bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Recurrent Sinus Barotrauma in Aviators: Comparison of Functional Endoscopic and “Classic” Sinus Surgery Techniques
Authors: Bolger William E. , Parsons David S.
Published: September 2007

Recurrent sinus barotrauma in an aviator is difficult to treat successfully. Exacerbation frequently results in marked discomfort, cycles of temporary restriction from aviation duties, or even permanent disqualification from flight duties. Medical management and “classic” sinus operations are often ineffective and seldom curative and have a disappointing record in returning the aviator to flying duties. Conversely, detailed computed tomographic scanning of the paranasal sinuses coupled with the functional endoscopic sinus surgery approach directs treatment at the causative pathologic condition, thereby improving sinus ventilation and making possible a return to active flight status without recurrence of sinus barotrauma. Initial experience with the functional endoscopic sinus surgery technique in such a patient population is reported and its effectiveness is compared to that of classic sinus surgeries, such as Caldwell-Luc and frontal sinus trephination, in treating aviators with recurrent sinus barotrauma.
Recent Advances in the Microbiology of Sinusitis and Their Relation to Persistent Ethmoidal Inflammation
Authors: Robinson Philip J. , East C. A. , Scott G. M.
Published: September 2007

The organisms that commonly cause acute sinusitis have been found to produce a number of factors which may be involved in the transition to a state of chronicity. These factors, combined with increasing ostial obstruction caused by tissue inflammation, propagate a hypoxic environment which favors pathogen survival at the expense of host defenses. Bacterial toxins and hypoxia disrupt the mucociliary clearance system. Both aerobic and anaerobic organisms produce proteases, which may act synergistically to cause immune subversion and prevent opsonization. We have studied the role of bacteria in persistent ethmoid mucosal inflammation in 13 patients undergoing endoscopic endonasal surgery for recurrent acute or chronic sinusitis and found that in 46% of samples there was no significant growth of bacteria but in 33% there was a significant growth of anaerobes. There appeared to be little evidence for synergistic activity between aerobes and anaerobes. Mucosal apposition may account for persistent inflammation in those cases without any significant growth. There is no evidence that the ethmoid sinus acts as a reservoir for reinfection, and it appears likely that acute exacerbations in chronic sinusitis are caused by viral infection. Treatment should be aimed at restoring the host's mucosal defenses either medically with topical decongestants or surgically by endoscopic endonasal surgery. Recurrent courses of antibiotic treatment are not indicated.
Effects of Posture on the Nasal Cycle
Authors: Hasegawa Makoto , Ohki Motofumi , Kurita Nobuhiko
Published: September 2007

The effects of posture on the nasal cycle were studied in 26 normal subjects whose spontaneous nasal cycle had been confirmed before the experiment. Nasal resistance was measured by anterior rhinomanometry with nozzles. With 14 subjects, the changes in nasal resistance were observed consecutively on changing from sitting to supine and from supine to sitting. Six reversals of the cyclic phase occurred in 56 postural changes (reversal rare: 10.7%). The reversal occurred once per 2.9 hours. By contrast, with 12 subjects, 27 reversals were induced in 60 postural changes (reversal rate: 45%), on changing from one lateral recumbent position to the other. The reversal occurred once per 27 minutes. Lateral recumbency tends to switch the phase of the cycle and affects its duration.
New Ideas in Allergen-Specific Immunotherapy
Authors: Mailing Hans-Jørgen
Published: September 2007

Immunotherapy represents the only allergen-specific treatment of allergic diseases. The clinical efficacy has been documented in a number of studies involving both rhinitis and asthma patients, although because of the multifactorial pathophysiology including hyperresponsiveness, asthma may not respond as satisfactorily as rhinitis. Owing to the capacity to reduce the release of allergic mediators and thereby the allergic inflammation, immunotherapy has advantages over the nonspecific drug treatment primarily interfering at the target level of mediators. The clinical efficacy may be improved and the risk of side effects reduced by the use of modified allergens or by immunological manipulation in parallel with allergen administration.
Stimulation of Mucociliary Activity by Substance P and Capsaicin is Not Mediated by Histamine
Authors: Dolata Jan , Lindberg Sven , Mercke Ulf
Published: September 2007

The mucociliary activity in the rabbit maxillary sinus is stimulated by exogenous substance P and by histamine (via H1 receptors). Also, endogenous substance P released by capsaicin stimulates the mucociliary activity. A substance P-induced release of histamine has been reported. The possibility that the mucociliary stimulation by substance P is secondary to a release of histamine was investigated using a photoelectric technique. For both substance P (0.01, 0.1, and 1.0 μg/kg) and capsaicin (15 and 30 μg/kg), neither the maximum mucociliary response nor the time-course curve was affected by pretreatment with the H,-antagonist pyrilamine (4 mg/kg). It is concluded that the mucociliary effects produced by substance P and capsaicin are not secondary to a release of histamine.
Sinobronchial Syndrome in Japanese People
Authors: Suzaki Harumi , Kudoh Shoji , Sugiyama Yukihiko , Maeda Hiroo , Nomura Yasuya
Published: September 2007

Sinobronchial syndrome (SBS) involves the coexistence of chronic rhinosinusitis and chronic lower airway inflammation. In Japanese patients, the lower airway lesions may be diffuse panbronchiolitis (DPB), chronic bronchitis, or chronic bronchiectasis. DPB is chronic inflammation of the region around the bronchioles, particularly the respiratory bronchioles, and seems to occur mostly in Japanese. The frequency of occurrence of SBS was 32 (10.4%) in 307 patients seen for chronic rhinosinusitis and 41 (55.4%) in 74 patients seen for chronic lower airway inflammatory disease. In many patients with SBS, the nasal symptoms appeared in childhood and the bronchial symptoms (coughing and expectoration) appeared in or after adolescence. Long-term follow-up of patients who underwent sinus surgery after the onset of SBS showed poor postoperative improvement of the lower airway symptoms. Correlation was strong between SBS and HLA-Bw54, an antigen found specifically in Mongoloids (corrected p value (pc), 3.88 × 10–7; relative risk (KR), 7.03). Correlation of HLA-Bw54 with DPB was stronger than with SBS as a whole (pc, 2.23 × 10–6; RR, 11.00). These results suggested that SBS, and particularly DPB, is a disease strongly dependent on a genetic diathesis in Japanese people.
Posterior Rhinometry as a Rapid Screening Test for Nasal Dysfunction
Authors: Schwartz Howard J. , Arnold Jean L. , Decker Michael J. , Hoekje Peter L. , Strohl Kingman P.
Published: September 2007

During two 3-day health fairs, 100 people agreed to perform posterior rhinometry and complete a brief screening questionnaire. Rhinometry curves were technically uninterpretable in 18 subjects (18%). Of those with acceptable data, mean nasal resistance, defined as the ratio of pressure over flow at 0.4 liters/sec was 5.09 ± 6.60 cm H2O/L/sec (mean ± 1 SD, n = 82). Nasal resistance in male subjects (n = 34) was significantly lower than in female subjects (n = 48). Values for nasal resistance were independent of a history for seasonal symptoms, snoring, asthma, atopy, and allergies including hay fever, either with each variable taken alone or taken in combination. We conclude that approximately 18% of naive subjects may not be able to perform posterior rhinometry without more extensive coaching and that outside the clinical laboratory there often may be no correlation between clinical history and objective measurements of nasal resistance.
Bioelectric Properties of Cultured Nasal Polyp and Turbinate Epithelial Cells
Authors: Bernstein J. M. , Cropp G. A. , Nathanson I. , Yankaskas J. R.
Published: September 2007

Epithelial cells isolated from nasal polyps and inferior turbinates from patients with cystic fibrosis (CF) and without CF were studied on permeable collagen matrices. Transepithelial potential difference and resistance were measured daily, and the equivalent short-circuit current was calculated from Ohm's law. CF polyp and CF turbinate samples had higher transepithelial potential differences than the corresponding non-CF samples, as has been previously reported. However, polyp-derived epithelium appeared to have a greater rate of transepithelial ion transport than turbinate-derived epithelium in both CF and non-CF patients. This may reflect differences in excision techniques, different distribution of cell types, or persistent effects of inflammatory mediators in polyp samples. It is suggested that mediators of inflammation that are known to be present in nasal polyps may have an effect on regulating ion transport in nasal polyp epithelium. This, in turn, could have an effect on movement of water into the cell and into the interstitial tissue, causing edema, which is the most prominent histopathological finding in nasal polyps.
The Efficacy and Safety of Nedocromil Sodium 1% Nasal Solution in the Treatment of Ragweed Seasonal Allergic Rhinitis
Authors: Schwartz Howard J. , Ellis Lorraine D. , Sher Theodore H.
Published: September 2007

The safety and efficacy of nedocromil sodium 1% nasal solution in the treatment of patients with ragweed seasonal allergic rhinitis was assessed in a double-blind group-comparative study. After a 1-week baseline period that coincided with the start of the ragweed season, patients were randomized to receive either nedocromil sodium 1% nasal solution or matched placebo (1 spray per nostril q.i.d.) for 8 weeks. The primary efficacy variable was the mean daily diary card symptom score for the 3-week peak pollen period. During this time, patients treated with nedocromil sodium showed a significant decrease in sneezing, runny nose symptoms, and sleep disturbances compared with the placebo group. Furthermore, the patient's and physician's assessments of the drug efficacy showed significant differences favoring the nedocromil sodium treatment. No serious adverse experiences were reported during the study. Both groups reported transient minor adverse experiences including sneezing and nasal irritation. Nedocromil sodium was effective in relieving symptoms associated with seasonal allergic rhinitis during peak ragweed seasonal challenge without significant adverse effects.
Endoscopic Surgical Approach for Antrochoanal Polyps
Authors: Chandrasekhar Sujana S. , Jacobs Joseph B.
Published: September 2007

The endoscopic surgical technique for the removal of antrochoanal polyps is a safe and effective method with minimal morbidity. We present our results in 14 patients treated with this approach. The follow-up time ranged from 3 months to 3 years with an average of 2 years. All patients are symptom free with normal appearing maxillary sinus mucosa on office endoscopy. Only two patients required a Caldwell-Luc procedure. There were no complications in our series. We recommended the endoscopic surgical technique for the management of the antrochoanal polyp.
Intraepithelial Cell Population in the Allergic Nasal Mucosa
Authors: Okuda Minoru , Yen Chen-Hsien , Okubo Kimihiro , Fooanant Supranee , Ikeda Masakazu , Pawankar Ruby
Published: September 2007

Intraepithelial migrating cells are presumed to play an important role in nasal mucosal immunity because these are the first to come into contact with various foreign particles inhaled and deposited on the nasal surface.

To elucidate nasal mucosal immunity, we carried out a quantitative study of the overall population of migrating cells and the lymphocyte subsets in the epithelial compartment of nasal mucosa in patients with house-dust nasal allergy, in patients with nonallergic rhinitis (chronic infectious rhinitis) and “normal” persons (as controls), using both light and electron microscopy in combination with an immunoperoxidase technique. Scrapings from the inferior turbinates were collected for examination of the epithelium.

In order of predominance, the most numerous migrating cells were lymphocytes, followed by eosinophils, mast cells, neutrophils, and macrophages in the allergy group; in the nonallergy group neutrophils, lymphocytes, followed by macrophages and eosinophils; and in the normal group lymphocytes were the most predominant. Electron microscopic observation revealed globule leukocytes in addition to the other cells. In subjects with nasal allergy, the migrating cell population in nasal secretion differed from scrapings, in that neutrophils and eosinophils were predominant. In our study of the lymphocyte subsets, although CD8+ cells (suppressor/cytotoxic T cells) were the most numerous (followed by CD16+ [natural killer cells], CD4+ [helper/inducer T cells] and CD21+ [B cells] in that order of predominance in the epithelium), no difference was noted in number among CD4+, CD8+, and CD16+ cells in nasal secretions.

On the basis of their ultrafine structure, many CD8+ cells and some CD4+ cells had the morphological appearance of activated lymphocytes. Lymphocytes, mast cells, and globule leukocytes, all of which reside in the allergic nasal epithelium, are likely to be involved in the nasal mucosal immunity.
The Effect of Intranasal Oxymetazoline on Serum Levels of Cocaine after Intranasal Cocaine Application
Authors: Huerter James V. , Lydiatt William M. , Gupta Sanjay K. , Earl Robert A. , Dickson Philip H. , Chapin James W. , Becker Gerald L.
Published: September 2007

A prospective analysis was performed on healthy volunteers to determine whether pretreatment with the vasoconstrictor, oxymetazoline, could decrease the blood concentration of cocaine topically applied to the nasal mucosa. Blood pressure, pulse, continuous ECG recordings, and participant responses also were monitored as an indicator of systemic effects. Anesthesia was roughly assessed using a sterile 22-gauge needle touched to the anterior aspect of the inferior turbinate. Blood samples drawn at predetermined intervals were analyzed for cocaine using gas chromatography. Pretreatment with oxymetazoline significantly reduced the rate and extent of the increase in blood cocaine levels and resulted in a statistically significant lower systolic blood pressure and pulse rate. There was no significant difference in topical anesthesia between the two groups. Pretreatment with oxymetazoline before application of nasal cocaine thus appears to be beneficial.
Upper Lid Crease Approach to the Medial Orbit and Ethmoid
Authors: Mann Douglas G.
Published: September 2007

A new approach to the ethmoid sinus through the upper lid crease affords superior cosmesis over other techniques when an external approach is indicated. In a series of six patients, only one had to be converted to a Lynch incision because of a lack of sufficient exposure. No serious complications occurred.
Local Capsaicin Treatment of the Nasal Mucosa Reduces Symptoms in Patients with Nonallergic Nasal Hyperreactivity
Authors: Stjärne Pär , Lundblad Lars , Änggård Anders , Lundberg Jan M.
Published: September 2007

Ten patients with nonallergic nasal hyperreactivity were selected from the outpatient department at the ENT clinic of the Karolinska Hospital. Traditional treatment had been ineffective. Local capsaicin treatment (30 μM solution) was performed on 3 consecutive days after careful nasal decongestion and local anesthesia with naphazoline and lidocaine. The treatment was evaluated using a diary where the patients were asked to score their subjective symptoms of nasal discharge, nasal blockage, and sneezing on a visual analogue scale. At the follow-up, the desensitization to local capsaicin application of the nasal mucosa was also tested. After 1 month the patients reported a 63% and 69% reduction of nasal blockage and nasal discharge respectively, which was parallel to a desensitization of the nasal mucosa to capsaicin. The results were similar after 3 months. After 6 months the patients had reverted to a score similar to that before the treatment. At this time the response of the nasal mucosa to capsaicin was normalized. In conclusion, capsaicin treatment of the nasal mucosa in patients with nonallergic nasal hyperreactivity induces a long-lasting reversible desensitization and a parallel subjective reduction of symptoms.
Osteotomy Drainage in Rhinoplasty
Authors: Ron Cannon C.
Published: September 2007

An osteotomy drainage system has been developed that decreases the edema and ecchymosis associated with lateral osteotomy during rhinoplasty. A prospective randomized trial has indicated a statistically significant improvement in terms of periorbital edema and ecchymosis postrhinoplasty in patients in whom the osteotomy drainage tube is used. It is simple in design, cost effective, and easily inserted at the time of surgery.
A Review of the Rhinological Manifestations in Children with Cystic Fibrosis
Authors: Morgan D. W. , Drake-Lee A. B.
Published: September 2007

This review looks at the natural history and the treatment of the nasal sinus manifestations of cystic fibrosis in childhood. Polyps are more common in boys and are associated with the respiratory rather than the gastrointestinal manifestations of the disease. The sinuses are radiopaque in all cases, and organisms are rarely cultured, the latter is probably because of antibiotic treatment. Polyps appear to be corticosteroid sensitive in about half the cases, and spontaneous resolution may occur. Although there are advocates for extensive sinus surgery, the natural history is of resolution if patients survive into adulthood. Although patients may have lung damage, simple polypectomy is probably the surgical treatment of choice.
Endoscopic Surgery for Frontal Sinusitis and Its Complications
Authors: Wigand Malte E. , Hosemann Werner G.
Published: September 2007

Endoscopic surgery of the paranasal sinuses has become popular during recent years, but the endonasal approach into the frontal sinus was only rarely recommended. Using a surgical endoscope with 70° optical deflection, the fenestration of the frontal sinus from below has proved a valuable and safe procedure in more than 500 procedures. The control of complications like osteitis and mucopyoceles, and of foreign bodies and benign tumors has become practical with endoscopic exposure.
The Evolution of Endonasal Sinus Surgery in Japan
Authors: Honda Y. , Takahashi R.
Published: September 2007

Endonasal sinus surgery was performed in Japan as early as 1918. Kenzo Takahashi and Ryo Takahashi initiated and refined the method. The concept of endonasal sinus surgery in Japan is to restore normal function of the nasal cavity as well as that of the paranasal sinuses.

This can be achieved by removal of diseased tissue and the creation of a nasal cavity that provides good ventilation and drainage of the paranasal sinuses. To do this, the structures of the nasal cavity must be restored to near normal form. The nasal septum, middle turbinate, lower turbinate, and olfactory fissure must be appropriately corrected and aligned. The principle of our endonasal sinus surgery has been based on the concept that the creation of normal intranasal structure is an integral part of successful sinus surgery.
Morphology of Human Nasal Mucosa on the Inferior Turbinate: A Structural Model
Authors: Anselmo Wilma Terezinha , De Oliveira José Antonio A. , Valeri Victório , Goncalves Renato Pinto
Published: September 2007

Representative samples of nasal mucosa were examined in 25 patients without nasal or paranasal symptoms with the aim of determining the types of epithelium that line the medial surface of the inferior turbinate. The collected material was examined by light microscopy and the structural details were determined by electron microscopy.

We conclude that the inferior turbinate is lined by respiratory epithelium on only 10% of its surface. The rest is lined by stratified epithelia: squamous (8.2%), columnar ciliated (13.6%), and cuboidal (46.6%). Thus cuboidal epithelium is the most widespread and presents variable features. Intermediate epithelial types without defined characteristics were found in transitional zones on 21.6% of the surface.

Based on our results, we offer a new concept of the constitution of the nasal mucosa. This revised concept can be helpful in understanding the physiology of the organ, as well as for the correct interpretation of biopsies and smears of the human nasal mucosa.
The Open Mouth and Oronasal Breathing
Authors: Leiberman Alberto , Ohki Motofumi , Cole Philip
Published: September 2007

Effects of nasal resistance on distribution of respiratory airflow between nose and mouth were investigated by a minimally invasive computer-assisted method using a modified CPAP nasal mask/pneumotach and a head-out body plethysmograph. In 18 subjects nasal resistance (p = 0.091), breathing frequency (p = 0.084), tidal volume (p = 0.352), and minute (p = 0.433) volumes were undisturbed by the masking procedure. Partial nasal breathing persisted in 16 of 33 healthy adults instructed to breathe through the mouth. Artificial additions to nasal airflow resistance that were made in 10 volunteers from the 16 persistent partial nose breathers whose nasal fraction > 25% increased the oral fraction of respiratory airflow. It is concluded that while the palate provides a switching mechanism for oronasal routing of respiratory airflow, the oral and nasal vestibules provide variable resistors that regulate its distribution.
Management of Nasal Polyps by Steroid Nose Drops
Authors: Lildholdt Torben , Fogstrup Joergen , Gammelgaard Niels , Kortholm Birger , Ulsoe Claus
Published: September 2007

Systemic steroids may remove symptoms from nasal polyps in most patients, while surgery only is necessary in a few resistant cases. However, topical medication is preferable. Sprays may prevent recurrencies, but they seldom suffice for removing polyps. The aim of the present study was to document clinical efficacy of steroid nose drops. In 24 patients with nasal polyps documented by mini biopsy, aqueous budesonide (Rhinocort Aqua, Draco, Sweden) was applied as nose drops. Every second day 0.25 ml was instilled in each nostril with the head down and forward. Conventional spraying was done twice daily.

The clinical condition, nasal expiratory peak flow, and sense of smell was monitored for at least two months. The frequency of applying drops was decreased if smell returned or polyps disappeared while spraying continued. A few patients were not able to comply, and a few noticed insignificant nasal bleeding. In most cases the patients were satisfied after two or three months of treatment. It is concluded that in many patients nasal polyps can be managed by budesonide nose drops. However, the results of the present pilot study should be confirmed by controlled trials before routine clinical use is justified.
Acoustic Rhinometry: A New Method to Evaluate the Geometry of the Nasal Cavity and the Epipharynx
Authors: Elbrønd O. , Hilberg O. , Felding J. U.
Published: September 2007

Acoustic rhinometry, a method to describe the geometry in the nasal cavity and the epipharynx, is based on reflection of an acoustic signal entered into the nasal cavity. This can be used to evaluate the cross-sectional area of the nasal cavity as a function of the distance from the nostril. The method has proved to be a potent tool in characterizing the geometry of the nasal cavity because of the direct access to the cavity, because it requires little cooperation from the subject, and it is noninvasive. By clinical examples it will be shown that the method can be used to monitor in an objective and dynamic way the effect of various principles of treatment procedures on pathological processes in the nasal cavity and the epipharynx.
Z-Plasty Correction of Congenital Nasal Vestibular Stenosis
Authors: Kennedy Kevin S. , Tatum Sherard A. , Kelleher Michael J.
Published: September 2007

Stenosis of the nasal vestibule is a difficult problem to alleviate because surgical treatment of this area often results in cicatrix formation and restenosis. Surgery and other forms of trauma are the most common cause of nasal vestibular stenosis. Posttraumatic vestibular stenosis involves primarily the floor of the vestibule. An usual case of bilateral congenital vestibular stenosis involving primarily the soft tissues of the lateral aspects of the nasal vestibules is reported. The Z-plasty correction of this stenosis is outlined with pertinent photographs and schematic drawings.
Masson's Lesion of the Maxillary Sinus
Authors: Goldsmith Ari J. , Safran Barbara E. , Zahtz Gerald D. , Stegnajajic Arsen , Molho Laura
Published: September 2007

Intravascular papillary endothelial hyperplasia (IPEH), or Masson's lesion, is a benign reactive lesion that can be located anywhere in the body, including the head and neck region. Common head and neck locations include the lip, tongue, buccal mucosa, cheek, and parotid, although two cases have been described in the nasal cavity. We present the first case to be described in the paranasal sinuses, in a patient presenting with chronic self-limiting epistaxis. Although the radiographic appearance resembled that of a polyp or cyst, histological analysis demonstrated IPEH. The importance of this lesion lies in its similarity to other vascular lesions, from which it must be distinguished.
Primary Ciliary Dyskinesia in an Adolescent Male
Authors: Phillips P. Perry , Kern Eugene B.
Published: September 2007

Nasal obstruction and recurrent sinusitis are among the most common problems encountered by rhinologists in daily practice. Unfortunately, the occurrence of primary ciliary dyskinesia and the symptoms common to this entity often lead to months or years of delayed diagnosis. Many testing methods have been used including phase contrast and electron microscopy although consensus on diagnosis and treatment has not been established. Described in this report is a male adolescent with this disorder and a new method of ciliary testing we have developed to aid in diagnosis.
A Scanning Electron Microscopic Study of Smoking and Age-Related Changes in Human Nasal Epithelium
Authors: Kushnick Steven D. , Pelton-Henrion K. , McCormick Steven A. , Kimmelman Charles P.
Published: September 2007

The nose is known to undergo dysfunctional changes as people age, probably due to exposure to agents such as smoking, environmental pollutants, and microbes. A morphologic expression of these insults might be a change in the number of ciliated cells present in the nasal mucosa. This study revealed that smoking and age were not related to a reduction in the number of ciliated cells of the inferior turbinate. Other factors, such as changes in the viscoelastic properties of mucus, may be the cause of senescent nasal symptoms such as drying and crusting.
Traumatic Aneurysm of the Cavernous Carotid Artery: Management of Delayed Massive Epistaxis
Authors: Cusick Brian , Casler John D. , David Christopher
Published: September 2007

Traumatic aneurysm of the internal carotid artery (ICA) occasionally may present with delayed cataclysmic epistaxis. Lack of awareness of this phenomenon has led to misdiagnosis and delay of treatment in many instances. Consequently, this clinical scenario is associated with a high rate of mortality. Analysis of this entity allows division of management into an immediate phase where bleeding is stopped, the patient is stabilized, and a later phase where definitive treatment is rendered. To gain a fuller understanding of this potentially life-threatening problem, the following case is presented.
Measurement of Aerodynamic Pattern in the Simulated Nasal Cavity by Laser Doppler Anemometry
Authors: Watanabe Soiku , Iwabuchi Yasuo , Furuta Shigeru
Published: September 2007

Using a polyethylene model, the pattern of airflow in the nasal cavity was studied with the flow rate measured by a laser Doppler anemometer. Airflow in the nasal cavity was arch shaped with the fastest flow occurring near the olfactory fissure. There was little flow in the middle meatus in the inspiratory phase, but reverse flow was observed in expiratory phase, where the flow rate was faster than in the inspiratory phase. These findings offer a rational explanation of such physiological functions as olfaction and the warming and humidification of inspired air.
Frontal Sinus Osteoma: Complete Removal via Endoscopic Sinus Surgery and Frontal Sinus Trephination
Authors: Busch Richard F.
Published: September 2007

Endoscopic sinus surgery has improved our understanding of normal sinus physiology and enabled us to provide better surgical treatment of sinus disease. A method for removal of frontal sinus osteomas was sought that would be less invasive and more physiologic than the conventional osteoplastic flap procedure. Endoscopic sinus surgery has been combined with conventional frontal sinus trephination to achieve total osteoma removal while maintaining normal sinus mucociliary flow. Two successive patients have been treated in this manner with gratifying results.
Invasive Inverted Papilloma during Pregnancy: A Therapeutic Dilemma
Authors: Lanza John T. , Har-El Gady , Lucente Frank E.
Published: September 2007

Inverted papilloma (IP) is histologically classified as a benign nasal tumor. However, its aggressive local invasive character can lead to devastating morbidity, with a 10 to 20% rate of malignant transformation. Because of its proclivity for the lateral nasal wall, it is routinely treated with en-bloc resection. IP involving the palate is rare. We describe a case of IP without coexistent carcinoma completely eroding the hard palate, nasal septum, and bilateral nasal walls, in a 23-year-old woman in her seventh month of pregnancy.
Localization of m3 Muscarinic Receptor mRNA in Human Nasal Mucosa
Authors: Baraniuk James N. , Kaliner Michael A. , Barnes Peter J.
Published: September 2007

Cholinergic nerves play an important part in the regulation of nasal secretions and nasal patency. In situ hybridization was used to identify the cells in human nasal mucosa that express the muscarinic m3 receptor mRNA, which codes for the M3 muscarinic receptor subtype protein. An m3 cDNA probe was biotin-labeled using terminal transferase and hybridized to tissue sections of formaldehyde- or formaldehyde/microwave irradiation-fixed human nasal mucosa. The biotinylated probe was detected using gold-labeled antibiotin antibodies with silver enhancement. Muscarinic m3 receptor mRNA was identified in all epithelial cells, both serous and mucous cells of submucosal glands, and endothelial cells of small muscular arteries, veins, and capillaries. This suggests that M3 receptors may mediate glandular secretion and vasomotor effects. M3-receptor antagonists active at these sites may reduce the glandular secretion and vasodilation that is produced by parasympathetic reflex activity in allergic and nonallergic rhinitis.
Nasal Mucus Weights in Experimental Rhinovirus Infection
Authors: Parekh Hemal H. , Cragun Kevin T. , Hayden Frederick G. , Hendley J. Owen , Gwaltney Jack M.
Published: September 2007

Experimental rhinovirus infection in volunteers has provided important new knowledge on the pathogenesis and treatment of rhinovirus colds. However, the clinical parameters of this illness have not been well defined. In the current study, data on 151 young adult subjects in 14 previous studies were used to determine representative values for nasal mucus weights and total and nasal symptom scores for the rhinovirus challenge model. The mean ± SD total mucus weight for 5 days was 22.6 g ± 22.2 and the mean total symptom score was 16.4 ± 12.7. By univariate analysis, the 5-day total mucus weight correlated with the 5-day score for rhinorrhea, nasal obstruction, and total symptoms, but by multivariate analysis the correlation was primarily with rhinorrhea. Similar findings were seen using daily mean values. The information obtained from this analysis will be useful in planning and interpreting the results of future experiments using the rhinovirus model.
Large Nasal Septal Perforations can be Closed Surgically
Authors: Meyer Rodolphe , Middelweerd René J.
Published: September 2007

The authors present their successful experience with two surgical techniques, allowing the closure of small to medium-sized and large nasal septal perforations (NSP). A one-stage procedure is described for NSP up to 4 cm diameter, and a three-stage procedure for larger perforations in, respectively, 38 and 16 patients. The closure rate is 89.5% in the one-stage procedure and 81.6% in the three-stage operation. No facial incisions are required.
Nasal Ciliary Beat Frequency after Nasal Allergen Challenge
Authors: Holmström Mats , Lund Valerie J. , Scadding Glenis
Published: September 2007

The aim of this study was to estimate nasal ciliary beat frequency (CBF) before and after nasal allergen challenge. Patients were challenged with Pharmalgen D Pteronyssinus or grass pollen. The nasal reaction was measured with active anterior rhinomanometry and visual analog scale. CBF was measured by a photometric technique, on nasal specimens obtained with a brush from the inferior turbinate before and 20 minutes after challenge. A positive response to nasal challenge was seen in 12 patients and associated with a decrease in CBF in all but one patient. The CBF mean value for this group fell from 13.1 (±1.9) Hz to 11.5 (±1.8) Hz (p < .01). In another 11 patients where the challenge was negative, there was a tendency to increased CBF after challenge, 14.1 (±2.1) Hz before and 14.8 (±2.1) Hz after (p = .07). Thus, in this study CBF was decreased when an allergic reaction was provoked and, in contrast, moderately increased after a negative challenge. In a nasal allergic reaction it is possible that decreased mucociliary function contributes to nasal obstruction and decreased ventilation of the sinuses.
The Source of Lactic Acid in Experimental Sinusitis
Authors: Stierna Pontus , Söderlund Karin , Carlsöö Bengt
Published: September 2007

Increased levels of L-lactate were found in secretions of the maxillary sinus in experimental sinusitis in rabbits. Analysis of certain epithelial metabolic enzymes in purulent sinusitis reveals an increased lactate dehydrogenase (LDH) activity in glands and epithelium. However, histochemically we could not find any decrease in oxidative enzyme capacity of the mucosal epithelium indicating an inadequate oxygen supply. In acute pneumococcal sinusitis, bacteria seem to resume a resting phase after a few days, and the lactate accumulation characteristic of the anaerobic milieu of the secretion appears to be mainly of leukocyte origin.
Frontal Mucopyocele and Epidural Abscess Secondary to Frontoethmoidal Osteoma
Authors: Tunkel David E. , Scott John C. , Zinreich S. James
Published: September 2007

A patient presented with a frontal sinus mucopyocele and an epidural space infection secondary to an obstructing frontoethmoidal osteoma. Preoperative diagnosis was facilitated by both computerized tomography and magnetic resonance imaging. His treatment involved both open and endoscopic surgical techniques of accomplishing sinus and epidural space drainage and osteoma removal. The clinical entity of paranasal sinus osteomas is discussed, with emphasis on diagnosis, associated complications, and decisions regarding surgical management.
Partitioning Nasal Airway Resistance in Normal Adults
Authors: Guyette Thomas W. , Smith Bonnie E.
Published: September 2007

A rhinomanometric method that partitions nasal airway resistance into its nasal cavity and velopharyngeal components is described. Nasal cavity resistance, velopharyngeal resistance and total nasal airway resistance is reported for 20 normal subjects (10 women and 10 men). During expiration, mean nasal cavity resistance for women (1.52 cm H2O/[liters per second] L/s) was 76.3% and mean velopharyngeal resistance (.64 cm H2O/L/s) constituted 23.7% of the total nasal airway resistance. For men, mean nasal cavity resistance (1.50 cm H2O/L/S) made up 70.2% and mean velopharyngeal resistance (.85 cm H2O/L/S) was 29.8% of the total nasal airway resistance. During inspiration, the mean nasal cavity resistance for women (1.47 cm H2O/L/s) was 75.8% and mean velopharyngeal resistance (.44 cm H2O/L/s) was 24.2% of total nasal airway resistance. For men, mean nasal cavity resistance (1.30 cm H2O/L/s) constituted 73.9% and mean velopharyngeal resistance (.83 cm H2O/L/s) made up 26.1% of total nasal airway resistance. The importance of this method in clinical practice is discussed.
Morphology and Ultrastructure of Human Nasal Mucociliary System
Authors: Xu Geng , Zhong Jie-fu , Bu Guoxuan
Published: September 2007

The entire surface of human nasal mucosa from two fresh autopsy specimens (four nasal cavities) were examined with scanning and transmission electron microscopy. The variations in length and thickness of the cilia present on different parts of the nasal cavity were evaluated. We conclude that the inferior part of the nasal cavity is the most important area for human nasal mucociliary transport. The fine internal structural features of the cilia that we observed were similar to those reported by other authors.
Posterior Nasal Packing and Sleep Apnea
Authors: Vaartjes Martin , Strijers Rob L. M. , de Vries Nico
Published: September 2007

Posterior nasal packing has been reported to be associated with cardiorespiratory complications and, occasionally, with sudden death. To study the rate and incidence of sleep apnea, between October 1989 and September 1990 polysomnography (PSG) was performed in 10 patients who were treated for severe epistaxis with posterior nasal packing. Of these 10 patients, three had obstructive apneas, one had central apneas, and four had a combination of central and/or obstructive and mixed apneas. One patient had no apneas, and one was unable to sleep during PSG. In six patients, PSG was repeated a few months after removal of the packs. Four of these six patients no longer had apneas; one patient had a considerable decrease in number of apneas. One patient did not sleep during the second PSG, however, he had no apneas during the first PSG. This study demonstrates that posterior nasal packing can induce sleep apneas or enhance the severity of an apnea syndrome when present. This may contribute to the cardiorespiratory morbidity and sudden death that has been reported in epistaxis patients treated with posterior packing.
Age-Related CT-scan Study of the Incidence of Sinusitis in Children
Authors: Van Der Veken P. J. , Clement P. A. R. , Buisserett Th. , Desprechinst B. , Kaufman L. , Derde M. P.
Published: September 2007

Because standard radiographies are not able to give exact information about the diseased state of the sinuses, 196 children with chronic nasal complaints, aged from 3 to 14 years were examined with computed tomographic scan. The aim of the study was to investigate whether an age-related pattern in the occurrence of rhinosinusitis in children could be found. The patient group was subdivided into six age groups (3 to 4, 5 to 6, 7 to 8, 9 to 10, 11 to 12, and 13 to 14 years). Especially younger children, until the age of 7 to 8 years seem to be prone to inflammatory changes of all their sinuses. In older children, mainly the maxillary sinuses stay frequently involved. Septal deviations occur in 16% of the youngest to 72% in the oldest age group. The occurrence of bullous conchae increases with age too, although less prominently.
Ultrastructural Changes of the Olfactory Epithelium in Alzheimer's Disease
Authors: Jafek Bruce W. , Eller Pamela M. , Johnson Edward W. , Chapman Mary M. , Filley Christopher M.
Published: September 2007

Recent studies have demonstrated an association between abnormalities in the sense of smell and Alzheimer's disease (AD). In our laboratory we have shown that olfactory dysfunction is accompanied by histopathological changes in the olfactory epithelium. These findings led us to believe that there were changes in the olfactory epithelium in AD that resulted in altered olfactory function. In the present study we have done biopsies of tissue from 12 patients who have been screened thoroughly and diagnosed with probable AD. Olfactory epithelium from 10 of these patients has been examined at the electron microscopic level. The overall appearance of the epithelium is altered from that seen in normosmic, age-matched controls. The ultrastructural appearance of olfactory receptor cells and support cells is disrupted. In addition, a crystallinelike material has been observed over the surface of the olfactory epithelium in six patients. This material was not observed in the respiratory epithelium of the same patients and has not been seen by us in any other pathological or normal tissues we have examined. The overall appearance of the olfactory epithelium in these probable AD patients seems to be unique when compared with other pathological states examined so far. The present study suggests that olfactory epithelium biopsy may be useful in the early detection of AD.
A Double-Blind Study of the Effects of Loratadine versus Placebo on the Performance of Pilots
Authors: Neves-Pinto R. M. , Lima G. Moreira , da Mota Teixeira R.
Published: September 2007

The effects of a single 10-mg dose of loratadine on the performance of commercial and military pilots was compared with placebo in this randomized double-blind trial. Performance was evaluated by flight simulator tests carried out before and after pilots received active drug or placebo. Simulators were specific for the DC-10, Boeing 747, and AT-26 Xavante fighter aircraft; all reproduced the respective conditions of flight. Pilots’ performance, rated by observers blinded to the test, was judged to be within operating standards. The findings were compatible with those of previous studies that found no sedating effects of loratadine that would impact adversely on automobile driving performance. This and other studies reinforce the pharmacokinetic observation that loratadine does not cross the blood-brain barrier, does not cause sedation, and, therefore, does not impair functional ability. These findings strongly suggest that loratadine use is compatible with the activity of pilots.
A Surgical Staging System for Chronic Sinusitis
Authors: Gaskins Ralph E.
Published: September 2007

The application of new technology over the past decade has brought a considerable increase in the volume of paranasal sinus surgery, especially for ethmoid sinus disease. Most literature reports have included patients with widely disparate clinical problems, which makes interpretation and/or prediction of clinical results less meaningful. A set of clinical criteria is proposed to provide a preoperative staging system for patients with paranasal sinus disease. This is backed by clinical results of several hundred patients who have undergone various sinus surgical procedures. Clinical factors used in staging include the anatomic extent of the sinus/nasal disease (as determined both by endoscopic examination and radiographic studies), previous sinus surgical history, presence and extent of polyps (again determined both by endoscopic examination and radiographic studies), presence and severity of immunologic disease (including allergic rhinitis), and the state of control of infection within the sinuses. This staging system can be used to guide procedure selection and in preoperative discussions of likely results. Use of such a system can also promote better scientific analysis of variations in technique.
The Abnormal Ostiomeatal Complex and Sinusitis
Authors: Salman Salah D.
Published: September 2007

Abnormalities in the ostiomeatal complex (OMC) constitute a major factor in the pathogenesis of sinusitis. They may be appreciated by the classical anterior rhinoscopy, the endoscopic examination, and/or the coronal computed tomographic (CT) scan. Cases are seen, however, with clinical and radiological evidence of blockage of the OMC with no clinical sinusitis. Conversely, cases with definite sinusitis may have negative clinical examination and CT scans. Some patients continue to have sinusitis despite anatomically successful endoscopic surgery. It should be remembered that sinusitis may be caused by or facilitated by factors other than obstructions of the OMC. The decision to surgically treat sinusitis remains a clinical one based on a comprehensive evaluation.
Optic Neuritis following Endoscopic Sinus Surgery
Authors: Johnson Perry J. , Huerter James V. , Peters John D. , Legge Richard H.
Published: September 2007

A case report of optic neuritis, a previously unreported complication following endoscopic sinus surgery, is presented with a review of the diagnosis, postulated pathophysiology, and treatment. Optic neuritis is an inflammatory condition involving the optic nerve and should be considered in the differential diagnosis inpatients who present with ocular complaints following endoscopic sinus surgery. Aggressive evaluation including computed tomography of the orbit and paranasal sinuses to rule out retroorbital hematoma, abscess or bony dehiscence, as well as ophthalmology consultation is essential. Prompt recognition of optic neuritis and institution of high dose corticosteroids and antibiotics may prevent visual loss.
Frontoethmoidectomy with Ceramic Hydroxyapatite Implant in the Treatment of Mucocele
Authors: Yamagishi Masuo , Ishizuka Yolchi , Nakano Yuichi
Published: September 2007

External frontoethmoidectomy with sinus obliteration using ceramic hydroxyapatite granules was applied to prevent the postoperative complications in 12 patients with frontal mucocele. Eleven patients were satisfactorily treated by this method, although minor complications such as slight diplopia and retraction of the frontal region were present in one case. One patient had small cyst persistence in the orbit and was treated again. There have been no recurrences to date in any of the patients during follow-up periods of 22 to 53 months.
Sinusitis in Thyroid Associated Ophthalmopathy
Authors: Davris S. , Riechelmann H. , Mann W. , Kahaly G.
Published: September 2007

In 19 patients with thyroid associated ophthalmopathy undergoing orbital decompression, histologic examination of paranasal sinus mucosa revealed moderate to severe inflammatory alterations in all patients. Only 2/19 patients had a history of chronic sinusitis. In 4/19 patients, mucosal abnormalities of the paranasal sinuses were found on preoperative computed tomography CT scans. Postoperatively, 10/19 patients developed purulent sinusitis. It is suggested that patients suffering from thyroid associated ophthalmopathy have an increased incidence of histologically detectable inflammatory changes of paranasal sinus mucosa. Because of preexisting mucosal inflammation, these patients are prone to develop episodes of purulent sinusitis following endonasal orbital decompressions.
Embolization of Posterior Epistaxis
Authors: Myssiorek David , Lodespoto Mark
Published: September 2007

Few reports address using selective arterial embolization for controlling posterior epistaxis. Internal maxillary artery ligation is an effective method of control but suffers from requiring an operation in an already traumatized field and may fail due to variations in arterial arborization and collateral circulation. Selective angiographic embolization can determine the site of bleeding and control it, obviating the need for surgery, continued packing, and its sequellae. Sixteen patients underwent embolization for uncontrollable epistaxis. One patient had transient diplopia during the angiogram. There were no permanent complications. Within hours of the procedure, 12.5% experienced transient neurologic symptoms that resolved. All patients were controlled. Within 24 hours of the embolization, 87.5% were unpacked. The average length of stay was 5 days. When corrected for days admitted because of posterior packing, the length of stay decreased to 3.9 days. It is concluded that embolization is a safe, efficacious, cost efficient method of controlling posterior epistaxis.