bluuebunny/crossref_metadata_2025 huggingface dataset:
Epstein-Barr Virus—Mild Acquired Immune Deficiency Syndrome (EBV—MAIDS) in Postsurgical Sinusitis
Authors: Toffel Paul H. , Christensen Joshua
Published: August 2018

Background

Functional endoscopic sinus surgery has remarkably improved the treatment of chronic rhinosinusitis patients. Computed tomography, endoscopic optical instrumentation, powered microdebriders, and computer-assisted surgery have surmounted the technical problems of obstructive sinusitis care. Most experienced practitioners achieve reported success rates of 85–95% among their surgical patients. However, the 5–15% refractory patients reported by all rhinologic surgeons leave an exasperating and perplexing group who, despite appropriate mechanical corrections, continue to experience debilitating rhinosinusitis episodes requiring repeated oral, nebulized, or intravenous antibiotics, and in some cases, antifungal therapy.

Methods

Recent studies have indicated that host immune response mechanisms may be altered in the paranasal sinus tissues of sinusitis patients. After years of observation, it was felt that these difficult patients may suffer from a common thread of significant partial immunocompromise. Drawing on military experience of treating immunoimmature populations prone to Epstein-Barr virus (EBV) infectious mononucleosis and the consequent postmononucleosis syndrome, it was sought to screen disabled refractory postsurgical sinusitis patients for this factor and treat them with long-standing military protocols for the immunoimmature populations dispatched to third-world combat conditions.

Results

Treatment of Epstein-Barr Virus-Mild Acquired Immune Deficiency Syndrome consisted of periodic intramuscular serum immune globulin injections (immunomodulator therapy), after obtaining their thorough written informed consent, which produced substantial and sustainable improvement in patient's quality of life.

Conclusion

Detection of mild-to-moderate acquired immune deficiency among postsurgical rhinosinusitis patients can lead to successful treatment and an improved quality of life.
A Retrospective Analysis of Treatment Outcomes and Time to Relapse after Intensive Medical Treatment for Chronic Sinusitis
Authors: Subramanian Hamsa N. , Schechtman Kenneth B. , Hamilos Daniel L.
Published: August 2018

Background

Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment. We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy. Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse.

Methods

Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids). After intensive medical therapy, adjunctive medical therapy was continued. A sinus computed tomography was performed at baseline and 6–8 weeks later and scored for extent of disease. Pre- and posttreatment symptom scores also were assessed. Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids.

Results

Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen. Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment. A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores. Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively). In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse.

Conclusion

Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks. A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms. In contrast, the presence of atopy, a history of asthma, or persistent OMU obstruction was not associated with earlier relapse. Although long-term benefits have not been established, a prospective study of treatment outcomes from intensive medical treatment appears to be warranted.
Complications of Hydroxyapatite Use for Transnasal Closure of Cerebrospinal Fluid Leaks
Authors: Stankiewicz James A. , Vaidya Abhay M. , Chow James M. , Petruzzelli Guy
Published: August 2018

Background

Hydroxyapatite cement (HAC) was first introduced in the 1980s as a new method for bone replacement. However, it has not been recommended for use in areas exposed to air. Despite this, surgeries have been performed using HAC to close nasal/sinus cerebrospinal fluid (CSF) leaks or in the treatment of encephaloceles.

Methods

This study retrospectively documented four patients in whom HAC was used for closure of ethmoid and sphenoid sinus CSF leaks.

Results

This study showed that exposed hydroxyapatite could be extremely problematic resulting in scarring, chronic granulation, infection, and prolonged healing. Oftentimes, revision surgery was necessary to help control the reaction to hydroxyapatite.

Conclusion

Because of the frequent complications occurring with use of hydroxyapatite in the paranasal sinuses, its use should be limited to selected individuals in whom difficulty in achieving closure of the CFS leak could be anticipated and in whom adequate tissue coverage could be provided.
The Human Vomeronasal Organ: Part IV. Incidence, Topography, Endoscopy, and Ultrastructure of the Nasopalatine Recess, Nasopalatine Fossa, and Vomeronasal Organ
Authors: Bhatnagar Kunwar P. , Smith Timothy D. , Winstead Welby
Published: August 2018

Background

Previous reports on the human vomeronasal organ (VNO) have been inconsistent. Observations of fossae on the nasal septum have been reported as the VNO.

Methods

Adult human subjects (210) and cadavers (31) were examined using rigid nasal endoscopy, serial histology, and biopsy ultrastructure (5).

Results

The nasopalatine fossa (NPF) and the nasopalatine recess (NPR) are discrete, but variable, structures located adjacent to the VNO region. The NPF is not a vomeronasal pit. A septal mucosal pit could hide the vomeronasal duct opening. The VNO is a submucosal structure located 2–8 mm superior to the NPR and cannot be positively identified either macroscopically or endoscopically.

Conclusion

The VNO has long been mistaken for the NPF and septal mucosal pits. We show that serial histology is the correct method for identifying the VNO.
Microbiology of Middle Meatus in Chronic Rhinosinusitis
Authors: Araujo Elisabeth , Palombini Bruno C. , Cantarelli Vladimir , Pereira Alexandre , Mariante Afonso
Published: August 2018

Background

Nasal endoscopy allows the collection of middle meatus secretion samples and is an alternative method for determining microorganisms in rhinosinusitis. This study assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with ipsilateral maxillary sinus aspirates and microbiological data of healthy individuals.

Methods

Middle meatus samples were collected from 114 CRS patients for aerobic, anaerobic, and fungal cultures; maxillary sinus secretions were collected from 13 of these patients. Twenty-three healthy volunteers served as controls.

Results

Aerobes were isolated in 86% of CRS patients, anaerobes were isolated in 8% of CRS patients, and fungi were isolated in 11% of CRS patients; the most frequent microorganisms were Staphylococcus aureus (36%), coagulase-negative Staphylococcus (20%), and Streptococcus pneumoniae (17%). Middle meatus and maxillary sinus cultures presented the same pathogens in 80% of cases. In healthy individuals, coagulase-negative Staphylococcus (56%), S. aureus (39%), and S. pneumoniae (9%) were the most frequent isolates.

Conclusion

The culture of endoscopically collected middle meatus secretions is effective in identifying microorganisms in CRS patients.
Outcome in Patients with Chronic Sinusitis after the Minimally Invasive Sinus Technique
Authors: Catalano Peter , Roffman Eric
Published: August 2018

Background

Controversy persists regarding the use of minimally invasive sinus techniques (MIST) to treat chronic sinusitis primarily because of an absence of comparative outcome data.

Methods

In this prospective study of 85 patients with chronic sinusitis treated surgically with MIST, the long-term postoperative outcome was assessed using the duration-based Chronic Sinusitis Survey (CSS) quality of life instrument. Patient age ranged from 4 to 81 years old (mean age, 42 ± 16.7 years). Forty-three subjects were male patients and 42 were female patients. Mean follow-up time was 23.8 ± 2.2 months.

Results

At follow-up, there was a 124.0% improvement in the mean CSS symptom score (p < 0.00001), a 30.1% improvement in the mean CSS medication score (p < 0.00001), and a 62.0% improvement in the mean CSS total score (p < 0.00001). An overall improvement was found in 78.8% of patients; 12.9% of patients were worse and 8.2% of patients were unchanged. Thirty-four patients (40.0%) had postsurgical CSS total scores within the normative interquartile range obtained in healthy controls. Twenty-six of these patients had postsurgical scores that actually surpassed the mean normative CSS total score. Before follow-up evaluation, 5 of the 85 patients (5.9%) had revision surgery after the initial procedure. All had revision MIST procedures and all were found to have an overall improvement at the time of follow-up.

Conclusion

We conclude that MIST significantly improves the outcome in patients with chronic sinusitis and should strongly be considered as the initial surgical option for such patients.
Rhinoplasty from the Goldman/ Cottle Schools to the Present: A Survey of 7447 Personal Cases
Authors: Stucker Fred J.
Published: August 2018

Background

To review the personal experience of a single surgeon over a 31 year period.

Method

A retrospective analysis of 7447 rhinoplasties performed by a single surgeon from 1969 to 2000. Ninety-five surgeries performed at educational courses were excluded from this series.

Results

During the many years of performing rhinoplasties, cartilage splitting, delivery, and external approach are among the most common techniques. In the first decade, 62% were cartilage splitting, 33% delivery, and 3% external. In the second decade, 13% were cartilage splitting, 58% delivery, and 26% external. In the third decade, 11% were cartilage splitting, 52% delivery, and 36% external.

Conclusion

Over a three-decade period, the techniques of the author have been influenced by national trends, training, and patient outcomes.
Sinonasal Osteocartilaginous Necrosis in Cocaine Abusers: Experience in 25 Patients
Authors: Trimarchi Matteo , Nicolai Piero , Lombardi Davide , Facchetti Fabio , Morassi Maria Laura , Maroldi Roberto , Gregorini Gina , Specks Ulrich
Published: August 2018

Background

Cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases.

Methods

From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. Serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase.

Results

Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti–proteinase 3 antibodies.

Conclusion

Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. Cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.
Long-Term Follow-Up of Patients with Microscopic Endonasal Dacryocystorhinostomy
Authors: Dietrich Christoph , Mewes Torsten , Kühnemund Matthias , Hashemi Basir , Mann Wolf J. , Amedee Ronald G.
Published: August 2018

Background

Stenosis of the nasolacrimal drainage system is a relatively frequent complication of acute or chronic inflammation, trauma, tumor, or congenital malformation. Symptoms include epiphora, intermittent purulent secretion, and swelling of the nasolacrimal sac. The principle of dacryocystorhinostomy (DCR) is to create an artificial opening of the lacrimal sac into the nasal cavity. This can be done via an external as well as an endonasal route.

Methods

In this retrospective study, we examined 74 microscopic endonasal DCRs, which were performed on 70 patients between 1990 and 2000. All of the 74 DCR operations had no major complications intraoperatively.

Results

Sixty DCR procedures (81.1%) were successful after a mean follow-up time of 3.18 years. This success rate is lower than those rates reported in the literature for the external approach, which range between 85 and 99%, although follow-up times were shorter in most of these studies.

Conclusions

Advantages of the endonasal approach such as saving the medial palpebral ligament, the lacrimal pump mechanism, and the horizontal apparatus are obvious. If necessary, additional management of sinus, septal, and conchal disease can be performed simultaneously. Our results reveal that the microscopic endonasal approach is a safe and reliable procedure in the management of postsaccular or saccular nasolacrimal duct obstruction and is an alternative to the traditional external route.
Endoscopic Anatomy of the Sphenopalatine and Posterior Nasal Arteries: Implications for the Endoscopic Management of Epistaxis
Authors: Schwartzbauer Heather R. , Shete Mona , Tami Thomas A.
Published: August 2018

Background

Refractory posterior epistaxis is a challenge for otolaryngologists. Most algorithms for managing this condition ultimately call for interrupting the arterial blood supply to the nasal mucosa. Traditionally, this was accomplished either by transantral arterial ligation or by arteriographic-guided embolization. More recently, the endonasal endoscopic approach has also been described. Because the primary blood supply to the posterior nasal cavity is derived from the terminal branches of the sphenopalatine and the posterior nasal arteries, we conducted this anatomic study to examine and describe the anatomic relationship of these two arteries as they exit the pterygopalatine fossa and enter the nasal cavity.

Methods

We performed endoscopic dissections of this anatomic region in nine fresh and one formalin-preserved cadaver specimens. A total of 19 sides were examined.

Results

In 3 of 19 specimens (16%), the sphenopalatine artery branched from the sphenopalatine artery within the sphenopalatine canal, allowing the two arteries to exit together. In 8 of the 19 specimens (42%), the sphenopalatine artery exited much more posteriorly, yet from within a shared posteriorly elongated sphenopalatine foramen. In the remaining eight specimens (42%), the sphenopalatine artery exited through a distinct foramen directly posterior to the larger sphenopalatine foramen.

Conclusion

Understanding this anatomic relationship is important in performing endoscopic arterial ligation. If the sphenopalatine artery is not specifically identified and ligated, an important component of the posterior nasal circulation will not be addressed adequately by this surgical approach.
Ventricular Tachycardia as an Electrocardiography Artifact during Functional Endoscopic Sinus Surgery
Authors: Gaiser Robert R. , Demetry Daphne J. , Schlosser Rodney
Published: August 2018

Background

Functional endoscopic sinus surgery is frequently performed during conscious sedation not provided by an anesthesiologist. Several monitors are used during conscious sedation, one of which is the electrocardiogram (EKG). Equipment used in the operating room may interfere with the EKG tracing.

Methods

A 30-year-old man underwent his fourth functional endoscopic sinus surgery during general anesthesia. For the procedure, a Xomed Straight Shot microdebrider was used.

Results

Because of stray electrical current, the use of the microdebrider caused the EKG waveform to resemble ventricular tachycardia.

Conclusion

This case alerts the clinician to this possible occurrence to prevent inappropriate therapeutics from being initiated.
Chronic Sinonasal Disease in Patients with Inflammatory Bowel Disease
Authors: Book David T. , Smith Timothy L. , Mcnamar Justin P. , Saeian Kia , Binion David G. , Toohill Robert J.
Published: August 2018

Background

The objective of this study was to explore the possible relationship between inflammatory bowel disease (IBD) and chronic sinonasal disease.

Methods

A cross-sectional study was undertaken of 241 patients with Crohn's disease (CD) or ulcerative colitis from a tertiary medical center IBD clinic. Patient demographic data and information regarding IBD diagnosis and management, sinonasal disease diagnosis and management, and complications related to these diagnoses were gathered by retrospective chart review and a standardized patient survey.

Results

One hundred sixty surveys (67%) were returned and analyzed. Overall, 48% of patients with IBD reported chronic sinonasal disease symptoms. Patients with CD had a higher prevalence of sinonasal disease than patients with ulcerative colitis (53% versus 32%; p < 0.02). The subgroup of CD patients with obstructive bowel complications had the highest prevalence of sinonasal disease (68% versus 27%; p = < 0.001), with 23% reporting chronic rhinosinusitis, 13% reporting chronic rhinitis, and an additional 32% reporting chronic nasal or sinus symptoms.

Conclusion

The prevalence of chronic sinonasal disease is elevated in patients with IBD, occurring in approximately one-half of patients followed at a tertiary IBD center. Patients with CD experiencing obstructive complications had significantly increased rates of sinonasal disease. The relationship between chronic sinonasal disease and obstructive CD is not defined, but several hypotheses are generated.
The Four Components of the Nasal Valve
Authors: Cole Philip
Published: August 2018

The nasal valve consists of four distinct airflow-resistive components. (i) The vestibule terminates in an airflow-resistive aperture between the septum and the caudal end of the upper lateral cartilage. Its cross-sectional area is stabilized by the cartilaginous structures and by inspiratory isometric contractions of alar dilator muscles. Its walls are devoid of erectile tissues that might otherwise affect its cross-sectional area and airflow resistance. By contrast, (ii) the bony entrance to the cavum is occupied by erectile tissues of both (iii) lateral (turbinate) and (iv) septal nasal walls that modulate the cross-sectional area of the airway and airflow resistance. The body of the cavum offers little resistance to airflow. Valve constrictions induce “orifice flow” of inspiratory air as it enters the body of the cavum, disrupting laminar characteristics and thereby enhancing exchanges with the nasal mucosa of heat, water, and contaminants. Acoustic rhinometric and rhinomanometric measurements show the sites, dimensions, and resistances of the valve constrictions and indicate that it is seldom necessary to extend septal and/or turbinate surgery far beyond the piriform aperture in the treatment of nasal obstruction.
An Assessment of Concentrations of Soluble CD4 and CD8 Receptors in Serum before and after Surgical Treatment in Patients with Chronic Maxillary Sinusitis
Authors: Olszewski Jurek , Chudzik Wiesław , Wiśniewski Kazimierz , Miłonski Jarosław , Matyja Robert
Published: August 2018

Background

The aim of this study was to assess the concentrations of soluble CD4 (sCD4) and sCD8 receptors in serum of patients before and after surgical treatment of chronic maxillary sinusitis.

Methods

We examined 57 patients, aged 20–63 years (mean age, 41 ± 0.5 years), and divided them into four groups: group I, 14 patients with chronic maxillary sinusitis without allergy; group II, 15 patients with chronic maxillary sinusitis with allergy; group III, 16 patients with cyst of maxillary sinuses without allergy (control); and group IV, 12 patients with cyst of maxillary sinuses with allergy (control). The assay of sCD4 and sCD8 receptor concentrations was performed by means of enzyme-linked immunosorbent assay method. The concentrations of sCD4 and sCD8 receptors before and after 30 days of surgical treatment of maxillary sinuses were examined.

Results

In our studies the increase of concentration of sCD4 in groups I and II in comparison with the concentration in control groups were statistically significant. The differences between mean concentrations of sCD8 in groups I and II and in the control groups were not statistically significant. After surgical treatment of chronic maxillary sinusitis, a significant decrease in values of sCD4 and sCD8 in comparison with the results before surgical treatment suggest that the measurement of cell suppression product concentration can be used to assess the extirpation of the inflammatory process and the effectiveness of the operation method.

Conclusion

Changes in concentration of sCD4 and sCD8 manifest activation or suppression of cells with particular receptor expression.
Paranasal Sinus Mucosal Regeneration: The Effect of Topical Retinoic Acid
Authors: Maccabee Mendy S. , Trune Dennis R. , Hwang Peter H.
Published: August 2018

Background

Paranasal sinus mucosa may suffer morphological and functional alterations as a result of surgical trauma. Mucosal stripping typically yields regenerated mucosa characterized by fibrosis, inflammatory infiltrate, and dysmorphic or absent cilia. The aim of this study was to determine the effect of topical retinoic acid (vitamin A) on regeneration of paranasal sinus mucosa.

Methods

Both maxillary sinuses of 12 New Zealand white rabbits were surgically opened and stripped of mucosa. Six rabbits received 0.01% topical retinoic acid gel treatment to the stripped left maxillary sinus (low concentration group). The remaining six rabbits received 0.025% topical retinoic acid gel to the stripped left maxillary sinus (high concentration group). The stripped right maxillary sinus of all 12 rabbits served as the operated, untreated control to reflect the normal healing process. Six other animals served as unoperated controls. The sinus mucosa was examined by light microscopy after 14 days.

Results

Untreated regenerated mucosa showed expected changes of submucosal gland loss, basal lamina and lamina propria fibrosis, cellular atypia, and loss of cilia. Topical retinoic acid treatment appeared to result in better mucosal regeneration marked by less cellular atypia and fibrosis. Although the regenerated mucosa was still grossly abnormal, the degree of ciliary loss and cellular derangement was reduced. The lower-concentration retinoic acid group had more favorable morphology than the higher-concentration retinoic acid group, and both were improved when compared with no treatment.

Conclusions

In a rabbit model, topical vitamin A in the form of retinoic acid gel appears to enhance regeneration of ciliated paranasal sinus mucosa. This preliminary study suggests that topical retinoids may have applicability in promoting sinus wound healing.
Comparison of Subject-Reported Allergy versus Skin Test Results in a Common Cold Trial
Authors: Krahnke Jason S. , Gentile Deborah A. , Cordoro Kelly M. , Angelini Betty L. , Cohen Sheldon A. , Doyle William J. , Skoner David P.
Published: August 2018

Background

Few studies have examined the relationship between subject-reported allergy and results of allergy skin testing in large unselected or unbiased cohorts. The objective of this study was to compare the results of self-reported allergy via verbal questioning with the results of allergy skin testing by the puncture method in 237 healthy adult subjects enrolled in a common cold study.

Methods

On enrollment, all subjects were verbally asked if they had a history of allergy and then underwent puncture skin testing to 19 relevant aeroallergens, as well as appropriate positive and negative controls. A skin test was considered positive if its wheal diameter was at least 3 mm larger than that obtained with the negative control.

Results

Forty-eight (20%) subjects reported a history of allergy and 124 (52%) subjects had at least one positive skin test response. A history of allergy was reported in 40 (32%) of the skin test-positive subjects and 8 (7%) of the skin test-negative subjects. At least one positive skin test response was found in 40 (83%) of those subjects reporting a history of allergy and 84 (44%) of those subjects denying a history of allergy.

Conclusion

These data indicate that there is a relatively poor correlation between self-reported history of allergy and skin test results in subjects enrolled in a common cold study. These results have implications in both clinical practice and research settings.
Coronal Computed Tomography Analysis of Frontal Cells
Authors: Meyer Tanya K. , Kocak Mehmet , Smith Michelle M. , Smith Timothy L.
Published: August 2018

Background

Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships.

Methods

Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified.

Results

In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01).

Conclusion

The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of frontal cells does not invariably lead to frontal sinusitis but may contribute to the mechanical obstruction of the frontal recess and should be appropriately addressed during the surgical management of frontal sinusitis.
Age-Related Olfactory Dysfunction: Cellular and Molecular Characterization in the Rat
Authors: Conley David B. , Robinson Alan M. , Shinners Michael J. , Kern Robert C.
Published: August 2018

Background

Olfactory receptor neurons (ORNs) undergo apoptosis at a baseline rate even in the absence of obvious disease. Although the precise triggers of the apoptotic cascade are unclear, ORNs are exposed directly to the external environment, making them susceptible to injury. As an adaptive mechanism, mammals have the ability to replace lost ORNs throughout adult life from neuronal precursors within the olfactory epithelium (OE). In humans, this process fails with age as the surface area of the OE and the number of ORNs decline, coupled with a loss of clinical olfactory function. The question addressed in this study is whether this age-related failure of olfactory sensation is a result of a decrease in neuronal proliferation or an increase in ORN cell death.

Methods

To begin to address this question the ribonuclease protection assay was used to assess expression of apoptosisrelated genes in rat OE as a function of age. Second, the terminal deoxynucleotide transferase end labeling assay was used to assess the percentage of ORNs undergoing apoptosis (apoptotic index) in three groups of animals: young (12 weeks), old (32 months), and bulbectomized rats. Bulbectomy is a standard model for ORN injury associated with a massive increase in ORN apoptosis and serves as a positive control.

Results

Ribonuclease protection assay data indicate an age-related increase in Bax, Bcl-xL, and procaspase-3 messenger RNA expression in aged compared with young rats. A similar but more pronounced increase in expression of these apoptotic-related genes is seen after bulbectomy. The terminal deoxynucleotide transferase end labeling assay also showed a statistically significant increase in the apoptotic index with both age and bulbectomy.

Conclusion

Taken together, the current results indicate that aging and injury induce parallel changes in OE. Furthermore, these findings support the hypothesis that age-related olfactory dysfunction is, at least in part, related to an increase in ORN cell death.
Effect of Asthma on Sinus Computed Tomography Grade and Symptom Scores in Patients Undergoing Revision Functional Endoscopic Sinus Surgery
Authors: Kountakis Stilianos E. , Bradley Dewayne T.
Published: August 2018

Background

The aim of this study was to determine the influence of asthma on sinus computed tomography (CT) grade, endoscopic appearance, and symptom scores in patients undergoing revision functional endoscopic sinus surgery (FESS).

Methods

Prospective data was collected of patients undergoing revision FESS at a tertiary medical center over a 2-year period. CT scans were graded as per the Lund and Mackay system. Patient symptom scores were recorded from the Sino-Nasal Outcome Test (SNOT 20) inventory and individual symptoms from the Rhinosinusitis Task Force major and minor symptom list were graded on a visual analog scale.

Results

Eighty patients underwent revision FESS and 20 of those patients had asthma. The average CT grade in asthmatic patients was 18.6 compared with 11.7 in patients who were nonasthmatic (p = 0.000006). The average SNOT 20 symptom score in patients with asthma was 49.6 and in nonasthmatic patients it was 44.9 (p = 0.238). Both asthmatic and nonasthmatic patients experienced a reduction in SNOT 20 symptom scores at 1 year with reductions of 70% (p = 0.0000)versus 72.6% (p = 0.0000), respectively.

Conclusion

Patients with asthma undergoing revision FESS had higher sinus CT grades compared with patients without asthma. Asthmatic and nonasthmatic patients had statistically significant reductions in symptoms scores after revision FESS. Asthmatic patients had similar symptomatic relief scores after revision FESS as compared with nonasthmatic patients.
The Impact of Ethanol and Tobacco Smoke on Intranasal Epithelium in the Rat
Authors: Vent Julia , Bartels Sande , Haynatzki Gleb , Gentry-Nielsen Martha J. , Leopold Donald A. , Hallworth Richard
Published: August 2018

Background

Investigations have shown the influence of ethanol and tobacco smoke on olfaction, epithelial metaplasia, and cancer formation in the head and neck. Analysis of ethanol and tobacco smoke-induced histopathological mucosal changes in the upper respiratory tract may provide important insight into the pathophysiology of secondary olfactory dysfunction.

Methods

Three groups of laboratory rats were experimentally exposed to either ethanol, tobacco smoke, or both, with a control group having no such exposure.

Results

Compared with controls, histopathological analysis of nasal mucosa in exposed rats revealed a decrease in the length of olfactory epithelium, especially in the rats exposed to both ethanol and tobacco smoke. Structural changes included loss of cilia and metaplasia.

Conclusion

The histological changes noted in rats after ethanol and tobacco smoke exposure, if relevant to human physiology, could explain the decreased olfactory ability seen in patients who use these products.
Nasal Cytology: Description of a Hyperchromatic Supranuclear Stria as a Possible Marker for the Anatomical and Functional Integrity of the Ciliated Cell
Authors: Gelardi Matteo , Cassano Pasquale , Cassano Michele , Fiorella Maria Luisa
Published: August 2018

Background

The aim of this study was to describe a particular intracellular hyperchromatic formation located over the nucleus of normal nasal ciliated cells. This finding, never described in literature, very rarely occurs in pathological conditions.

Methods

A nasal cytological test and mucociliary transport test were performed in a group of 24 subjects with rhinologic diseases and in a control group of 10 healthy subjects.

Results

The “hyperchromatic supranuclear stria” (SNS) was observed in a high percentage of normal cells (90.3%); SNS was present in very few pathological subjects (in only 6.26% of pathologic cells).

Conclusion

We interpreted SNS as a specific marker for the anatomic and functional integrity of the ciliated cell. Therefore, the absence of SNS is considered an abnormal finding in the nasal mucosa and therefore could be useful as a “prognostic sign” of the disorders themselves and as an indication of the “therapeutic efficacy” of pharmacologic treatments, both topical and systemic.
Minimally Invasive Treatment of the Nasal Inverted Papilloma
Authors: Llorente José L. , Deleyiannis Fred , Rodrigo Juan P. , Nuñez Faustino , Ablanedo Pilar , Melón Santiago , Suárez Carlos
Published: August 2018

Background

The purpose of this work is to evaluate our results in the treatment of the nasal inverted papillomas with an endoscopic approach using a retrospective case series.

Methods

Between 1993 and 2000 we treated 27 patients with nasal inverted papillomas. All patients underwent endoscopic nasal surgery under general anesthesia. None of the inverted papillomas extended outside of the paranasal sinuses. All tissue samples underwent polymerase chain reaction and hybridization in situ to detect genetic sequences of the human papilloma virus and Epstein Barr virus.

Results

The study population consisted of 16 men and 11 women with a median age of 52 years (range, 22–77 years). Ten patients (37%) had undergone a previous nasal surgery. The median follow-up was 5 years (range, 2–8 years). None of the patients presented with bilateral nasal involvement or a synchronous carcinoma. Seven patients underwent an additional surgical approach (two endoscopic approaches via a Caldwel-Luc approach, four sublabial approaches via a Caldwel-Luc approach, and one external ethmoidectomy). There were no surgical complications. Two patients (7%) had recurrent papilloma 4 and 6 years after surgery and again underwent endoscopic resection. The amplification both by polymerase chain reaction and hybridization in situ for human papilloma virus and Epstein Barr virus were negative in the specimens from all patients.

Conclusions

According to the literature and our own experience, we believe that the initial surgical management of primary and recurrent inverted papillomas limited to the nasal cavity and paranasal sinuses should be endoscopic sinus surgery.
Sellar Reconstruction: Is it Necessary?
Authors: Sonnenburg Robert E. , White David , Ewend Matthew G. , Senior Brent
Published: August 2018

Background

Sellar reconstruction is practiced routinely during the transsphenoidal approach to pituitary tumor resection. This practice exposes the patient to risks of donor site complications and may interfere with measuring postoperative tumor reduction. We propose that it is not a necessary component of transsphenoidal pituitary surgery in the absence of intraoperative cerebrospinal fluid (CSF) leak.

Methods

A retrospective chart review of 45 cases of minimally invasive pituitary surgery were reviewed. Twenty-eight cases were identified with no sellar reconstruction being performed. Age, sex, revision surgery, postoperative CSF leak, days with lumbar drain, meningitis, ophthalmoplegia, visual acuity loss, postoperative epistaxis, diabetes insipidus, development of empty sella syndrome, and length of stay were investigated in these cases.

Results

Twenty-three cases were the primary procedure and five cases were revision surgery. Complication rates were low and compared favorably with those reported in the literature. Five cases of transient diabetes insipidus occurred. There was one postoperative CSF leak that required 4 days with a lumbar drain. No cases of empty sella syndrome developed. There were no cases of meningitis. The average length of stay was 2.9 days.

Conclusion

Sellar reconstruction during transsphenoidal approach to pituitary tumor resection is not required for patients without evidence of an intraoperative CSF leak. This practice exposes the patient to the risks of donor site complications without reducing the rate of postoperative complications.
Objective Testing and Quality-of-Life Evaluation in Surgical Candidates with Chronic Rhinosinusitis
Authors: Smith Timothy L. , Rhee John S. , Loehrl Todd A. , Burzynski Mary L. , Laud Prakash W. , Nattinger Ann B.
Published: August 2018

Background

Discordance has been reported between patient symptoms and objective measures of disease in chronic sinusitis, such as radiographic evaluation. The objective of this study was to evaluate the association between presurgical objective studies and presurgical quality of life (QOL). This work was designed as a cross-sectional study of 90 consecutive patients presenting to a tertiary rhinology practice for surgical management of sinonasal disease.

Methods

QOL assessment was performed using disease-specific instruments (Chronic Sinusitis Survey and Rhinosinusitis Disability Index). Computed tomography (CT) scans were scored according to the Lund-Mackay CT scoring system and endoscopy evaluation was scored by the system proposed by Lund and Kennedy.

Results

Ninety surgical candidates were enrolled and included in the analysis. Correlation between the QOL total scores and subscale scores was excellent (r = 0.39; p = 0.0001) as was the correlation between CT and endoscopy scores (r = 0.59; p = 0.0001). In contrast, correlation between QOL and objective measures was poor. These results were not significantly influenced by subgroup analysis by diagnosis, comorbidity, and other patient factors.

Conclusion

Preoperative objective measures of CRS disease show little, if any, correlation with disease-specific QOL measures in surgical candidates. It is likely that CT and endoscopy are measuring a different aspect of CRS disease than the QOL measures. In addition, it is possible that preoperative QOL, either alone or in combination with CT and endoscopy, may prove important in selecting patients most likely to benefit from surgery.
A Comparison of the Efficacy of Telithromycin versus Cefuroxime Axetil in the Treatment of Acute Bacterial Maxillary Sinusitis
Authors: Buchanan Patricia P. , Stephens Thad A. , Leroy Bruno
Published: August 2018

Background

Telithromycin, a new ketolide, exhibits potent activity against respiratory pathogens, including resistant strains.

Methods

Five days of telithromycin (800 mg once daily) was compared with 10 days of cefuroxime axetil (250 mg twice daily) in subjects (n = 593) with acute bacterial maxillary sinusitis (ABMS). Bacteriologic sampling was accomplished by sinus puncture or nasal endoscopy. The primary efficacy variable was clinical outcome at the posttherapy/test-of-cure evaluation in clinically evaluable patients.

Results

Clinical cure was achieved in 85.2% of telithromycin patients and 82.0% of cefuroxime axetil patients (difference in proportions, 3.2%; 95% confidence interval, 27.1–13.4%). Satisfactory bacteriologic response rates were comparable. Treatment-emergent adverse events for both drugs were mild or moderate. The most frequently reported treatment-emergent adverse events were nausea and diarrhea.

Conclusion

Once-daily telithromycin for 5 days was equivalent in efficacy to twice-daily cefuroxime axetil for 10 days in patients with ABMS. Telithromycin is a suitable option for short-course therapy of ABMS.
Particle Deposition of Therapeutic Aerosols in the Nose and Paranasal Sinuses after Transnasal Sinus Surgery: A Cast Model Study
Authors: Saijo Ryuichiro , Majima Yuichi , Hyo Noboru , Takano Hiroshi
Published: August 2018

Background

The topical administration of steroids or antibiotics to the nose and the sinuses is one of the important postsurgical therapies of endoscopic sinus surgery (ESS).

Methods

To investigate the effective deposition of aerosols in the paranasal sinuses after ESS, we restored the human nasosinus model that underwent ESS and studied the particle depositions on the ostiomeatal complex (OMC), maxillary, and ethmoid sinuses quantitatively.

Results

A 45° nozzle insertion angle significantly increased the particle depositions more than the 30° angle (p < 0.05). A computer simulation-assisted analysis shows that the inertial deposition at OMC increased with a nozzle angle of 45° versus 30°. The particles with 5.63 mm in diameter significantly deposit on OMC and maxillary sinus compared with the particles with 16.37 mm (p < 0.05).

Conclusion

The topical administration of drugs to the paranasal sinuses postoperatively must be performed in consideration with aerodynamics of aerosols.
Treatment of Allergic Rhinitis during Pregnancy
Authors: KeleSl Nesil
Published: August 2018

Background

Allergic rhinitis (AR) affecting ∼20–30% of women in childbearing age can be considered one of the most common group of medical conditions that complicate pregnancy. AR with symptoms of nasal obstruction, sneezing, and itching may require pharmacotherapy. However, there are concerns regarding the safety of different available agents that can be used during pregnancy with respect to both maternal and fetal well being.

Conclusions

The best first-line approach in the management of AR is avoidance of allergens. If environmental modification is ineffective, then the pharmacologic agents should be chosen. For symptoms of rhinorrhea, sneezing, or itching, intranasal cromolyn, with its excellent safety profile, should be considered as first-line therapy. If cromolyn is ineffective or poorly tolerated, first-generation (e.g., chlorpheniramine and tripelennamine) and second generation (e.g., cetirizine and loratadine) antihistamines can be given. Intranasal steroids (e.g., beclomethasone dipropionate, and budesonide) can be added to first-line therapy especially for severe nasal obstruction. There are no epidemiological studies with newer intranasal steroids (e.g., flunisolide, triamcinolone acetonide, fluticasone propionate, and mometasone furoate) during the first trimester of pregnancy. Immunotherapy has not proven to be teratogenic and is clinically useful in improving symptoms. Oral and topical decongestants can be considered as second-line therapy, for short-term relief, when no safer alternative is available.
A Post-Traumatic Nasal Epidermoid: An Endoscopic Approach
Authors: Colreavy Michael P. , Oleary Stephen J. , Mckelvie Penny A.
Published: August 2018

Background

Epidermoid cysts are thought to arise as a result of implantation of epidermal cells into the deeper dermal elements. These cysts have previously been described postsurgery but not after accidental nasal trauma.

Methods

We outline a case of a nasal epidermoid occurring post-blunt nasal trauma and its subsequent excision.

Results

The lesion was excised successfully endoscopically without recourse to an open technique.

Conclusion

We describe, for the first time, the successful intranasal removal of a post-traumatic epidermoid cyst via an endoscopic approach.
Invasive Fungal Sinusitis: A 15-Year Review from a Single Institution
Authors: Parikh Shatul L. , Venkatraman Giridhar , Delgaudio John M.
Published: August 2018

Background

The aim of this study was to review our experience with patients with invasive fungal sinusitis (IFS) to determine outcomes and identify factors that may affect patient survival.

Methods

A retrospective review was performed.

Results

Forty-three patients were identified accounting for 45 cases of IFS. The underlying reasons for immunosuppression were hematologic malignancy (28 patients), diabetes mellitus (10 patients), solid organ transplant (3 patients), chronic steroid use (3 patients), and acquired immunodeficiency syndrome (1 patient). Eight of 45 cases (18%) died of IFS. Of the 28 cases associated with hematologic malignancy, 3 patients died of IFS (11%) and 4 patients (14%) died of other causes with persistent IFS. None of these 7 patients had recovery of their absolute neutrophil count, and all patients who recovered from IFS recovered to a normal absolute neutrophil count. Four of 10 (40%) diabetic patients died of IFS, and 66% of survivors had persistent neurological or visual morbidity. The mortality rate was 29% for patients infected with Mucor and 11% for patients infected with Aspergillus.

Conclusion

We have found the overall mortality rate directly related to IFS to be 18%. The rate is higher for diabetic patients than for patients with hematologic causes for their immunosuppression. This is likely because of the higher index of suspicion and early diagnosis and treatment of patients with neutropenia and a less-fulminant, slower-progressing form of IFS from Aspergillus, apparently a less virulent fungus than Mucor. Intracranial involvement and failure to recover from neutropenia are the factors that led to poor prognosis in this series.
Myeloperoxidase in Nasal Secretion as a Cell-Activation Marker in Acute Sinusitis
Authors: Haxel Boris R. , Woywode Claudia , Mewes Torsten , Mann Wolf J.
Published: August 2018

Background

Acute bacterial infections of the upper respiratory tract, including the nasal sinuses, lead to an activation of neutrophil granulocytes. The protein myeloperoxidase (MPO) is released by this cell type only and therefore can act as a marker for activity of inflammation.

Methods

In a prospective multicenter study, 45 patients with acute bacterial sinusitis (diagnosed by clinical examination, ultrasonography, and X ray or computed tomography scan) were treated with two different antibiotics (Cefditoren or Cefuroxim twice a day for 10 days). Nasal secretions were collected with absorbing foam-rubber samplers and a concentration of MPO was evaluated before the therapy and after 7 ± 1 days and 14 ± 2 days of antibiotic treatment. The concentrations of MPO were measured by a radioimmunoassay method and the dilution factors were determined by the lithium method.

Results

Significant differences in the MPO concentration in nasal secretions between the first and third visit could be found in both groups (p < 0.01 each). No significant difference was seen within the two different antibiotics used.

Conclusion

Measurement of MPO concentration in nasal secretions showed a significant change after antibiotic treatment of acute bacterial rhinosinusitis. The reduction of MPO levels correlated with the observed clinical and radiological improvement of the disease. Additional investigations are needed to achieve more knowledge about basal concentrations of MPO in healthy persons and different activation patterns before it can be determined whether the MPO measurement could be a suitable method for monitoring the success of an antibiotic treatment in acute bacterial sinusitis.