Methods

Forty-eight patients with symptoms of allergic rhinitis were treated with the KTP/532 laser. All had positive skin tests for common allergens. Treatments were provided on an ambulatory basis in one to three sessions under local anesthesia with lidocaine nose spray. Outcome was determined by daily symptom reports and regular endoscopy examination and interviews for 12 months.

Results

Treatment was very well tolerated. There were no major side effects. At examination after 1 year, nasal obstruction was improved in 69% and nasal discharge in 40% of cases.

Conclusion

The KTP/532 YAG laser is effective for the treatment of nasal obstruction and discharge. Comparison with other techniques showed it to be the most effective in reducing nasal discharge. It can be done as an office procedure and does not damage the nasal mucous membrane. The KTP/532 YAG laser is effective as an additional treatment for patients refractory to medication.
Nasal Physiological Reactivity of Subjects with Nonallergic Rhinitis to Cold Air Provocation: A Pilot Comparison of Subgroups
Authors: Shusterman Dennis J. , Tilles Stephen A.
Published: February 2010

Background

Noninfectious nonallergic rhinitis (NINAR) is characterized by self-reported hyperreactivity to nonspecific physical or chemical stimuli. The relationship between these two classes of triggers is not well established, however. We compared NINAR subjects with predominantly physical or chemical triggers versus normal controls with respect to subjective (symptomatic) and objective (obstructive) responses to cold, dry air challenge.

Methods

We studied 14 NINAR subjects and 10 normal controls. Exposures consisted of 15 minutes of cold dry air (0°C/5% RH) or warm moist air (25°C/50% RH) on two separate days a week apart. Subjects rated symptoms using visual analog scales and had their nasal airway resistance measured at baseline, immediately after, and at 15-minute intervals for 1 hour postexposure.

Results

The majority of NINAR subjects reported physical triggers as more troublesome than chemical. Immediately postprovocation, the mean net proportional change in nasal airway resistance from baseline was +0.18 in NINAR (physical), +0.05 in NINAR (chemical), and –0.01 in control subjects (NS). However, a pooled linear regression by number of physical triggers (0–5) revealed a 7.5% increase in cold air–induced nasal airway resistance per trigger reported (p < 0.05). Similarly, raising the criterion number of physical triggers from ≥1 to ≥2 also distinguished NINAR subjects from controls in a bivariate analysis.

Conclusion

Either considering self-reported physical triggers as a continuous scale (0–5) or requiring more physical triggers (≥ 2 rather than ≥1) to define NINAR successfully predicts objective nasal reactivity to cold air provocation.
Prophylactic i.v. Antibiotics in Functional Endoscopic Sinus Surgery: Trends and Attitudes of the American Rhinologic Society Membership
Authors: Chandra Rakesh K. , Conley David B. , Kern Robert C.
Published: February 2010

Background

Use of antibiotic prophylaxis in otolaryngology–head and neck surgery is a practice that exhibits significant variation among practitioners, and trends vary by subspecialties within the field. The objective of this study was to assess these habits among otolaryngologists with special interest or experience in functional endoscopic sinus surgery (FESS).

Methods

Attendees of the 2008 Annual Meeting of the American Rhinologic Society were surveyed regarding practice patterns and attitudes concerning the use of prophylactic i.v. antibiotics in FESS.

Results

Surveys were returned from 49 attendees, and within this sample, i.v. antibiotic prophylaxis was used by 28 (57%) and was not in 21 (43%). Among those who used prophylaxis, only 2/28 (7%) did so because they felt there was strong evidence to support such a practice, while 26/28 (93%) used prophylactic antibiotics despite the opinion that there is no solid evidence in support of this. The most common antibiotic chosen empirically was a cephalosporin (25/28; 89%). There was no significant difference between those who did and did not use prophylactic i.v. antibiotics with regard to number of years in practice or practice situation (full-time academic, academic affiliated private, solo private, and group private).

Conclusion

Opinion of the respondents suggests there is no solid empiric evidence supporting the use of prophylactic i.v. antibiotics in FESS. Nonetheless, this practice is more common than not. Possible explanations for these observations are explored in the context of new pay for performance quality measures.
Matrix Metalloproteinase-9 Promoter Gene Polymorphism (–15620T) in Nasal Polyposis
Authors: Erbek Selim S. , Yurtcu Erkan , Erbek Seyra , Sahin Feride I.
Published: February 2010

Background

Expression of matrix metalloproteinase (MMP)-9 increases in nasal polyp tissues. However, the impact of MMP-9 genotypes on the development of nasal polyposis (NP) is unknown. The aim of this study was to examine a potential association of MMP-9 promoter gene polymorphism with the development of NP.

Methods

A prospective and case–control study was performed on 93 patients with NP and 115 controls without sinonasal disease. Genotypes of MMP-9 (–1562C>T) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction.

Results

The frequency of – 1562CT genotype of MMP-9 was significantly high in NP patients with aspirin-induced asthma (p = 0.014). Distribution of T allele was significantly high in NP patients with aspirin-induced asthma (p = 0.013). MMP-9 genotypes were not associated with gender or the presence of atopy.

Conclusion

In this study, MMP-9 – 1562CT genotype was associated with susceptibility to NP in aspirin-induced asthmatic patients. Because this report is a population-based study, further research should be performed on larger study subjects to reveal the precise role of MMP-9 promoter gene polymorphism in the development of NP.
The Two Holes Syndrome
Authors: Mladina Ranko , Vuković Katarina , Poje Gorazd
Published: February 2010

Background

Defects in the fontanel region of the lateral nasal wall have been described in the literature as “accessory” or “secondary” ostia. The authors consider them a sign of chronic maxillary sinusitis. Along with mucus recirculation between the natural ostium and the fontanel defect, we call it the Two Holes Syndrome. The aim of this study was to determine the incidence of fontanel defects in patients with chronic rhinosinusitis (CRS) and in healthy subjects.

Methods

Eighty-eight hundred seventy-nine outpatients with CRS were examined by means of nasal fiberendoscopy. The control group consisted of 1442 healthy volunteers with no previous history of CRS.

Results

Defect in the posterior fontanel was found in 1713/8879 CRS patients (19.3%). It was bilateral in 1165 cases (68.03%). Defect in the anterior fontanel was found in 54 patients (0.61%). The circulating mucus ring was identified in 162 patients with fontanel defects (9.17%). The defect in the posterior fontanel was found in 7/1442 healthy volunteers (0.48%). It was never bilateral, the circulating mucus was not observed and defect in the anterior fontanel was not found.

Conclusion

Posterior fontanel defects were found more frequently in CRS patients than in healthy subjects. These defects have been clinically related to chronic infection of the maxillary sinus and should not be called “accessory” or “secondary” ostia. CRS with defects of the fontanel region and mucus recirculation can promote a number of health disturbances (chronic postnasal drip, headache, and cough). We named this entity the Two Holes Syndrome.
Mastoid Bone as a New Graft Material in Rhinoplasty
Authors: Sadooghi Mahmood , Kouhi Ali
Published: February 2010

Background

The management of certain nasal deformities, especially after prior rhinoplasty, may require grafting material. In this study we describe the use of mastoid bone as a viable and low morbidity autologous graft.

Methods

Mastoid bone was used for nasal augmentation, smoothing dorsal nasal irregularities, or augmentation of radix. Candidates for mastoid bone graft were patients undergoing primary rhinoplasty suffering from low radix or saddle nose deformity and candidates for secondary rhinoplasty suffering from prior overresection of the osteocartilaginous structures.

Results

Fifty-six patients met the study criteria. Eighteen patients underwent secondary rhinoplasty and suffered from prior overresection of osteocartilaginous structures and 38 patients underwent primary rhinoplasty. Of these, 18 patients had a low radix and 20 patients had a saddle nose deformity. Follow-up was 6–49 months (mean, 23 months). All cases resulted in an augmented straightened nasal dorsum, increased tip projection, and adjusted radix. There were no cases of graft infection. In two cases the graft was displaced requiring revision. The amount of graft absorption even after 2 years follow-up was acceptable. There were no donor site complications.

Conclusions

The mastoid bone graft provides adequate autologous bone in most cases of primary or revision rhinoplasty. The donor site carries low morbidity and a well camouflaged scar. It is easily accessible especially for the otolaryngologist who is accustomed to operating on the mastoid bone.
Anatomic Variations of Sphenopalatine Artery and Minimally Invasive Surgical Cauterization Procedure
Authors: Midilli Rasit , Orhan Mustafa , Saylam Canan Y. , Akyildiz Serdar , Gode Sercan , Karci Bulent
Published: February 2010

Background

Sphenopalatine artery (SPA) ligation or cauterization stands to be one of the most common management options of refractory epistaxis. Ramification pattern of SPA as it passes through sphenopalatine foramen (SPF) has not been clearly established. The aim of this study is to investigate situations in which middle meatal approach may fail due to anatomic variations of SPA and to define a minimally invasive surgical cauterization procedure. Anatomic variations of SPA were determined by microdissection of 20 adult sagittally cross-sectioned head specimens.

Methods

Branching characteristics of SPA and its anatomic relations were evaluated and anatomic variations were noted.

Results

SPA was generally (80%) forming branches within SPF before entering into the nasal cavity. In 20% of the specimens, SPF was located superior to the horizontal lamella of the middle turbinate, and accessory foramen was present in 10%. In 10% of the cases, the posterior lateral nasal branch was situated as two branches in a deep sulcus in the middle meatus.

Conclusion

The ramification pattern of SPA can not be fully exposed without resection of the posterior part of the middle turbinate via the middle meatal approach. Two-step procedures are advocated in reducing failure rates. Previously defined two-step procedures are relatively invasive. A less invasive procedure is defined based on the variations of SPA and SPF.
Rosai-Dorfman Disease of the Nasal Cavities: A CO2 Laser Excision
Authors: Belcadhi Malek , Bellakhdhar Mouna , Sriha Badreddine , Bouzouita Kamel
Published: February 2010

Background

Rosai-Dorfman disease (RDD) is a rare nonneoplastic histiocytic proliferative disorder characterized by painless massive lymphadenopathy. Extranodal manifestations frequently occur in the head and neck area.

Methods

We report the clinical and histological features of nasal cavities and cervical lymph node RDD in a 72-year-old woman, who complained of major nasal obstruction and hyposmia.

Results

Nasal endoscopy revealed polypoid masses arising from the turbinates; the septum was intact. Immunohistochemical analysis revealed staining for S-100 protein, CD68, and alpha-1 antitrypsin. The presence of the Epstein-Barr virus was revealed by serology and also by in situ hybridization. The general examination and systemic evaluation did not find other extranodal localization.

Conclusions

Because the disease is known for not responding to local or systemic steroids, CO2 laser excision was used to clear the nasal obstruction with a satisfactory result. This is, to the best of our knowledge, the first description of the use of laser excision for nasal cavities RDD.
A Systematic Review of Outcomes after Dacryocystorhinostomy in Adults
Authors: Leong Samuel C. , MacEwen Caroline J. , White Paul S.
Published: February 2010

Background

This study was designed to systematically review the clinical outcomes of dacryocystorhinostomy (DCR) surgery. Data sources included PubMed for English language literature from January 1966 to December 2008 combined with a manual review of citations within article bibliographies.

Methods

Citations acquired from the targeted search were filtered independently by two researchers. Relevant articles were reviewed to obtain information including interventions and outcome measures. The surgical techniques were categorized into external DCR (EX-DCR), endonasal laser-assisted DCR (LA-DCR), and nonlaser endoscopic endonasal DCR techniques (EN-DCR). Articles were then assigned level-of-evidence grades as defined by the Oxford Center for Evidence-Based Medicine.

Results

A total of 73 studies that fulfilled the inclusion criteria were analyzed. Of these, 68 were graded as level 4, 11 were graded as level 3b, and 1 was graded at level 2b evidence. A total of 4800 patients were pooled, from which 4921 DCRs were performed. All studies reported success during the follow-up period, although the outcome measures used were not consistent in the studies. Success varied between 65 and 100% after EX-DCR compared with EN-DCR, which varied from 84 to 94%. The success rate of LA-DCR varied widely between 47 and 100%. There was low evidence base to support the use of silicone stent to improve surgical success. Most studies did not show significantly improved outcomes with an antimetabolite. The overall intra- and postoperative complication rates were 1.0 and 6%, respectively.

Conclusions

DCR is an effective and safe method for the treatment of nasolacrimal obstruction. Meta-analysis of outcomes was not feasible because of the heterogenous patient groups and outcome measures used. Nonetheless, the literature provides considerable levels 3 and 4 evidence to support DCR surgery in adults. Outcomes after EN-DCR and EX-DCR were comparable. The failure rate for LA-DCR was higher.
Association of the CD14 Gene Polymorphism C-159T with Allergic Rhinitis
Authors: Han Demin , She Wenyu , Zhang Luo
Published: February 2010

Background

Altered expression of the cluster differentiation antigen, CD14, may affect the proportion of T-helper type 1 (Th1) to Th2 cells, thereby influencing the immunoglobulin E (IgE) response and associated inflammatory phenotype in allergic conditions. Therefore, the gene encoding CD14 is considered as a positional candidate gene for atopy. Recently, a functional C-159 T polymorphism has been described in the promoter region of the gene and has been associated with increased gene expression and atopic phenotypes in various ethnic populations. We evaluated the relationship between the C-159 T polymorphism in the promoter of the CD14 gene and the total serum IgE level in Chinese adult patients with allergic rhinitis.

Methods

Polymerase chain reaction with restriction fragment length polymorphism (RFLP) analysis was used to determine the C-159 T polymorphism in subjects with allergic rhinitis (n = 92) and nonallergic disease controls (n = 72). Total serum IgE was also measured.

Results

In the allergic rhinitis group, the frequency of the TT homozygotes was significantly higher than for the control group (p < 0.05). In both groups, the C-159 T polymorphism is not associated with serum IgE levels.

Conclusions

TT homozygotes are more common in adult patients with allergic rhinitis among the Chinese population.
Incidence of Staphylococcal Colonization and of the 753Q Toll-like Receptor 2 Variant in Nasal Polyposis
Authors: Sachse Florian , Becker Karsten , Rudack Claudia
Published: February 2010

Background

The impact of Staphylococcus aureus on the development of chronic sinusitis with nasal polyps (nasal polyposis [NP]) is a controversial discussion because different S. aureus colonization rates have been reported. Aside from the presence of a microbial stimulus, elements of innate immunity such as Toll-like receptors (TLRs) and/or impaired TLR function could be relevant for the development of this disease. Because the 753Q TLR2 variant may predispose to staphylococcal infection, we simultaneously analyzed staphylococcal colonization and the R753Q TLR2 single nucleotide polymorphism (SNP) in NP.

Methods

Sixty-eight patients with NP (47 men and 21 women; mean age [±SD], 51.8 years [16.3]) and 51 controls (32 men and 19 women; mean age [±SD], 36.3 years [12.2]) were included. Patient characteristics studied included status of allergy, asthma, aspirin intolerance, and endoscopic and CT polyp score. For detection of bacteria, standard procedures of bacteriology and 16S rRNA gene sequencing were used. The R753Q TLR2 polymorphism was studied by allelic discrimination assay.

Results

Overall, 128 isolates were cultured from 68 NP specimens, with Staphylococcus epidermidis and S. aureus being the most frequent bacterial isolates. Other bacterial species were infrequently detected. Fifty-nine isolates were cultured from 51 controls. Similarly, S. epidermidis and S. aureus were the most frequent bacterial isolates. S. aureus colonization was significantly increased in NP (p < 0.05). However, SNP genotyping results showed no association of the 753Q TLR2 variant with NP.

Conclusions

Although S. aureus detection was increased in NP, nasal polyp pathology is not related to the 753Q TLR2 variant.
Fracture of Bony Lamellae within the Frontal Recess after Balloon Catheter Dilatation
Authors: Khalid Ayesha N. , Smith Timothy L. , Anderson James C. , Mace Jess , Sautter Nathan B.
Published: February 2010

Background

The precise manner in which balloon catheter dilatation (BCD) alters the dimensions of the frontal recess and frontal sinus outflow tract is not well characterized. The purpose of this investigation was to determine whether BCD within the frontal recess is associated with reproducible patterns of fracture in bony lamellae, to characterize changes between pre- and postintervention measurements of the frontal sinus outflow tract, and to compare the degree of change seen with endoscopic Draf I dissection.

Methods

Eight cadaver heads underwent pre- and postintervention endoscopic visualization and computed tomography (CT) of the frontal recess and frontal sinus outflow tract. Frontal recesses were assigned for either BCD or Draf I dissection. CT scans were evaluated by two reviewers (principal investigator and neuroradiologist).

Results

Inter-rater reliability was strong for all measures (r > 0.77; p < 0.001). The sagittal and coronal dimensions of the frontal sinus outflow tract increased significantly after BCD and Draf I dissection (p < 0.028). Significantly less change was noted in average coronal dimensions of the frontal sinus outflow tract after BCD compared with Draf I dissection (0.9 ± 0.5 mm versus 2.6 ± 0.6 mm; p < 0.018). Mean change in the sagittal dimension was significantly less after BCD compared with Draf I dissection (1.0 ± 0.8 mm versus 4.0 ± 1.2 mm; p < 0.018). The anterior face of the ethmoid bulla was the most frequently fractured lamella after BCD (56%).

Conclusions

The sagittal and coronal dimensions of the frontal sinus outflow tract increased significantly after BCD and Draf I dissection. A significantly greater change in dimensions of the frontal sinus outflow tract is observed after Draf I dissection compared with BCD. No orbital or skull base injury was noted with either technique.
Comparison of Azelastine versus Triamcinolone Nasal Spray in Allergic and Nonallergic Rhinitis
Authors: Kalpaklioglu Ayse Fusun , Kavut Ayse Baccioglu
Published: February 2010

Background

Intranasal antihistamine has not been thoroughly studied in the treatment of rhinitis of different etiologies. This study was designed to show the comparative efficacy of nasal antihistamine and nasal corticosteroid in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR).

Methods

A comparison of the efficacy of azelastine nasal spray (AZENS) versus triamcinolone acetonide nasal spray (TANS) on total nasal symptom scores (TNSS), nasal peak inspiratory flow rate (nPIFR), and nasal cytology was studied in a 2-week randomized parallel-group trial. The Epworth Sleepiness Scale (ESS) and health-related quality of life (HRQoL) were also analyzed.

Results

The study group consisted of 132 patients (100 women and 32 men) with a mean age of 33.14 ± 12.52 years. Sixty-nine patients had AR and 63 had NAR. Although TNSS including sneezing, itching, rhinorrhea, congestion—but not anosmia—significantly improved in both groups, intranasal azelastine reduced ocular symptoms greatly compared with intranasal triamcinolone (p = 0.05). Patients with NAR seemed to respond more to TANS, whereas AZENS was more useful in AR. The nPIFR improved in AR and NAR, with no significant difference between the treatment groups. Neither intranasal azelastine nor intranasal triamcinolone changed cytology in nasal lavage. Both medications were well tolerated, but AZENS led to more adverse events than TANS (56.9 and 19%, respectively; p = 0.001), mainly because of bitter taste. Scores on each domain of generic HRQoL (36-Item Short-Form Health Survey) and mini–rhinitis QoL questionnaires, as well as ESS score, significantly improved in both groups, irrespective of rhinitis etiology.

Conclusions

In this first comparative demonstration, AZENS appears to be as effective as triamcinolone in symptom scores, nPIFR, ESS, and HRQoL, equally in AR and NAR.
Correlation between Computed Tomography Staging and Quality of Life Instruments in Patients with Chronic Rhinosinusitis
Authors: Zheng YongBo , Zhao Yu , Lv Dan , Liu YaFeng , Qiao XiaoMing , An Ping , Wang DeYun
Published: February 2010

Background

Because chronic rhinosinusitis (CRS) is one of the most common health conditions in humans, it is important to assess its impact on quality of life (QoL). This study investigated the relationship between the findings of computed tomography (CT) staging and a patient-based questionnaire for CRS patients in Western China.

Methods

In this prospective study, the Lund—MacKay CT staging system, a visual analog scale (VAS), the 20-Item Sinonasal Outcome Test (SNOT-20), and the Short Form 36 Health Survey (SF-36) were completed for all preoperative recruits. The patients were classified into several subgroups according to whether CRS was associated with nasal polyps (CRS with nasal polyps [CRSwNPs]) or not (CRS without nasal polyps [CRSsNPs]), sex, duration of disease, and educational background.

Results

A total of 121 patients were recruited. In the total cohort of patients, there were significant correlations between scores on SNOT-20 and SF-36 (r = –0.561; p < 0.01), SNOT-20 and VAS (r = 0.743; p < 0.01), and SF-36 and VAS (r = –0.504; p < 0.01). Significant but weak correlations were found between the CT stage and scores on the patient-based questionnaires in the CRSwNP subgroup (CT versus SNOT-20, r = 0.31 and, p = 0.005; CT versus SF-36, r = –0.358 and p = 0.002; CT versus VAS, r = 0.358 and p = 0.002). The CT stage did not correlate with the scores in the patient-based questionnaires in the total cohort of patients. However, the CT stage was higher in the CRSwNP subgroup than in the CRSsNP, but QoL was better in the CRSwNP subgroup than in the CRSsNP subgroup. The two groups differed on the Lund–MacKay stage and the SNOT-20 and VAS scores (p < 0.05).

Conclusions

The scores on patient-based questionnaires such as the SNOT-20, SF-36, and VAS correlate with each other. The CT stage correlated weakly but significantly with the scores in the patient-based questionnaires only in the CRSwNP subgroup. The presence of nasal polyps was not associated with poor QoL in CRS patients.