bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonspecific Nasal Mucosal Reactivity, Expressed as Changes in Nasal Airway Resistance after Bilateral Saline Provocation
Authors: Haavisto Lotta , Sipilä Jukka , Suonpää Jouko
Published: July 2007

When using intranasal provocation tests in diagnosing nasal allergy or other hyperreactivity, it is essential to know which part of the reaction is caused by some nonspecific stimulus. The purpose of this study is to evaluate nonspecific nasal reactions of patients with chronic nonallergic perennial rhinitis as well as normal controls. The provocations were made bilaterally with normal saline solution (0.9% sodium chloride), and the changes in the nasal resistance were recorded by active anterior rhinomanometry. There was no significant difference between the chronic rhinitis patients and the normal controls. However, the individual variations were large. We conclude that a change of ±100–150% in the unilateral nasal resistance can be caused by a nonspecific reactivity.
Correction of the Twisted Nose Deformity: A Surgical Algorithm Using the External Rhinoplasty Approach
Authors: Hwang Peter H. , Maas Corey S.
Published: July 2007

Successful correction of the twisted nose is challenging due to the complex nature of the underlying anatomic deformity. Although the literature has in general supported endonasal rhinoplasty techniques for the twisted nose, we propose a surgical algorithm using the external rhinoplasty approach. The algorithm offers a stepwise, structured method that is adaptable to individual variations in anatomic deformity. The advantages and relative disadvantages of the external rhinoplasty approach are discussed, and a clinical experience of 30 patients is reviewed. Application of the external rhinoplasty algorithm in correction of the twisted nose can yield consistently satisfactory functional and aesthetic results.
Endoscopically Guided Frontal Sinus Beclomethasone Instillation for Refractory Frontal Sinus/Recess Mucosal Edema and Polyposis
Authors: Citardi Martin J. , Kuhn Frederick A.
Published: July 2007

Despite its metabolic complications, systemic corticosteroid therapy remains a mainstay in the treatment of refractory polyposis after endoscopic frontal sinusotomy. Furthermore, topical nasal corticosteroids often fail, presumably due to the relatively small dosage actually absorbed by the polyps. In order to minimize steroid complications while increasing the locally absorbed dose, beclomethasone (approximately 1 cc, 84 mcg/100 μl) was instilled under endoscopic guidance directly into the frontal sinus in 31 instances in 16 patients with postoperative frontal recess/sinus polyposis and mucosal edema. The frontal recess/sinus polyposis/edema resolved completely in 9 frontal sinuses, improved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complications were noted. AM cortisol levels remained in the normal range. Endoscopically guided frontal sinus beclomethasone instillation should be considered for the treatment of refractory postoperative frontal sinus/recess polyposis/edema. Further basic and clinical research into the pathophysiology of the nasal mucosa is also warranted.
Intracranial Complications of Sinusitis: A Pediatric Series
Authors: Giannoni Carla , Sulek Marcelle , Friedman Ellen M.
Published: July 2007

Intracranial complications of sinusitis (ICS) (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and contemporary topic. The progressive pneumatization and continued development of the sinuses after birth and the late appearance of the frontal and sphenoid sinuses imply that some infections would not appear until later childhood. We reviewed the records at a large pediatric hospital between 1986 and 1995 and found 10 children with 13 ICS (cerebral abscess, 5; extra-axial empyema, 5; and meningitis, 3). Of 43 children with cerebral abscess and 16 with extra-axial abscesses treated in this period, 12% of cerebral and 63% of extra axial abscesses were due to a sinogenic source. Multiple intracranial and extracranial complications of sinusitis in a single patient were common. The average age of children with ICS was 12.2 years old. We present these 10 cases and discuss their presentation, microbiology, and clinical course. Although the majority presented with a classic picture of headache, altered mental status, and fever, a few had symptoms that were more subtle. One child had recurrent meningitis, believed to be due to skull base dehiscence after endoscopic sinus surgery (ESS). He has required multiple otolaryngologic and neurosurgical procedures in an effort to prevent further episodes of meningitis. Ultimately, nine of 10 patients survived with an average hospital stay of 27.8 days (median of 17 days). The diagnosis of ICS requires a high index of suspicion, imaging of the brain and paranasal sinuses, and aggressive intervention.
The Versatile Autogenous Rib Graft in Septorhinoplasty
Authors: Sherris David A. , Kern Eugene B.
Published: July 2007

In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed. The costal cartilage graft and rib bone/costal cartilage combination graft are excellent alternatives. In this study 14 patients received 40 grafts from 20 autogenous ribs harvested during septorhinoplasty. Materials were harvested for use as septal replacement grafts, cantilevered grafts, dorsal onlay grafts, columellar struts, and tip grafts. Patient followup was 6 to 31 months, and no evidence of graft resorption or warpage was evident during that period. Complications of harvest were minimal, and harvest techniques are detailed.
Subjective Comparison of Nd:YAG, Diode, and CO2 Lasers for Endoscopically Guided Inferior Turbinate Reduction Surgery
Authors: DeRowe Ari , Landsberg Roy , Leonov Yaron , Katzir Abraham , Ophir Dov
Published: July 2007

Lasers using different wavelengths and delivery systems have been used to reduce the inferior turbinate mass when hypertrophic inferior turbinates obstruct the nasal airway. Different laser systems produce different laser-tissue interactions. This study presents a comparison between three laser systems: CO2, Nd:YAG, and Diode lasers for inferior turbinate reduction surgery, all performed under endoscopic control. A total of 46 patients were randomized into three treatment groups and followed for more than 1 year. Subjective and objective data were collected. Subjective impressions of improved nasal airway was achieved in 41% (Diode), 47% (Nd: YAG) and 57% (CO2) and was not statistically significant. There was more postoperative bleeding in the CO2 laser group, with 3 patients requiring tamponade. The CO2 laser procedure also took longer to perform. These results failed to show a significant difference between the different lasers for inferior turbinate reduction. Overall, the results were not impressive.
A Protocol for Management of a Catastrophic Complication of Functional Endoscopic Sinus Surgery: Internal Carotid Artery Injury
Authors: Park Albert H. , Stankiewicz James A , Chow James , Azar-Kia Behrooz
Published: July 2007

Injury to the cavernous portion of the internal carotid artery is a well recognized and dreaded complication of functional endoscopic sinus surgery. Little information, however, has been presented in the Otolaryngology literature regarding the etiology, prevention, or treatment of this complication. The purpose of this study is to present a case report of a cavernous carotid artery injury during functional endoscopic sinus surgery. Relevant anatomy, preventive measures, and treatment approaches are discussed for this difficult problem.
Interobserver Variations in Assessment of Antral Disease from Direct Sinoscopic Observations Compared to Video Recordings
Authors: Westergren Viveka , Lundblad Lars , Timpka Toomas
Published: July 2007

We tested the reliability of visual clinical sinoscopic observations by using video recordings. An edited video tape was made from the video-recorded bilateral antral sinoscopies of nine patients included in a prospective case series of inflammatory maxillary sinus disease in critically ill patients. An expert panel of four consultant ENT surgeons made individual appraisals of the video using a structured form. They had only been informed in general about the study, but had no further case knowledge in order to avoid all biases. Concordance and interobserver variabilities in the expert panel were compared in pairs. The assessments of the expert panel were compared with the observations of the performer, who was biased through individual case knowledge. Nine patients, either nasotracheally intubated or tracheotomized, had ventilator treatment for more than 7 days. One ENT surgeon performed all sinoscopies and made the direct observations. Satisfactory agreement was found on mucosal alterations. The concordance of recognizing bacterial infection was almost perfect. However, the assessment of redness from a video recording displayed only chance agreement. The differences between κ statistic values within the expert panel group compared to the comparisons of performer versus expert panel were not significant. The case knowledge of the sinoscopist did not alter the assessments markedly and thus seemed only to have minor influence. Video recording as a method for second opinion was shown to be a useful technique, but will have to be further developed.
The Evaluation of Ciliary Function: Electron versus Light Microscopy
Authors: Kupferberg Stephen B. , Bent John P. , Porubsky Edward S.
Published: July 2007

Diagnosing Primary Ciliary Dyskinesia can often be difficult. Physical findings suggest the disease, but definitive diagnosis should be made with a ciliary biopsy. Twenty biopsies were obtained from 16 patients and all underwent both light and electron microscopic examination. In 8/20 (40%) there was a discrepancy between the different imaging techniques. Therefore, light microscopy should be used to assess adequacy of biopsy and motion of the cilia along with electron microscopy to examine ultrastructure.
Frontoethmoidectomy with Sewall-Boyden Reconstruction: Alive and Well, A 25-Year Experience
Authors: Dedo Herbert H. , Broberg Todd G. , Murr Andrew H.
Published: July 2007

Recent controversies in the rhinologic literature regarding surgical management of the frontal sinus center around relatively new techniques using endoscopic intranasal approaches. Few authors have addressed the concept of frontal “duct” reconstitution, relying instead upon variations of the stenting concept, which fail at least 30% of the time. Some oral presentations and discussions in the past have gone so far as to say that external frontoethmoidectomy is an antiquated operation with few indications. One reason for its recent disfavor concerns the reported high rate of postoperative naso-frontal drainage track stenosis leading to recurrent disease. The senior author has a 25-year experience with a frontal recess reconstruction technique known as the Sewall-Boyden flap. This technique, coupled with the frontoethmoidectomy approach, has been effective with a low failure rate in 41 cases. This article serves to remind sinus surgeons of a safe, effective technique for establishing a drainage track from the frontal sinus: external fronto-ethmoidectomy with Sewall-Boyden flap reconstruction.
Muscarinic Ciliostimulation Requires Endogenous Prostaglandin Production
Authors: Gayner Scott M. , McCaffrey Thomas V.
Published: July 2007

Prostaglandin E2 (PGE2) is a known modulator in upper airway ciliary activity and may be involved in the transduction of the muscarinic acetylcholine receptor signal. We studied the in vitro effects of muscarinic ciliostimulation on ciliary beat frequency (CBF) and PGE2 in human adenoid explants to determine whether PGE2 production is an essential step in the signal transduction mechanism. Methacholine applied to adenoid explants significantly increased ciliary beat frequency. This effect was blocked by the application of diclofenac, a cyclooxygenase inhibitor. Using radioimmunoassay, PGE2 production was measured during ciliostimulation with methacholine. Methacholine produced a significant increase in production in PGE2 during ciliostimulation. The roles of phospholipase C and phospholipase A2 in prostaglandin production were investigated by inhibiting these enzymes. D609, a phospholipase C inhibitor, significantly inhibited ciliary beat frequency increase and PGE2 production during methacholine stimulation. However, PACOCF3, a phospholipase A2 inhibitor, did not block ciliary beat frequency increase or PGE2 production in response to methacholine. These data show that phospholipase C is required for PGE2 production and ciliostimulation.
Usefulness of Patient Symptoms and Nasal Endoscopy in the Diagnosis of Chronic Sinusitis
Authors: Rosbe Kristina W. , Jones Kim R.
Published: July 2007

The diagnosis of chronic sinusitis can be difficult due to the variety and lack of specificity of presenting symptoms. Sinus CT scanning is presently considered the most sensitive and specific diagnostic method, but is expensive. In order to determine whether a combination of patient symptoms and nasal endoscopy could be used to predict which patients would have CT evidence of chronic sinusitis, we conducted a prospective study in which 92 consecutive patients referred for chronic sinusitis were required to fill out a questionnaire detailing their symptoms. Their responses were then correlated with subsequent findings on nasal endoscopy and CT scanning. Briefly, we found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip. Also, nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.
Efficacy of an Aqueous and a Powder Formulation of Nasal Budesonide Compared in Patients with Nasal Polyps
Authors: Tos Mirko , Svendstrup Frank , Arndal Helge , Ørntoft Steffen , Jakobsen John , Borum Peter , Schrewelius Camilla , Larsen Per L. , Clement Finn , Barfoed Claus , Rømeling Frans , Tvermosegaard Torben
Published: July 2007

Nasal polyps are commonly treated surgically. Intranasal administration of topical corticosteroids has gained increased acceptance as a treatment alternative. The aim of our study was to compare the efficacy of treatment of two formulations of budesonide with placebo on nasal polyps. At four Danish clinics 138 patients suffering from moderate or severe nasal polyps were randomized to a twice daily treatment with Rhinocort® Aqua 128 μg, Rhinocort Turbuhaler® 140 μg or placebo (Astra Draco, Sweden) for 6 weeks. Polyp size (primary efficacy variable), nasal symptoms, sense of smell, and patients’ overall evaluation of treatment of efficacy were assessed by scores. Polyp size was reduced significantly in both budesonide treated groups compared with placebo, but there was no statistical difference between the two actively treated groups. Patients’ nasal symptom scores was significantly more reduced in the Aqua compared to the Turbuhaler treated group, and both reduced symptom scores were significantly better compared to placebo. Sense of smell was significantly improved in the actively treated groups compared to placebo. The proportion of patients rating substantial or total control over symptoms after 6 weeks treatment was 60.9% and 48.2% in the Aqua and Turbuhaler-treated groups, respectively, which was significantly better compared with 29.8% in the placebo-treated group. Rhinocort Aqua and Rhinocort Turbuhaler were equally well tolerated.
A Schematic Approach to Preexisting Sinus Disease for the Immunocompromised Individual
Authors: Mirza Natasha , Montone Kathleen T. , Stadtmauer Edward A. , Lanza Donald C.
Published: July 2007

Fungal rhinosinusitis is an aggressive and potentially lethal complication of chemotherapy and bone marrow transplant-induced neutropenia. Preexisting noninvasive sinusitis may be a significant risk factor in this population. An illustrative case is presented where preexisting noninvasive fungal sinusitis developed into the tissue-invasive and angio-invasive form of aspergillosis during chemotherapy. We propose an algorithmic approach to all patients before chemotherapy or bone marrow transplantation. If there is a suspicion of sinusitis based on a screening questionnaire, we recommend an otolaryngology consultation and a CT of the paranasal sinuses. Evidence of sinus disease should then be treated aggressively before chemotherapy or a bone marrow transplantation. Close posttreatment surveillance during the neutropenic phase is necessary with “urgent” biopsies if recurrence of disease is suspected.
Immunohistochemistry of p53 in Sinonasal Inverted Papilloma and Associated Squamous Cell Carcinoma
Authors: Fang Sheen-Yie , Yan Jin-Jou , Ohyama Masuru
Published: July 2007

Gene mutation of p53 is documented in head and neck cancer. No reports exist relating human sinonasal inverted papilloma (IP) and its transformation to squamous cell carcinoma (SCC). Using immunohistochemical techniques improved by an antigen retrieval method, p53 protein was analyzed in the following subjects: 16 IP, 12 SCC arising in IP, and 15 SCC alone subjects. Both the intensity (PI) and rate (PR) of positive p53 immunostaining were evaluated using a quantitative AutoCAD program. We correlated p53 protein expression with clinical features. p53 immunoreactivity is significantly lower in IP than in SCC specimens. Both the IP and SCC portions of IP synchronous SCC subjects showed similar p53 protein expression. SCC arising in IP shows a lower p53 immunoreactivity than SCC alone. Alteration of p53 protein may have an important role in the early stages of IP malignant transformation and prove a potential biomarker for risk assessment. Low p53 immunoreactivity, indicating the presence of a wild-type p53, may correlate with the prognosis for SCC arising in IP. However, further clinical trials are required to investigate this possibly worthwhile prognostic marker.
Effect of Recombinant Neutral Endopeptidase (EC 3.4.24.11) on Neuropeptide-Mediated Nasal Fluid Secretion and Plasma Exudation in the Rat
Authors: Josefsson Malin , Becker Magnus , Stroman Fritz , Brenner Daniel G. , Petersson Göran
Published: July 2007

The nasal mucosa harbors sensory nerves containing neuropeptides such as substance P (SP), which are released by capsaicin. The neuropeptides are degraded by peptidases, e.g., neutral endopeptidase (NEP) that is present in the nasal mucosa. We studied the effect of enzymatically active recombinant NEP (rNEP) on neuropeptide-evoked secretion of nasal fluid and plasma exudation in rats. rNEP administered intranasally (i.n.) reduced the capsaicin-evoked nasal fluid secretion but failed to reduce the secretion evoked by SP (exogenous) under the experimental conditions used. rNEP reduced the increase in nasal plasma exudation evoked by capsaicin (endogenous neuropeptides). Because rNEP reduced neuropeptide-mediated nasal fluid secretion and plasma exudation in the rat, we suggest that peptidase activity in the nasal mucosa will determine the magnitude of the response to locally released neuropeptides.
Sluder's Sphenopalatine Ganglion Neuralgia—Treatment with 88% Phenol
Authors: Puig Christine M. , Driscoll Colin L.W. , Kern Eugene B.
Published: July 2007

Patients who experience chronic recurring head and face pain present a diagnostic and therapeutic challenge. Treatment options for Sluder's neuralgia, an uncommon cause for recurring head and face pain, are controversial. We reviewed the outcomes of patients who underwent intranasal phenolization of the sphenopalatine ganglion for the treatment of Sluder's neuralgia. Eight patients were treated with intranasal cauterization of the sphenopalatine ganglion between 1990 and 1995. Patients were treated an average of 13 times. Overall, patients experienced a 90% decrease in head and face pain for an average of 9.5 months duration. Interestingly, the patients described recurrent pain as less severe, less frequent, and of shorter duration. Intranasal phenolization of the sphenopalatine ganglion appears to be a safe and effective, although temporary, treatment for patients with Sluder's neuralgia. This article will review the symptomatology, differential diagnosis, and phenolization technique for treatment of Sluder's neuralgia.
Computed Tomographic Measurements of the Nasal Sinuses and Frontal Bone in Mummy-Heads Artificially Deformed in Infancy
Authors: Merkle Elmar M. , Parsche Franz , Vogel Jochen , Brambs H.-J. , Pirsig Wolfgang
Published: July 2007

The purpose of the present study was to ascertain whether artificial skull deformation, carried out during infancy, has an effect on the pneumatization of the frontal and maxillary sinuses and on the osseous structure of the frontal bone. Thus, two normal and 12 artificially deformed adult human skulls (12 males, two females) from the collection of pre-Columbian Peruvian skeletons and mummies in the Institute of Anthropology and Human Genetics (University of Munich) were investigated by computed tomography. These skulls had been excavated from four sites on the Peruvian coast: Las Trancas, Cahuachi, Pacatnamú, and Estaqueria. The volumes of the maxillary sinuses varied from 5.18 mL to 17.19 mL. Those of the frontal sinuses varied from zero to 6.21 mL. The artificial deformation of the skull, which occurred during infancy, had no influence on the size of the maxillary and frontal sinuses. There was also no difference in the average bone thickness of the os frontale; however, artificial deformation in infancy had an influence on the bone structure, resulting in a tremendous rarefication of the diploe of the frontal bones. Based on these findings we conclude that the various types of skull deformation instituted in infancy seem to exert no inhibitory effect on the pneumatization of either the frontal or maxillary sinuses.
Anticholinergic Properties of Brompheniramine, Chlorpheniramine, and Atropine in Human Nasal Mucosa in Vitro
Authors: Fang Sheen-Yie , Druce Howard M. , Baraniuk James N.
Published: July 2007

Brompheniramine and chlorpheniramine have anticholinergic activities, but the relative potency of these effects has not been well defined. The anticholinergic properties of brompheniramine, chlorpheniramine, and atropine were assessed in an in vitro model of human nasal mucosal glandular secretion. Methacholine was used as a cholinergic agonist to stimulate glandular secretion of 7F10-mucin. These drugs (0.01–1000 μM) or vehicle (saline) were added to explant cultures with and without 100 μM methacholine. 7F10-mucin concentrations were measured in culture supernatants after 2-hour incubations. The effective dose reducing methacholine-induced secretion (ED50) was determined. ED50 was 0.25 μM for atropine, 4.10 μM for brompheniramine, and 4.63 μM for chlorpheniramine. None of the anticholinergic drugs changed spontaneous glandular exocytosis. Brompheniramine and chlorpheniramine are equipotent anticholinergic agents in human nasal mucosa in vitro. Atropine was 16 to 19 times more potent.
Congenital Bony Nasal Cavity Deformities
Authors: Jones Jacqueline E. , Young Eytan , Heier Linda
Published: July 2007

Although the most common form of nasal obstruction in neonates is soft tissue edema, congenital bony nasal deformities are being recognized as an important cause of newborn airway obstruction. In addition to the well described choanal atresia, CT imaging of the newborn in respiratory distress reveals two other forms of bony nasal cavity deformities: nasal pyriform aperture stenosis and nasal cavity stenosis. All of the three types of bony nasal cavity deformities have characteristic anatomical features, are associated with distinctive congenital anomalies, and are postulated to have differing embryological causes. Five patients with congenital bony nasal cavity deformities are presented. These cases illustrate the clinical and radiological presentation of varied types of congenital nasal cavity obstruction as well as the criteria used to guide clinical management.
The Effect of Nasal Surgery on Snoring
Authors: Elsherif Ibrahim , Hussein Sayed Naser
Published: July 2007

Patients with nasal obstruction often have associated snoring. It is uncertain whether surgery, which relieves the nasal obstruction, will also relieve the snoring. We have reviewed 96 patients who complain of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 48 patients (50%), was less loud in a further 38 patients (40%), unchanged in 8 patients, and louder in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after nasal surgery is postulated to be important in influencing snoring relief. This study suggests that, when snoring and nasal obstruction coexist, nasal surgery should be considered as the first line of surgical treatment.
Combined Intranasal Ipratropium Bromide and Oxymetazoline in Experimental Rhinovirus Infection
Authors: Pitkäranta Anne , Wecker Margaret T. , Korts David C. , Hayden Frederick G.
Published: July 2007

The topical anticholinergic ipratropium bromide and topical decongestant oxymetazoline were tested to determine whether oxymetazoline alone and the combination were well tolerated and reduced rhinorrhea and middle ear pressure abnormalities during experimental rhinovirus infection. The study was double-blind, placebo-controlled, and double dummy in design. Healthy volunteers (n = 109) with low serum neutralizing antibody titer (≤1:2) were. Treatments inoculated with rhinovirus (type 39 or Hank's strain) and randomized to treatment with ipra-tropium bromide 0.06% two sprays per nostril (84 μg per treatment) and oxymetazoline 0.05% two sprays per nostril, oxymetazoline alone, or placebo. Treatments were self administered twice daily for 5 days beginning 1 day after rhinovirus inoculation. The overall infection rate was 83% and of those infected, 88% felt that they had a cold. During the 3-hour period after dosing, the increase in nasal discharge was significantly lower in the combined ipratropium and oxymetazoline (0.13 ± 0.17 gm/3 hr, mean ± SE) than after oxymetazoline alone (0.60 ± 0.18 gm/3 hr) or vehicle (0.73 ± 0.18 gm/3 hr). Over the 5-day observation period, total daily nasal discharge also tended to be lower in the ipratropium plus oxymetazoline group (3.67 ± 0.70 gm/24 hr, mean ± SE) compared to oxymetazoline (5.61 ± 0.73; 35% reduction) or the vehicle (5.04 ± 0.73; 27% reduction) recipients, but the differences were not statistically significant. Subjective assessments of rhinorrhea indicated that the severity of rhinorrhea was significantly better among patients receiving oxymetazoline alone or with ipratropium compared to the vehicle. No significant difference in the cumulative frequencies of middle ear pressure abnormalities (27–31%) were found among the treatment groups. Oxymetazoline does not consistently stimulate or decrease nasal mucus production, and ipratropium added to oxymetazoline is well tolerated and reduces rhinorrhea during experimental rhinovirus infection.
The Reliability of Computerized Tomographic Detection of the Onodi (Sphenoethmoid) Cell
Authors: Driben Jeffrey S. , Bolger William E. , Robles Hector A. , Cable Benjamin , Zinreich S. James
Published: July 2007

Optic nerve injury is a devastating potential complication of endoscopic sinus surgery. Anatomic variations of the posterior ethmoid sinus are certainly contributing factors. In the most well described posterior ethmoid anatomical variant, the sphenoethmoid or Onodi cell, the optic nerve is placed at risk during sinus surgery. Improving preoperative and intraoperative identification of the sphenoethmoid (Onodi) cell could decrease the risk of optic nerve injury. The purpose of this investigation was to assess the reliability of computerized tomography (CT) in detecting the sphenoethmoid (Onodi) cell, and further our understanding of this clinically relevant anatomic variant. A total of 41 sinonasal complexes from 21 human adult cadaveric heads were studied with a standard coronal and axial plane CT, and subsequent endoscopic dissection. The prevalence of the sphenoethmoid (Onodi) cell was determined by CT and endoscopic dissection, as were other anatomic characteristics of the posterior ethmoid anatomy. In our study, CT identified a sphenoethmoid (Onodi) cell in 3/41 (7%) of the sphenoethmoid complexes. However, anatomic dissection identified a sphenoethmoid (Onodi) cell in 16/41 (39%) complexes. Coronal orientation of the anterior sphenoid wall was never associated with a sphenoethmoid (Onodi) cell. Conversely, oblique or horizontal orientations were present in all cases of sphenoethmoid (Onodi) cells. Current CT scanning protocols for the paranasal sinuses did not reliably detect the Onodi cell. Endoscopic dissection indicates that the sphenoethmoid (Onodi) cell is a more frequent anatomic variant than previously appreciated. Awareness of anterior sphenoid wall orientation may assist surgeons in identifying the Onodi cell, thereby reducing the risk of optic nerve trauma.
Enhancement of Histamine-Induced Vascular Permeability in Guinea Pigs Infected with Bordetella bronchiseptica
Authors: Gawin Alexander Z. , Kaliner Michael , Baraniuk James N.
Published: July 2007

In the nasal mucosa, histamine induces vascular permeability, stimulates nociceptive nerves, and recruits parasympathetic reflexes that regulate glandular exocytosis. Unilateral histamine nasal provocations were performed in a group of guinea pigs in the prodromal stage of undiagnosed Bordetella bronchiseptica infection. Vascular permeability in the histamine challenged nostrils was increased approximately 2- to 4-fold compared to healthy animals (p < 0.001). The duration of significant vascular leak was prolonged from 10 to 30 minutes. In the contralateral, nonchallenged nostrils, secretion of total protein and albumin, but not exudation of intravenously injected 125I-bovine serum albumin, was increased, suggesting an augmentation of parasympathetic reflexes without changes in contralateral vascular leak. These observations suggest that Bordetella bronchiseptica infection leads to hyperresponsiveness to histamine in the nasal mucosa with increased vascular permeability and recruitment of nociceptive nerve-parasympathetic reflexes.
Is Monocular Perception of Depth through the Rigid Endoscope a Disadvantage Compared to Binocular Vision through the Operating Microscope in Paranasal Sinus Surgery?
Authors: Tasman Abel-Jan , Wallner Frank , Kolling Gerold H. , Stammberger Heinz
Published: July 2007

Vision through the endoscope is strictly monocular. Perception of depth (stereopsis) during ethmoid surgery through the operating microscope would be expected to be superior due to binocular view. To investigate whether monocularity of the endoscope is a disadvantage in paranasal sinus surgery, we compared stereoacuity in a model of the nasal cavity using a headlamp, an operating microscope, and a 0°-Hopkins-endoscope. Twenty volunteers were asked to touch defined points in a spatial model of the nasal cavity. Due to the configuration of the model, which allowed binocular vision of all contact points with headlamp, performance was significantly better than with optical instruments. Manipulations were performed faster with the endoscope than with the microscope. Under microscopic guidance more faults in point sequence were made than with the endoscope. Various monocular phenomena obviously allow sufficient spatial orientation through the endoscope, so that monocularity of the endoscope appears not to be a disadvantage for quick and safe manipulations during functional endoscopic sinus surgery.
Prevalence of Sinonasal Symptoms in Patients with HIV Infection
Authors: Porter Jennifer Parker , Patel Alpen A. , Dewey Charlene M. , Stewart Michael G.
Published: July 2007

Infection with the human immunodeficiency virus (HIV) is increasing in prevalence, and disease patterns are changing as patient survival lengthens. The purpose of this cross-sectional epidemiological study was to assess the prevalence and severity of self-reported symptoms of otolaryngologic disease in a group of patients attending a general HIV outpatient clinic (n = 203), and to compare the prevalence of self-reported symptoms with a sample of patients without HIV infection (n = 100).

Of the HIV-infected patients, 65% of patients had AIDS, 35% were HIV-positive, and the median CD4 count was 135. Although only 11% of patients had seen an otolaryngologist in the prior 6 months, the majority of patients (66%) reported the presence of sinonasal disease during that time. Allergic rhinitis (80%) and sinusitis (54%) were the most commonly reported sinonasal symptoms, and 44% regularly used nasal or sinus medications. Sinonasal disease severity was significantly higher than the self-reported severity of mouth/throat disease (p = 0.01), ear disease (p = 0.03), and neck/salivary disease (p = 0.01). Although patients’ self-reported overall health status was associated (p = 0.02) with CD4 count, the severity of sinonasal symptoms was not associated (p = 0.93) with CD4 count. Similarly, sinonasal symptom severity did not differ between HIV-positive and AIDS patients (p = 0.45). In other words, sinonasal disease severity did not improve as general health status improved.

In this series, sinonasal disease was the most significant otolaryngologic manifestation in HIV-positive and AIDS patients. A similar prevalence and severity of self-reported sinonasal symptoms was reported in the non-HIV-infected group of patients. These data may help guide resource allocation and policy decisions on research and treatment of HIV-infected patients.
Severity Staging in Chronic Sinusitis: Are CT Scan Findings Related to Patient Symptoms?
Authors: Stewart Michael G. , Sicard Michael W. , Piccirillo Jay F. , Diaz-Marchan Pedro J.
Published: July 2007

Chronic sinusitis is a prevalent problem. The symptoms of CS cause patients to seek medical attention, and therefore the presence of symptoms drives the use of health care resources. There is widespread clinical belief that computed tomography (CT) scan findings may be a reasonable proxy for disease severity in chronic sinusitis, and many authors have proposed that CT scan findings make up the key component in severity staging systems for chronic sinusitis. However, the relationship between symptom severity and CT scan findings in chronic sinusitis has not been well explained to dale. To explore this relationship further, we examined data from consecutive patients with both a CT scan and a sinusitis symptom score, from ongoing prospective outcomes studies at two large academic centers in different cities (n = 254). CT scans were graded using two validated staging systems; symptom severity was assessed using two validated health status instruments and summary items. In addition, we explored multiple statistical modifications and permutations of CT staging to identify potential relationships between the two variables. In summary, no association between CT scan findings and symptom severity could be identified using both CT staging systems and patient-based symptom instruments. For instance, CT scans were examined: after eliminating normal scans, using different scoring algorithms, by worst side, by nonlinear association, when grouped into strata, and by eliminating patients with very severe disease; no statistical association was found between CT findings and patient-based symptoms using any of those techniques. Since symptom severity is a pivotal outcome measure in chronic sinusitis, these findings have significant implications for outcomes research and the development of severity staging systems.
Immunohistochemical Localization of Epidermal Growth Factors in Mouse Olfactory Epithelium
Authors: Ohta Yasushi , Ichimura Keiichi
Published: July 2007

Our object was to clarify changes in epidermal growth factor (EGF) occurring in the olfactory epithelium with aging. We investigated the changes in EGF in the murine olfactory epithelium with aging by an immunohistochemical method. We examined six mice at each of the following stages: embryonal (embryonic days 14 and 16), neonatal (postnatal days 1 and 7), adult (postnatal weeks 5 and 12), and aged (postnatal years 1.5–2). The olfactory epithelium of each mouse was stained with anti-EGF polyclonal IgG using an immunohistochemical method. EGF were observed in the whole layer of the olfactory epithelium at all stages. The mesenchyme under the epithelium was stained in the embryonal stage, and the circumference of the olfactory gland cells was also stained, although weakly, in the adult stage. We believe that EGF contribute to cell proliferation, growth and turnover of the olfactory epithelium. However, the decrease in EGF was less than expected in the aged mice.
Nasal Nitric Oxide is Independent of Nasal Cavity Volume
Authors: Chatkin Jose M. , Djupesland Per G. , Qian Wei , McClean Patricia , Furlott Henry , Gutierrez Carlos , Zamel Noe , Haight James S.
Published: July 2007

This study was performed to evaluate the relationship between nasal nitric oxide (NO) and changes in nasal cavity volume resulting from the topical application of xylometazoline and saline and between upright and supine posture. Nasal NO was measured using a fixed high flow technique that avoids contamination with lower airways NO. In nine healthy subjects nasal NO concentration was measured by a rapid response chemiluminescent analyzer. A tapered tube was inserted in one nostril, into which room air was insufflated to produce a constant flow of 100 ml/second; another tube was inserted into the opposite nostril for NO sampling (air exit side). Subjects were instructed to keep the vellum closed while NO was sampled through a sideport connected to the analyzer. Nasal cavity volume was measured by acoustic rhinometry from a segment of the acoustic pathway, 2 to 5 cm from the nostril. Nasal cavity volume and NO measurements were made at baseline, 15 minutes, and 60 minutes after intervention (administration of saline 0.9%, xylometazoline or posture changes on 3 consecutive days). Xylometazoline produced a significant increase in nasal cavity volume, together with a significant reduction in NO level at 15 and 60 minutes after intervention. In addition, the change from seated to supine position decreased the total nasal volume significantly, but without changes in nasal NO. No correlation was found between the magnitudes of changes in nasal NO and the changes in nasal volume. Topical application of xylomethazoline resulted in increased nasal cavity volume and reduced NO output. In contrast to previous published reports, a technique using high flow rate insufflation demonstrated an abscence of correlation between the magnitudes of changes in nasal NO and nasal cavity volume brought about by decongestant, saline, or posture.
The Effects of Different Levels of Air Pollution on Atopy and Symptoms of Allergic Rhinitis
Authors: Keleş Nesil , Ilicali Cenker , Değer Kemal
Published: July 2007

We evaluated the prevalence of symptoms of allergic rhinitis and atopy among two groups living in areas with different pollution levels. The study was conducted among high school students living in Bayrampa§a (polluted by SO2 and TSP) and Beykoz (unpolluted, residental area) in Istanbul (n = 386). Each subject filled out a standardized self-administered questionnaire. Atopic status was evaluated by skin-prick testing using eight different allergens. Also, anterior active rhinomanometry was performed to evaluate the symptoms objectively. Significantly higher prevalence rates for symptoms of allergic rhinitis were found in Bayrampaşa (22.8%) compared to Beykoz (6%). However, no significant difference was found for atopic status among the two groups. When we evaluated the atopic status of subjects with symptoms of allergic rhinitis between the two areas, the prevalence of atopic students was found to be relatively higher in the unpolluted area (BZ). This difference was not statistically significant. Within the atopic population, subjects complaining of symptoms of allergic rhinitis were significantly more frequent in the polluted area (BP), suggesting that air pollution causes an increase in symptoms of allergic rhinitis in the atopic population, but this is not significantly higher than the increase in symptoms of allergic rhinitis of the total study group. Our results suggest that pollutants exert irritant effects on mucous membranes of the population in general rather than aggrevating symptoms in predisposed individuals. Smoking was more frequent in the unpolluted area. Exposure to parental smoking in childhood and heating systems in houses were evenly distributed. Household crowding was lower in Beykoz. Rhinomanometric measurements among the two groups did not show significant difference. Multiple logistic regression models estimating the role of each risk factor independently showed significant odds ratio associated with residence in Bayrampaşa for symptoms of allergic rhinitis (OR = 4.6, 95% CI = 9.0–2.3). In conclusion, this study suggests that outdoor pollution has adverse effects on the symptoms of allergic rhinitis, while it has no effect on the prevalence of atopy in Istanbul in the 1990s.
Allergic Fungal Sinusitis-Induced Visual Loss
Authors: Marple Bradley F. , Gibbs Scott R. , Newcomer Mark T. , Mabry Richard L.
Published: July 2007

In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.
Cardiovascular Safety of Second-Generation Antihistamines
Authors: Barbey Jean-Thierry , Anderson Mark , Ciprandi Giorgio , Frew Anthony J. , Morad Martin , Priori Silvia G. , Ongini Ennio , Affrime Melton B.
Published: July 2007

Reports of serious cardiac arrhythmia associated with some second-generation antihistamines have prompted concern for their prescription. This article reviews the nature of the adverse events reported and concludes that the blockade of potassium channels, particularly the subtype responsible for the rapid component of the delayed rectifier current (IKr), is largely responsible for such adverse cardiac events. Consequently, antihistamines with little or no interaction with these channels are expected to have the greatest safety margin. The main cardiac arrhythmia of concern is that of torsades de pointes, a potentially fatal phenomenon characterized by prolonged ventricular depolarization that manifests as a prolonged QT interval and polymorphic ventricular tachycardia, with twisting of the QRS complexes. Based on preclinical and clinical evidence, it appears that loratadine, cetirizine, and fexofenadine are safe from cardiac arrhythmia via the IKr channel, whereas astemizole and terfenadine have a propensity to cause ventricular tachyarrhythmias.
Primary Amyloidosis Presenting as a Nasopharyngeal Mass
Authors: Lim Jin S. , Lebowitz Richard A. , Jacobs Joseph B.
Published: July 2007

Amyloid is defined as a pathologic proteinaceous substance which, when deposited between the cells of tissues and organs, leads to various clinical conditions. Immunohistochemistry has allowed for better classification and understanding of the pathophysiology of amyloidosis. In the upper aerodigestive tract, amyloidosis is a rare condition occurring most frequently in the larynx. We present the case of a 42-year-old woman with complete nasal obstruction due to primary nasopharyngeal amyloidosis. This represents the first reported case of primary nasopharyngeal amyloidosis containing both the λ and κ immunoglobulin light chains. The clinical and radiologic findings, as well as the management of primary amyloidosis of the upper aerodigestive tract, will be discussed. A review of the literature pertaining to nasal and nasopharyngeal amyloidosis will be presented.
Possible Relationship of Gastroesophagopharyngeal Acid Reflux with Pathogenesis of Chronic Sinusitis
Authors: Ulualp Seckin O. , Toohill Robert J. , Hoffmann Raymond , Shaker Reza
Published: July 2007

Gastroesophagopharyngeal reflux (GEPR) has been suggested as a cause of pediatric sinusitis. However, its contribution to the pathogenesis of chronic sinusitis in adults has not been systematically investigated. We evaluated the prevalence of GEPR in 11 CT confirmed chronic sinusitis patients (51 ± 4 years) who had not responded to conventional therapy, and 11 normal healthy controls (44 ± 7 years). A 3-site ambulatory esophagopharyngeal pH monitoring technique (probe location: 2 cm proximal, 3–4 cm distal to UES and 5 cm proximal to LES high pressure zones) was used. A pharyngeal pH drop was accepted as a true reflux event only if it was coincident with or preceded by esophageal pH declines of a similar or larger magnitude. Studies were performed while subjects were on a uniform 2500 calorie diet (provided). Results: Ambulatory pH monitoring documented GEPR in seven of 11 patients (1–12 episodes) and two of 11 normal volunteers (1,2 episodes) (p < 0.05). A total of 34 nonbelch related pharyngeal acid reflux events were identified in patients, but none was associated with coughing. In both groups, all pharyngeal acid events occurred in the upright position. Compared to normal controls prevalence of pharyngeal reflux of gastric acid is significantly higher in patients with chronic sinusitis unresponsive to conventional therapy and suggests a different esophagopharyngeal distribution pattern of gastric refluxate in this patient group; these findings suggest that GEPR may contribute to the pathogenesis of chronic sinusitis in some adult patients.
Distilled Water Nasal Provocation in Hyperreactive Patients
Authors: Baudoin Tomislav , Anzic Srdjan Ante , Kalogjera Livije
Published: July 2007

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.